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Clinical Coverage Policy No. 10

Service Code
96132 (CPT) Evaluation of Testing (First hour, GT eligible)
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96132 (CPT) Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

How to Submit

N/A - No authorization is required

Resources

Neuropsychological Testing

Service Code
96133 (CPT) Evaluation of Testing (Each add’l hour, GT eligible)
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Neuropsychological Testing is intended to assess cognition and behavior, examining the effects of any brain injury or neuropathological process that a person may have experienced.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

Up to 9 unmanaged units of testing administration

Length of Stay

Up to 9 unmanaged units of testing administration

Exclusions

  • 1. Testing for the following is not covered: a) for the purpose of educational testing; b) if requested by the school or legal system, unless MN exists for the psych testing; c) if the proposed psych testing measures have no standardized norms or documented validity, OR; d) if the focus is not the symptoms of the DSM-5 diagnosis.
  • 2. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 3. A Psychiatric Diagnostic Interview is not allowed on the same day as Psychological Testing when provided by the same provider.
  • 4. May only be performed by licensed psychologists, licensed psychological associates, and qualified physicians.
  • 5. Testing must include all elements detailed in the service definition.
  • 6. The provider shall communicate and coordinate care with others providing care.

Level of Care

While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.

How to Submit

N/A - No authorization is required

Resources

Neuropsychological Testing

Service Code
96133 (CPT) Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Mental Health, Substance Use

Neuropsychological Testing is intended to assess cognition and behavior, examining the effects of any brain injury or neuropathological process that a person may have experienced.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Psychological Testing does not cover testing for the purpose of educational testing; if requested by the school or legal system, unless MN exists for the psychological testing; if the proposed psychological testing measures have no standardized norms or documented validity, or; if the focus of assessment is not the symptoms of the current diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Testing must include all elements detailed in the CCP.
  • 4. The provider shall communicate and coordinate care with others providing care. When the member is receiving multiple BH services in addition to this service, a tx plan must be developed, and outpatient behavioral health services are to be incorporated into the tx plan.

Level of Care

For substance use disorders, clinical across the six ASAM criteria assessment dimensions is required.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96133 (CPT) Evaluation of Testing (Each add’l hour, GT eligible)
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96133 (CPT) Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

How to Submit

N/A - No authorization is required

Resources

Neuropsychological Testing

Service Code
96136 (CPT) Testing Administration (First 30 minutes)
Prior Authorization Required
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Neuropsychological Testing is intended to assess cognition and behavior, examining the effects of any brain injury or neuropathological process that a person may have experienced.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

Up to 9 unmanaged units of testing administration

Length of Stay

Up to 9 unmanaged units of testing administration

Exclusions

  • 1. Testing for the following is not covered: a) for the purpose of educational testing; b) if requested by the school or legal system, unless MN exists for the psych testing; c) if the proposed psych testing measures have no standardized norms or documented validity, OR; d) if the focus is not the symptoms of the DSM-5 diagnosis.
  • 2. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 3. A Psychiatric Diagnostic Interview is not allowed on the same day as Psychological Testing when provided by the same provider.
  • 4. May only be performed by licensed psychologists, licensed psychological associates, and qualified physicians.
  • 5. Testing must include all elements detailed in the service definition.
  • 6. The provider shall communicate and coordinate care with others providing care.

Level of Care

While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.

How to Submit

N/A - No authorization is required

Resources

Psychological Testing (Hourly)

Service Code
96136 (CPT) Testing Administration (First 30 minutes)
Prior Authorization Required
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Psychological testing involves the culturally and linguistically appropriate administration of standardized tests to assess a recipient’s psychological or cognitive functioning. Testing results must inform treatment selection and treatment planning.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

Up to 9 unmanaged units of testing administration

Exclusions

  • 1. Testing for the following is not covered: a) for the purpose of educational testing; b) if requested by the school or legal system, unless MN exists for the psych testing; c) if the proposed psych testing measures have no standardized norms or documented validity, OR; d) if the focus is not the symptoms of the DSM-5 diagnosis.
  • 2. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 3. A Psychiatric Diagnostic Interview is not allowed on the same day as Psychological Testing when provided by the same provider.
  • 4. May only be performed by licensed psychologists, licensed psychological associates, and qualified physicians.
  • 5. Testing must include all 9 elements detailed in the CCP.
  • 6. The provider will communicate and coordinate care with other professionals providing care to the recipient.

Level of Care

While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.

How to Submit

N/A - No authorization is required

Resources

Neuropsychological Testing

Service Code
96136 (CPT) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Mental Health, Substance Use

Neuropsychological Testing is intended to assess cognition and behavior, examining the effects of any brain injury or neuropathological process that a person may have experienced.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Psychological Testing does not cover testing for the purpose of educational testing; if requested by the school or legal system, unless MN exists for the psychological testing; if the proposed psychological testing measures have no standardized norms or documented validity, or; if the focus of assessment is not the symptoms of the current diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Testing must include all elements detailed in the CCP.
  • 4. The provider shall communicate and coordinate care with others providing care. When the member is receiving multiple BH services in addition to this service, a tx plan must be developed, and outpatient behavioral health services are to be incorporated into the tx plan.

Level of Care

For substance use disorders, clinical across the six ASAM criteria assessment dimensions is required.

How to Submit

N/A - No authorization is required

Resources

Psychological Testing (Hourly)

Service Code
96136 (CPT) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Psychological testing involves the culturally and linguistically appropriate administration of standardized tests to assess a member’s psychological or cognitive functioning. Testing results must inform treatment selection and treatment planning.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

  • 1. Psychological Testing does not cover testing for the purpose of educational testing; if requested by the school or legal system, unless MN exists for the psychological testing; if the proposed psychological testing measures have no standardized norms or documented validity, or; if the focus of assessment is not the symptoms of the current diagnosis.
  • 2. Limit of eight hours of Psychological Testing allowed to be billed per date of service.
  • 3. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 4. Testing must include all elements detailed in the CCP.
  • 5. The provider shall communicate and coordinate care with others providing care. When the member is receiving multiple BH services in addition to this service, a tx plan must be developed, and outpatient behavioral health services are to be incorporated into the tx plan.

Level of Care

For substance use disorders, clinical across the six ASAM criteria assessment dimensions is required.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96136 (CPT) Testing Administration (First 30 minutes)
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96136 (CPT) Testing Administration (First 30 minutes)
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96136 (CPT) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96136 (CPT) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources

Neuropsychological Testing

Service Code
96137 (CPT) Testing Administration (Each add’l 30 minutes)
Prior Authorization Required
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Neuropsychological Testing is intended to assess cognition and behavior, examining the effects of any brain injury or neuropathological process that a person may have experienced.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

Up to 9 unmanaged units of testing administration

Length of Stay

Up to 9 unmanaged units of testing administration

Exclusions

  • 1. Testing for the following is not covered: a) for the purpose of educational testing; b) if requested by the school or legal system, unless MN exists for the psych testing; c) if the proposed psych testing measures have no standardized norms or documented validity, OR; d) if the focus is not the symptoms of the DSM-5 diagnosis.
  • 2. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 3. A Psychiatric Diagnostic Interview is not allowed on the same day as Psychological Testing when provided by the same provider.
  • 4. May only be performed by licensed psychologists, licensed psychological associates, and qualified physicians.
  • 5. Testing must include all elements detailed in the service definition.
  • 6. The provider shall communicate and coordinate care with others providing care.

Level of Care

While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.

How to Submit

N/A - No authorization is required

Resources

Psychological Testing (Hourly)

Service Code
96137 (CPT) Testing Administration (Each add’l 30 minutes)
Prior Authorization Required
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Psychological testing involves the culturally and linguistically appropriate administration of standardized tests to assess a recipient’s psychological or cognitive functioning. Testing results must inform treatment selection and treatment planning.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

Up to 9 unmanaged units of testing administration

Exclusions

  • 1. Testing for the following is not covered: a) for the purpose of educational testing; b) if requested by the school or legal system, unless MN exists for the psych testing; c) if the proposed psych testing measures have no standardized norms or documented validity, OR; d) if the focus is not the symptoms of the DSM-5 diagnosis.
  • 2. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 3. A Psychiatric Diagnostic Interview is not allowed on the same day as Psychological Testing when provided by the same provider.
  • 4. May only be performed by licensed psychologists, licensed psychological associates, and qualified physicians.
  • 5. Testing must include all 9 elements detailed in the CCP.
  • 6. The provider will communicate and coordinate care with other professionals providing care to the recipient.

Level of Care

While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.

How to Submit

N/A - No authorization is required

Resources

Neuropsychological Testing

Service Code
96137 (CPT) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Mental Health, Substance Use

Neuropsychological Testing is intended to assess cognition and behavior, examining the effects of any brain injury or neuropathological process that a person may have experienced.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Psychological Testing does not cover testing for the purpose of educational testing; if requested by the school or legal system, unless MN exists for the psychological testing; if the proposed psychological testing measures have no standardized norms or documented validity, or; if the focus of assessment is not the symptoms of the current diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Testing must include all elements detailed in the CCP.
  • 4. The provider shall communicate and coordinate care with others providing care. When the member is receiving multiple BH services in addition to this service, a tx plan must be developed, and outpatient behavioral health services are to be incorporated into the tx plan.

Level of Care

For substance use disorders, clinical across the six ASAM criteria assessment dimensions is required.

How to Submit

N/A - No authorization is required

Resources

Psychological Testing (Hourly)

Service Code
96137 (CPT) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Psychological testing involves the culturally and linguistically appropriate administration of standardized tests to assess a member’s psychological or cognitive functioning. Testing results must inform treatment selection and treatment planning.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

Limits

  • 1. Psychological Testing does not cover testing for the purpose of educational testing; if requested by the school or legal system, unless MN exists for the psychological testing; if the proposed psychological testing measures have no standardized norms or documented validity, or; if the focus of assessment is not the symptoms of the current diagnosis.
  • 2. Limit of eight hours of Psychological Testing allowed to be billed per date of service.
  • 3. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 4. Testing must include all elements detailed in the CCP.
  • 5. The provider shall communicate and coordinate care with others providing care. When the member is receiving multiple BH services in addition to this service, a tx plan must be developed, and outpatient behavioral health services are to be incorporated into the tx plan.

Level of Care

For substance use disorders, clinical across the six ASAM criteria assessment dimensions is required.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96137 (CPT) Testing Administration (Each add’l 30 minutes)
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 10

Service Code
96137 (CPT) Testing Administration (Each add’l 30 minutes)
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
Medicaid Child (Age 0-20)
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service.

How to Submit

N/A - No authorization is required

Resources