National Psychologist, Vol. 15 No. 2
2006 issue, page 4
New testing codes create winners, losers
By Paula Hartman-Stein, Ph.D.
In January psychologists who perform testing services
either had a raise in income or a major reduction.
the change? For the first time in the history of third-party payment
for clinical services, testing codes have been assigned work values
and new regulations about their use. Geographic location and
knowledge of correct coding procedures are determining the financial
According to Tony Puente, Ph.D., the APA representative to
the American Medical Association’s Current Procedural Terminology
(CPT) Committee, reimbursement for testing services performed
directly by licensed psychologists increased from 22 percent to 69
percent. Yet there are disgruntled psychologists.
“The average level of psychologists’ knowledge of coding,
billing and documentation is low,” says Puente. “Some people
don’t understand what a unit of billing is. So when you add a
change to a foundation that is relatively unstable and incomplete,
you have the present scenario of misunderstanding.”
Some of the frustration is a result of current non-payment of
claims. Neil Pliskin, Ph.D., chairman of the Practice Advisory
Committee of APA’s Division of Neuropsychology, explained, “The
codes are not yet widely recognized by private insurance carriers.
But the surprise has been that some local Medicare carriers have
policies under which coverage is denied or unclear.” As of
mid-February there were technological problems in Massachusetts and
California and policy issues in Minnesota, Wisconsin, Illinois and
Magellan, a large managed care company, reviewed the new
codes in November 2005 and determined they would not cover the new
technician codes but recently reversed that decision. Ted Peck,
Ph.D., director of the Professional Affairs and Information
Committee for the National Academy of Neuropsychology (NAN), said,
“What I see going on is a period where both psychologists and
insurance companies are trying to understand very drastic and
important changes with the deletion of old testing codes and
implementation of new ones.”
Peck said some commercial carriers misunderstood the new
technician code. “They were initially concerned about the time,
cost and labor that would be involved if they had to credential a
new class of providers.” Once managed care administrators
understood that the technician would not need to be separately
credentialed, more allowed the technician billing code.
Peck categorized the problems into several categories. One is
a computer software issue whereby code numbers higher than 96117,
have been blocked. “This is an innocent issue,” said Peck,
“one that is readily addressed.” Newly added code numbers, for
example, are 96118, 96119, and 96120.
Uncertainty regarding how many billing units are appropriate
for psychologists to bill for their interpretation of test data and
write up of reports is another topic for the flood of e-mail
questions that Peck, Pliskin and Puente receive each day. “There
are no specific guidelines for this. Billing is supposed to be
related to actual time spent in these activities,” said Peck.
With the adoption of CPT codes 96102 and 96119, the work of
technicians is clearly acknowledged for the first time, yet some
psychologists in academic and hospital-based settings are not
pleased. For example, Rose Lynn Sherr, Ph.D., director of Outpatient
Psychology at the Risk Institute of Rehabilitation Medicine of New
York University Medical Center said, “The new codes are for
technicians, not for high-level pre- and post-doctoral trainees.
With the new codes we cannot charge for their scoring and writing
time so our charges for neuropsychological evaluations are
ridiculously low, a great blow to the service institutions that
support our training.”
Puente does not see the label of technician as demeaning.
Anyone who does not have the contractual obligation to the insurer
and is under the supervision of the licensed psychologist has the
role of technician, he said. The technician and professional codes
are interdependent. Puente said that CPT code 96119,
neuropsychological testing with the technician spending face-to-face
time with the patient, cannot be billed unless code 96118, the
professional service, also occurs.
“Greater parity and engagement in the health care system
requires greater transparency, accountability and uniformity in what
we do,” said Puente. He believes that the liberal arts tradition
in psychology training programs conflicts with the traditions in
training and practice of most health care professionals. “I have
made the choice of embracing the accountability tradition inherent
in health care. Our future lies in the professionalism of our
Several professional groups agree that psychologists need
more training in coding and billing. NAN and Division 40 are
co-sponsoring a free webcast tutorial with Puente at the helm in the
near future. At the 2006 APA convention two symposia are scheduled
thus far on coding, one organized by Division 40 and another by
Ph.D., from Division 12. The directorate is
currently developing a toolkit to help address claim rejections.
and www.personality.org (from
the Society for Personality Assessment) address frequently asked
questions about the coding problems and provide sample scenarios for
billing the new codes.
Paula Hartman-Stein, Ph.D., is a consultant, trainer and
practitioner in Kent, Ohio, specializing in geropsychology. She can
be reached through e-mail, email@example.com