from The National Psychologist,
Vol. 14, No. 6 Nov/Dec pg. 20
AMA restructures CPT testing codes
By Paula E. Hartman-Stein, Ph.D.
A new system of coding procedures for psychological testing
services slated to begin in January 2006 is likely to result in
substantial increases of reimbursement, but only when the
psychologist, without assistance from a technician, provides the
service, according to James Georgoulakis, Ph.D., APA’s
representative to the Relative Update Committee (RUC) of the
American Medical Association’s (AMA).
With input from the APA and other professional groups, the AMA
has recently revamped the Central Nervous System section of the
Current Procedural Terminology (CPT) system. In an interview with The
National Psychologist, Georgoulakis explained the code revisions
that were released in early October.
Q: What is the major change that will result from the new
A: "One of the very key things about the new codes deals
is the differentiation of when the psychologist is actually working
with the patient, when a technician is working with the patient, and
when the patient is working with the computer."
Q: In your opinion, is the new system an improvement for the
A: "Prior to the new coding system, those psychologists
who have been performing all of the work with the patient to a large
degree have been shortchanged. Now I think we are correcting some of
the inadequacies of the previous system. If the psychologist is
administering a neuropsychological assessment, and he/she is face to
face with the patient the whole time, the compensation should be at
a greater rate for that clinician as opposed to the psychologist who
utilizes a technician or the computer. I think this new
differentiation is fair."
Q: What will the reimbursement be for psychological testing?
A: "The AMA just released the new codes, but the Center
for Medicare and Medicaid Services (CMS) has not yet released the
work values that determine reimbursement rates. We will know in late
November with the publication of the Federal Register exactly
what the work values will be for the new codes. It is likely that
there will be substantial increases in reimbursement only when the
psychologist does the work. CMS is supportive that there should be
split codes and that the reimbursement will change accordingly. We’ve
got to be cautiously happy about the new codes. But I won’t feel
good till I see work values, practice expense and overhead values
associated with the codes because that means now we can be paid.
That is the bottom line."
Q: What are some specific code changes?
A: "For example, the former CPT code for
neuropsychological testing, 96117, will be deleted, with three codes
taking its place, codes 96118, 96119 and 96120. Code 96118
represents per hour unit of a psychologist’s or physician’s
time, both face to face with the patient, preparing the test
results, and writing the report. Code 96119 per hour will be used
when a qualified technician does the testing, and code 96120 will be
used when a computer is used for the administration of a
Q: What other codes are deleted?
A: "96100, psychological testing, is replaced by 96101,
96102, and 96103, with the same corresponding breakdown of
psychologist’s time, technician’s time, and use of a computer
for test administration."
Q: Will code 96115, neurocognitive status exam, change in the
A: "No, it will be deleted and replaced by code 96116,
that actually has the same language as the 96115 had, but 96116 will
only be coded for a psychologist’s or physician’s time. This
change will help with reimbursement. The payor knows it is paying
for face to face time and other professional time."
Q: Have any testing codes not been changed?
A: "The only code that looks the same is 96105,
assessment of aphasia. The language of that code is the same."
Q: Will these new codes be used only with patients covered
under the Medicare system?
A: "The Medicare system will use the new codes as of
January 1, 2006. Ninety-nine percent of all private payors are
utilizing the work values in some fashion. Everyone is keying off
this system. The old codes will not exist in the CPT manual and all
insurance companies use the same CPT codes."
Q: So will this change impact psychotherapy reimbursement?
A: "We’re only talking about the CPT codes of the
Central Nervous System."
Q: Will the new codes impact the frequency of audits?
A: "Effective October 1, CMS has put together a
demonstration project that is covering three states, California, New
York, and Florida, with the sole purpose of monitoring the people
who are monitoring the audits. We are going to have increased
audits, there is no question about that. For every dollar Congress
puts into monitoring, they get four dollars in return."
Q: How were the new codes and the work values determined?
A: "The codes were determined in accordance by the AMA’s
policies of the RUC survey process."
Q: How will psychologists learn more about the new codes?
A: "Invest some money into buying the new 2006 CPT code
book. Also APA will most likely set up some training seminars. There
are a lot of coding issues that are not covered by simply studying
the CPT manual."
Q: Congratulations on your hard work paying off on behalf of
organized psychology. Do you feel heartened that your work has been
successful in establishing the new codes?
A: "No matter how many times I say it, having a code is
wonderful, you have to have the code to start with, but that is not
enough. The issue becomes how much they pay for the codes, and it is
likely that there will be very minimal payment when the computer is
used during a testing battery."
Note: Georgoulakis and Tony Puente, Ph.D., were given special
recognition at the APA convention for their dedication and hours of pro
bono work with the AMA and CMS regarding changing the testing
codes and setting up work values.
Paula Hartman-Stein, Ph.D. is a consultant, practitioner, and
trainer who specializes in geropsychology in Kent, Ohio and is
Director of geriatric psychology at Summa Health System in Akron,
Ohio. She was one of seven psychologists who were involved with the
original system that set up reimbursement for psychological services
under Medicare. She can be reached through her website: www.centerforhealthyaging.com.