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Psychiatric Diagnostic Evaluations and Testing

Central Nervous System Assessments/Testing Codes and Guidelines
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Central Nervous System Assessments/Testing Codes and Guidelines

CPT codes and Colorado Division of Workers’ Compensation Rule 18 guidelines have changed for central nervous system (CNS) assessments/testing. These codes are used to report the services provided when testing CNS functions — such as memory, speech, visual motor responses, abstract reasoning and problem-solving abilities.

Testing procedures include

  • Assessment of aphasia and cognitive performance testing
  • Developmental screening/behavioral assessments and testing
  • Psychological and neuropsychological testing

Per Rule 18, a maximum of sixteen hours is allowed for services unless there is prior authorization for additional time. Send the written authorization with the original bill when prior authorization for additional time has been obtained.

Per CPT guidelines, the time reported for codes 96130 - 96133 is face-to-face time with the patient and the time spent integrating and interpreting data. Test administration and scoring is reported under 96136 - 96139 and should only be reported when two or more tests are performed.

Per Rule 18, the documentation and time must be submitted on each of the following activities when performed:

  • Face-to-face time with the patient
  • Reviewing and interpreting standardized test results and clinical data
  • Integrating patient data
  • Clinical decision-making and treatment planning
  • Report preparation
Psychiatric diagnostic evaluations

CPT 90791

Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment including history, mental status and recommendation. The evaluation may include communication with family or other sources and the review and ordering of diagnostic studies.

CPT 90792

This code includes the evaluation (CPT 90791) with medical services and other physical examination elements as indicated.

Testing services performed on the same or subsequent days after the evaluation require a report that is separately identifiable from the testing documentation.

Codes for testing, evaluation, administration and scoring services performed over multiple days should be billed together on the last date of service when the evaluation process is completed. If there is a delay in scheduling the feedback session, the provider may incorporate the feedback into the first session for psychotherapy.

A base code shall be billed only for the first unit of service of the evaluation process. For subsequent dates of service, use the add-on codes to bill for services.

Some services are typically performed together. As an example, testing evaluation codes can be billed with the test administration and scoring codes.

The documentation shall include the total time and the approximate time spent for each of the activities. The services follow standard CPT timed guidelines (e.g., a minimum of 16 minutes for each 30-minute code and a minimum of 31 minutes for the one-hour codes).

For questions, contact Pinnacol’s medical bill auditors at billing.success@pinnacol.com


Colorado Division of Workers’ Compensation, Rule 18-4(G)(4)(c)

COVID-19 policy update