Covered by Medicare and Most Private Insurance
The codes that we recommend billing with the CANS-MCI, which generally fit best within the CPT code definitions, are 96136, 96137 and 96132.
- CPT 96136 – Psychological or neuropsychological test administration and scoring* (first 30 minutes)
- CPT 96137 – Each additional 30 minutes* (add-on code)
- CPT 96132 – Neuropsychological testing evaluation services by physician or other qualified healthcare professional* (first hour)
* 30 minute codes require a minimum of 16 minutes; 1 hour codes require a minimum of 31 minutes.
In addition to the CANS-MCI cognitive assessment, which utilizes CPT codes 96136, 96137 and 96132, for our customers who wish to offer comprehensive care planning services, CPT 99483 may be provided to patients with established cognitive impairment. Contact us at 866-668-9038, ext 3, for further information.
The national average reimbursement for the CANS-MCI using CPT codes 96136 and 96137 is $85.48. If a follow-up appointment using CPT 96132 is added, total average reimbursement is $218.02.
Medicare Billing Rates
Table 1. Medicare Payments for CNS Assessments/Tests and Follow-up Patient Visits
|HCPC/CPT||Description||Physician Fee (National) **|
|96136||Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes.||$44.99|
|96137||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 (add-on code).||$40.49|
|96132||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 report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour.||$132.54|
** Medicare reimbursement information (national and regional) can also be found on the CMS website.
- Physician Fee Schedule Search: At the bottom of this page ‘License for Use of Current Procedural Terminology, Fourth Edition (“CPT®”)’, click ‘Accept’. On the ‘Physician Fee Schedule Search’ page ‘Selected Criteria’ section drop-down boxes, under ’Year’, select ‘2020’; under ‘Type of Info’, select ‘Pricing Information’; under ‘HCPCS Criteria’, select ‘Single HCPCS Code’; under ‘MAC Option’ select ‘Specific Locality’; under ‘HCPCS’, select CPT code (96136, 96137, 96132); under ‘Modifiers’, select ‘All Modifiers’; and then under ‘Locality’, find your local region. Click ‘Update Results’ box. Results will appear below. Most practices will fall under ‘Non-Facility Price’.
- Search for Local Coverage Determinations: Under “HCPCS Code” enter CPT code (96136, 96137 or 96132), Under “MAC Option” select “Specific Locality”, and in “Specific MAC Locality” enter your location.
You can also check the Fee Schedule posted by your locale’s Medicare Administrator.
LIMITATIONS ON MEDICARE INFORMATION PROVIDED IN THIS WEBSITE
The information provided on Physician Fees/Medicare Reimbursement is widely available to the general public, and is meant to be broadly informative for physicians; but not definitive.
Since physician fees under Medicare reimbursement routinely change (according to changes in RVUs, conversion factors and GPCIs)—and since the applicability of many of the codes themselves change (HCPC/CPT/ICD-10)—physicians, not Screen Inc., have sole responsibility for ensuring that they are following all billing requirements of Medicare and all other payer requirements.
The information on this page is current as of Nov 1, 2021. Please check with your billing experts, Medicare, and/or your insurance carriers before billing for any services.