Medicare Payments for CNS Assessments/Tests Using The CANS-MCI

Covered by Medicare and Most Private Insurance

Cognitive testing, combined in Screen’s CANS-MCI with an assessment of depression and behavioral risk factors for cognitive decline, is extremely valuable for the emotional and physical well-being of patients. Through early detection and doctor follow-up, a gift of months or even years is given to patients who might ultimately be diagnosed with MCI (Alzheimer’s). For those who might have been unnecessarily worrying about Alzheimer’s, neuropsychological testing can allay any concerns.

The CANS-MCI battery is covered by CNS Assessments/Tests CPT codes 96103 (computer administered psychological test) and 96120 (computer administered neuropsychological test), and typically a follow up office visit with the patient (one of the CPT codes in the 99211-99215 series) to go over the results and discuss a course of action, as appropriate.

 

Specifically, the CANS-MCI battery is captured by CPT codes 96103 (computer administered psychological test) and 96120 (computer administered neuropsychological test), and typically a follow up office visit with the patient (one of the CPT codes in the 99211-99215 series) to go over the results and discuss a course of action, as appropriate.

Medicare Billing Rates

As an example of Medicare’s rates, in Seattle (King County), the following apply:

Table 1. Medicare Payments for CNS Assessments/Tests and Follow-up Patient Visits
HCPC/CPT Description Physician Fee (Seattle, WA)  **
96120 Neuropsychological testing (e.g., Wisconsin Card Sorting Test, Screen’s CANS-MCI Test Battery), administered by a computer, with qualified health care professional interpretation and report. $52.92 per test
96103 Psychological testing (includes psychodiagnostic assessment of emotionality, personality and psychopathology), administered by a computer, with qualified health care professional interpretation and report. $28.94 per test

** Medicare reimbursement information can be found on the CMS website.

  • Search for Local Coverage Determinations: Select Local Coverage Documents, Geographic Area, and CPT/HCPCS (96103 or 96120).
  • Physician Fee Schedule Search: Select “Specific Locality” in the 3rd set of options, enter 96103 or 96120 in the “HCPCS Code” field, select “All Modifiers” in the Modifier drop-down, and select your locale in the Carrier/MAC Locality drop-down.

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, 2016. Please check with your billing experts, Medicare, and/or your insurance carriers before billing for any services.