Medicare, CGS (KY, OH) psychological testing coverage: limits and who can bill
By Javier Alvarez · Updated · 1 min read
1 row: Medicare (CGS). Public policy, not the member's benefits.
Medicare, CGS (KY, OH)
CGS LCD L34353 Outpatient Psychiatry and Psychology Services, central nervous system assessments and tests · KY, OH
| Visit limits | Psychological testing typically takes 4 to 6 hours. Time over several days is combined and reported on the last date of service. Above eight hours a report may be requested to show medical necessity. Diagnostic testing is not subject to the outpatient mental health treatment limitation. [1] |
|---|---|
| Who can bill | Payment for psychological testing is limited to physicians, clinical psychologists, and on a limited basis to qualified non-physician practitioners such as speech language pathologists for aphasia evaluation. A treating physician who only reads another clinician's report does not bill the testing codes. [1] |
| Also | Documentation: the record must indicate the presence of mental illness or signs of it, plus the tests performed, scoring and interpretation, and time. Each test must be individually necessary, repeat testing needs a change in condition, and routine testing of nursing home patients is screening and not covered. The LCD text still cites the retired 96101 to 96120 code range. [1] |
What Medicare, CGS (KY, OH)'s documents say
The table above has every field we found for Medicare, CGS (KY, OH), with numbered sources. In short:
- Visit limits. Psychological testing typically takes 4 to 6 hours. Time over several days is combined and reported on the last date of service. Above eight hours a report may be requested to show medical necessity. Diagnostic testing is not subject to the outpatient mental health treatment limitation.
- Who can bill. Payment for psychological testing is limited to physicians, clinical psychologists, and on a limited basis to qualified non-physician practitioners such as speech language pathologists for aphasia evaluation. A treating physician who only reads another clinician's report does not bill the testing codes.
Psychological testing coverage at other national payers
Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral, Cigna and Evernorth and Carelon Behavioral Health.
Check Medicare, CGS (KY, OH)'s claim against the row
Before the claim goes out, compare it with the row above: the evaluation and administration codes pair the way the policy says, the hours fit any cap, the referral question is documented, and prior authorization covers the units. The psychological testing table compares Medicare (CGS) with every other payer we checked.