Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI) psychological testing coverage: limits and who can bill
By Javier Alvarez · Updated · 1 min read
1 row: Medicare (Wellpoint Federal). Public policy, not the member's benefits.
Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI)
Wellpoint Federal LCD L33632 Psychiatry and Psychology Services, Section VII Central Nervous System Assessments/Tests · CT, IL, MA, ME, MN, NH, NY, RI, VT, WI
| Where it applies | Testing used when mental illness is not suspected is a screening procedure that Medicare does not cover. Changes in mental illness can justify new testing, but repeat testing not needed for diagnosis or continued treatment is considered medically unnecessary. [1] |
|---|---|
| Visit limits | Psychological testing typically takes 4 to 6 hours. If done over several days, the time is combined and reported all on the last date of service. If it exceeds eight hours, medical necessity for the extended time should be documented. [1] |
| Who can bill | Psychological testing is limited to physicians, clinical psychologists, and on a limited basis qualified non-physician practitioners. A physician who only reads or explains another clinician's testing report does not bill it; that is included in E/M payment. [1] |
| Also | Each test must be individually medically necessary; a standard battery is only necessary if each test in it is. Adjustment reactions or dysphoria on moving to a nursing facility do not justify testing, but a suspected serious mood disorder on admission may. [1] |
What Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI)'s documents say
The table above has every field we found for Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI), with numbered sources. In short:
- Visit limits. Psychological testing typically takes 4 to 6 hours. If done over several days, the time is combined and reported all on the last date of service. If it exceeds eight hours, medical necessity for the extended time should be documented.
- Who can bill. Psychological testing is limited to physicians, clinical psychologists, and on a limited basis qualified non-physician practitioners. A physician who only reads or explains another clinician's testing report does not bill it; that is included in E/M payment.
- Where it applies. Testing used when mental illness is not suspected is a screening procedure that Medicare does not cover. Changes in mental illness can justify new testing, but repeat testing not needed for diagnosis or continued treatment is considered medically unnecessary.
Psychological testing coverage at other national payers
Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral, Cigna and Evernorth and Carelon Behavioral Health.
Check Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI)'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 (Wellpoint Federal) with every other payer we checked.