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Psychological Testing Benefit Reminders

Tuesday, September 10, 2019

Psychological testing is a covered TRICARE benefit when medically or psychologically necessary, and is provided in conjunction with otherwise covered psychotherapy or required applied behavior analysis assessments. 

Health Net Federal Services, LLC (HNFS) would like to remind providers there is a limit when using Common Procedural Terminology (CPT®) code 96137 to bill for time beyond the initial 30 minutes. The Defense Health Agency limits TRICARE coverage for CPT® code 96137 to no more than 11 units per day (one unit equals one 30-minute increment). View the “Maximum Numbers of Services Per Day for Procedure Codes” list at https://health.mil > Military Health Topics > Business Support > Rates and Reimbursement > Limits on Number of Services without Override Code.

CPT® Code Description  Limit
96136 Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes 1 unit
96137 Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes 11 units


Active duty service members require prior approval from HNFS. All other beneficiaries do not require HNFS approval; however, TRICARE Prime beneficiaries who seek care from non-network providers without HNFS approval are subject to Point of Service costs. HNFS has aligned its online referral and authorization submission tools with the Outpatient Prospective Payment System coding for psychological testing. Select request type P171 when submitting approval requests to HNFS, which will allow the system to auto-populate approved codes, number of visits and duration of the authorization.

Effective Jan. 1, 2019

Request Type Description/CPT® codes
P171

Psychological/Neuropsychological Testing: 

90791–90792, 96130–96146 


For additional information on the psychological testing benefit, visit our Psychological Testing benefit page. 

 

 

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