Neurology & Pain Management Coding Alert

Question: As a neurologist, may I provide and bill for psychological testing, 96100? If so, which diagnoses will justify the claim? My experience has been that Medicare will not cover psychiatric codes, but I would like to provide Minnesota multiphasic personality inventory tests (MMPIs) for our migraine patients.
      
Maine Subscriber

 
Answer: Mental-health providers reimbursed under Part B include psychiatrists, nonclinical psychologists and clinical psychologists, and clinical social workers who meet specified requirements. Specifically, Medicare covers outpatient and inpatient therapeutic services and diagnostic services (e.g., 96100, psychological testing [includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI] with interpretation and report, per hour) when provided by a psychologist who meets the definition of a clinical psychologist. Also, psychological and neuropsychological testing meets the requirements for medical necessity only for a diagnosis of suspected mental illness or neuropsychological abnormality or to evaluate a change in mental illness or neuropsychological abnormality.
 
You should ask your local Medicare carrier whether 96100 is payable and, if so, which diagnoses will support the claim. However, more than likely, payment will not be made. You should refer patients to a psychologist if such testing is necessary.