Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Neuropsychological Testing for Neurologically Based Conditions

Policy #:07.03.08i

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract. The Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition.


MEDICALLY NECESSARY

Neuropsychological testing using the most recent version of a valid and reliable test for neurologically based conditions is considered medically necessary, and, therefore, covered when ALL of the following are met:
  • The reason for testing must be based on a specific referral question that cannot be answered adequately by means of clinical interview and/or behavioral observations and the results based on this referral question(s) are reasonably expected to provide information that will effectively guide the course of treatment.
  • The Individual is neurologically and cognitively able to understand and participate in all activities that are necessary to perform neuropsychological testing, and the individual has a primary medical diagnosis with at least one of the following documented indications:
    • A known brain disorder
    • A known risk factor for brain disorder with a change in behavior
    • A suspected brain disease or trauma based on the observation of a change in thinking or behavior related to other potential factors (e.g., disease elsewhere in the body with known or possible cognitive effects, medication side effects)

AND meets at least one of the following rationale for testing:
  • To establish a baseline in the individual's brain functioning for either of the following:
    • Prior to a neurosurgical procedure (e.g., epilepsy surgery, deep brain stimulation, surgical treatment of a brain tumor, hemorrhage, other lesion, hydrocephalus)
    • Prior to the initiation of medication for a neurological condition (e.g., Parkinson's disease)
  • To establish the presence of abnormalities or distinguish them from changes that may occur with normal aging, or the expected progression of other disease processes
  • To assist in establishing a clinical diagnosis in neurological or systemic conditions known to affect central nervous system functioning when neuropsychological data can be combined with clinical, laboratory, and neuroimaging data
  • To assess potential impact of adverse effects of therapeutic substances that may cause cognitive impairment (e.g., radiation, chemotherapy, antiepileptic medications)
  • To obtain an objective measurement of the individual's subjective complaints about memory, attention, or other cognitive dysfunction, which serves to determine treatment by differentiating psychogenic from neurogenic syndromes
  • To quantify cognitive or behavioral deficits related to central nervous system impairment (e.g., determining prognosis, informing treatment planning by determining rate of disease progression)
  • To establish a treatment plan by determining functional abilities/impairments in individuals with known or suspected central nervous system disorders
  • To establish treatment planning through identification and assessment of the neurocognitive sequelae of systemic disease (e.g., hepatic encephalopathy or anoxic/hypoxic injury associated with cardiac procedures)
  • To determine whether an individual can comprehend and participate effectively in complex treatment regimens and to determine functional capacity (e.g., for healthcare decision making, work, independent living, managing financial affairs)
  • To design, administer, and/or monitor outcomes of medically necessary cognitive rehabilitation procedures (e.g., compensatory memory training for brain injured individuals)
  • To assess neurocognitive function for the formulation of rehabilitation and/or management strategies among individuals with neuropsychological disorders.
  • To diagnose cognitive or functional deficits in children and adolescents based on the inability to develop expected knowledge, skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or physical demands.
  • To diagnose and/or manage the neurocognitive effects of the following medical conditions such as, but not limited to:
    • Cerebrovascular disease
    • Intracranial arteriovenous malformation
    • Stroke or cerebral vascular injury
    • Hydrocephalus
    • Intracranial neoplasm or abscess
    • Demyelinating disorders including multiple sclerosis
    • Movement disorders including Parkinson's disease, to assess before and after initiation of medication
    • Early dementia of any etiology, to distinguish between normal aging and mild dementia caused by conditions such as, but not limited to, early Alzheimer's disease, infectious disease, and HIV, or a psychological disorder that presents with a similar constellation of symptoms.
    • Neurotoxic exposure
    • Hypoxic brain injury
    • Seizure disorders including epilepsy
    • Traumatic brain injury
    • Encephalopathy, where there is a specific medical condition causing progressive loss of functioning (e.g., hepatic encephalopathy, Wernicke's encephalopathy)
    • Neurologically complicated attention deficit disorder with or without hyperactivity (e.g., hydrocephalus, post--head trauma, seizures)
    • Neurologically complicated developmental disorder
    • Depression that presents with neurologic symptomatology

Based on currently accepted standards of practice, testing beyond eight hours is typically not necessary. Supporting documentation in the medical record must be present to justify greater than eight hours per individual per evaluation. When testing is performed over several days, the cumulative testing time must be reported on the same claim form upon completion of the testing; each hour of service should be reported as one unit.

REPEAT NEUROPSYCHOLOGICAL TESTING
Repeat neuropsychological testing is considered medically necessary and, therefore, covered when needed to assess or determine a treatment change, when there is a reasonable suspicion of a new problem or when needed to reconfirm a diagnosis (e.g., following deterioration or change of the individual’s condition) and the results of testing are expected to provide information that will effectively guide the course of treatment.

COMPUTER-BASED NEUROPSYCHOLOGICAL TESTING
Computer-based neuropsychological testing (e.g., Impact™, Headminder®, Wisconsin Card Sorting Test) is considered medically necessary and, therefore, covered as an adjunct to conventional testing (e.g., standard examiner-administered tests, clinical assessment) for the assessment of cognitive impairment.

NEUROPSYCHOLOGICAL TESTING AND SPECIALTY PROVIDER GROUPS
Certification granted by the American Board of Professional Psychology (ABPP) and the American Board of Professional Neuropsychology (ABN) are the accepted standard of board certifications and specialty training. Neuropsychological evaluation/testing for neurologically based conditions must be performed directly by a certified, state licensed professional provider or a trained technician under the direct supervision of a professional provider in any of the following specialty groups:
  • Neurology
  • Psychiatry
  • Psychology

Any aspects of the test conducted by an individual not certified require the direct supervision of a professional provider certified by the ABPP or ABN to ensure the appropriate interpretation and reporting of findings. The certified professional provider must be immediately available to furnish assistance and direction throughout the test administration. The certified professional provider is not required to be present in the room where the testing is being performed or within any other physical boundary as long as the professional provider is immediately available.

NOT MEDICALLY NECESSARY

Neuropsychological testing is considered not medically necessary and, therefore, not covered for any of the following circumstances because the available published peer-reviewed literature does not support its use in the diagnosis or treatment of illness or injury:
  • When there is not a reasonable suspicion of a new problem, relapse, or deterioration in condition
  • When testing results will not likely change treatment decision-making (e.g., progressive dementing illness)
  • When testing is used for self-administered or self-scored inventories, or screening tests of cognitive function (whether paper and pencil or computerized), (e.g., Folstein Mini Mental Status Examination)
  • When testing is used for the following conditions (such as, but not limited to), unless an associated neurologically based medical condition is suspected or exists and is documented in the individual's medical record:
    • Intellectual disability (moderate or severe)
    • Autistic spectrum disorders (ASD)
    • Developmental disability, developmental delay
    • Learning disability
    • Attention deficit disorders with or without hyperactivity, unless the diagnostic interview, clinical observations, and results of appropriate behavioral rating scales are inconclusive
    • Psychiatric conditions (e.g., anxiety disorders, personality disorders, mood disorders)
    • Delirium
    • Psychosis
    • Chronic fatigue syndrome
    • Headaches including migraine headaches
    • Substance abuse background, either ongoing or currently intoxicated
    • A medically acute condition

SCREENING EXAMINATIONS

Screening examinations (e.g., the Mini-Mental Status Examination [MMSE] or the Neurobehavioral Cognitive Status Examination [NCSE], are considered part of the overall comprehensive neuropsychological testing and are, therefore, not separately reimbursed. These simple screening examinations do not qualify as comprehensive neuropsychological testing.

BENEFIT EXCLUSION

Neuropsychological testing is considered a benefit contract exclusion and is, therefore, not covered when performed for any of the following non-medical indications such as, but not limited to:
  • Employment
  • Disability qualification
  • Legal/court related purposes (e.g., custody evaluation, parenting assessments, or other court or government ordered or requested testing)
  • As a screening method for any purpose (e.g., educational purposes, solely as a screening test for Alzheimer's disease)
    • Screening to evaluate an individual for learning disabilities or for educational planning should be performed by the child's school per the federal mandate, the Individuals with Disabilities Education Act.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS

Portions of the neuropsychological testing battery may be administered either by a computer or by a technician under the direction of an appropriately trained professional provider. Each portion of the test should be reported using the Current Procedural Terminology (CPT) code that appropriately represents the service performed.

For computer-based tests (such as Impact™, Headminder®, or Wisconsin Card Sorting Test), any eligible professional provider specialty type (including, but not limited to, a sports medicine physician) should report these tests using CPT code 96120. This code is not an hourly code; it should be reported only once per testing session.

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, neuropsychological testing is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

NEUROPSYCHOLOGICAL TEST SELECTION

Neuropsychological testing consists primarily of individually administered tests that comprehensively sample ability domains that are known to be sensitive to the functional integrity of the brain. There are numerous components of neuropsychological testing, and it is the responsibility of the professional provider to determine which tests are most appropriate for each individual. Each individual does not need the full battery of tests; some individuals may only need a subset of tests.

Description

NEUROPSYCHOLOGICAL TESTING

Neuropsychological testing is the in-depth assessment of an individual's brain function abilities and mental status. Neuropsychological testing mainly focuses on cognitive capabilities, such as memory and attention, but may also include personality functioning and mood, social behavior, emotional status, motor skills, language, visual perception, and adjustment to limitations. Neuropsychological testing provides the basis for the conclusions regarding neurocognitive effects of various medical conditions. Neuropsychological testing should be delayed until any acute changes have stabilized following trauma, infections, or metabolic or vascular insults to the central nervous system. The goal of neuropsychological testing may be clarification of a diagnosis, determination of the clinical and functional significance of a brain abnormality, or the development of recommendations regarding neurological rehabilitation planning, but always for the purpose of developing a treatment plan. It is frequently a part of the overall neurodiagnostic assessment, which may include other neurodiagnostic testing such as computerized tomography (CT), magnetic resonance imaging (MRI), electroencephalogram (EEG), and single-photon emission computerized tomography (SPECT).

Neuropsychological testing is typically directed by the types of questions asked at the time of the referral, which should ideally include the following:
  • General information about the individual (e.g., age, education, medical and psychiatric history)
  • Reasons why the evaluation is requested
  • A description of the problem to be assessed
  • Any pertinent history (e.g., known substance abuser, physical limitations [e.g., hemiparesis, blindness, hearing impaired])
  • Relevant lab work-up
  • Findings of prior structural or functioning imaging

Neuropsychological testing provides quantitative measurements that are compared to normative values. The data provided by the neuropsychological testing can be used to compare an individual's present function to some point in the future or the past, but also involves comparison to standardized data from samples of normal individuals.

Neuropsychological testing employs a variety of fixed or flexible batteries of tests. A fixed battery provides a standardized and broad approach to measuring cognitive function that can be applied to a range of disorders requiring assessment. The most commonly used fixed neuropsychological testing is the Halstead-Reitan Battery, a set of six tests that measure multiple neurocognitive domains. While it is comprehensive, not all the resulting data may be pertinent. Most neuropsychologists choose to perform a flexible subset of tests from within a fixed battery, an individualized approach that focuses on the specific areas of cognitive function in question. The choice of a fixed versus flexible battery is based on the neuropsychologist's review and assessment of the individual's history. Typical subset tests employed include the Wechsler Adult Intelligence Scale Revised (WAIS-R), Boston Diagnostic Aphasia Examination (BDAE), Rey Auditory Verbal Learning Test (RAVLT), Wisconsin Card Sorting Test (WCST), and the Rey Complex Figure Test.

Simple screening tests such as the Mini-Mental State Examinations (MMSE) and the Neurobehavorial Cognitive Status Examination (NCSE) do not qualify as comprehensive neuropsychological testing.

There are a number of computerized test batteries, individual tests, and scoring programs. These are generally not used in lieu of a battery of tests administered by a neuropsychologist or technician, but serve as an adjunct.

Neuropsychological testing should be performed by a qualified, credentialed clinician. Certification granted by the American Board of Professional Psychology (ABPP) and the American Board of Professional Neuropsychology (ABN) are the accepted standards of board certification and specialty training. Aspects of the test conducted by an individual not certified requires the direct supervision of a professional certified by the ABPP or ABN to ensure the appropriate interpretation and reporting of findings.

Individuals referred for a neuropsychological testing are usually classified as one of three groups. The first group, and probably the largest, consists of individuals with a known brain disorder. The most common brain disorders are cerebrovascular disorders, head injury, hydrocephalus, Alzheimer's disease, Parkinson's disease, multiple sclerosis, tumors, seizures, and infections. A neuropsychological evaluation may be useful in defining the nature and severity of the individual's functional problem. The assessment would provide useful information about the individual's cognition, personality characteristics, social behavior, emotional status, and adjustment to limitations.

The second group consists of individuals with a known risk factor for brain disorders. This would involve a change in behavior possibly resulting from a disease or injury to the brain (i.e., a blow to the head from an automobile accident). For these individuals, neuropsychological testing may be used to provide evidence of brain dysfunction and to describe the nature and severity of problems. An evaluation would focus on divided attention, sustained concentration and mental tracking, and memory.

Lastly, the third group consists of those with a suspected brain disease or trauma based on the observation of a change in a person's behavior without an identifiable etiology. The individual has no risk factors for brain disorder, and this diagnosis is being considered on the knowledge that all other disorders have been excluded.

NEUROPSYCHOLOGICAL TESTING FOR PROPOSED CONDITIONS
Although neuropsychological testing has been proposed to play a role in the evaluation of various conditions, the following conditions are examples of where there is insufficient clinical evidence to demonstrate that neuropsychological testing is useful in clinical decision making or will improve management of such conditions.

Neuropsychological testing has been proposed in the evaluation of autism spectrum disorders (ASD). Autism spectrum disorder is characterized by persistent deficits in social communication and social interactions across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviors used for social interaction, and skills in developing, maintaining, and understanding relationships. In addition, ASD is characterized by restricted, repetitive patterns of behavior or interests. Symptoms cause clinically significant impairment of functionality. There is no reported evidence that confirms or excludes a diagnosis of autism based on cognitive patterns alone. As previously noted, neuropsychological testing consists of the administration of a series of standardized tests of differing mental functions and the interpretation of the findings so that inferences about brain function can be made. There is insufficient available published peer-reviewed literature to support standard use of neuropsychological testing for individuals with ASD; however, neuropsychological testing may be helpful in evaluating specific neurologic conditions that are present in an individual with suspected ASD. The gold standard diagnostic tools in research and clinical assessment of ASD are the Autism Diagnostic Observational Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). These instruments alone do not determine diagnostic status. Rather, results obtained guide clinical decision making for assigning an ASD diagnosis.

It has also been proposed that neuropsychological testing be used in the assessment of attention deficit disorders with or without hyperactivity (ADHD). Attention deficit disorder causes clinically significant impairment in social, academic, or occupational functioning in settings such as school, work, and/or home. While there is no specific test to confirm a diagnosis of ADHD, the diagnosis is applied to children and adults who display certain characteristic behaviors over a period of time. There is much less evidence for the utility of neuropsychological testing in management of ADHD than there is for many other medical conditions (Pritchard et al., 2012) and tests of executive functions have often been found to be poor predictors of functional impairment in the disorder (Barkley & Murphy, 2010; Jonsdottir et al., 2006). Further research is needed to better define the role of neuropsychological testing in ADHD (Haavik 2010, Pineda 2007). Neuropsychological testing may be helpful in evaluating suspected neurological comorbidities in an individual with suspected ADHD; however, there is no evidence for the use of neuropsychological testing in the evaluation of ADHD where such comorbidities are not suspected.

The available published peer-reviewed literature addressing the neuropsychological consequences of migraine has been inconclusive. The International Headache Society diagnoses a migraine by its pain and number of attacks (at least five, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound.  Reports of cognitive testing in individuals with migraines and controls have yielded inconsistent results (O'Bryant et al., 2005). Baars, et al. (2010) states that no evidence was found that migraine headaches or migraine related medication use are risk or protective factors for cognitive dysfunction or cognitive deterioration over time. There is insufficient clinical evidence that demonstrates that neuropsychological testing is useful in clinical decision making or will improve management of headaches including migraine headaches.

The available published peer-reviewed literature does not support the use of neuropsychological testing in the diagnosis or treatment of chronic fatigue syndrome (CFS). Chronic fatigue syndrome is a debilitating and complex disorder characterized by intense fatigue that is not improved by bed rest and that may be worsened by physical activity or mental exertion. Individuals with CFS often function at a substantially lower level of activity than they were capable of before they became ill. Because there is no blood test, brain scan, or other lab test to diagnose CFS, it is a diagnosis that can only be made after ruling out other possible illnesses. The current research shows that slowed processing speed, impaired working memory and poor learning of information are the most prominent features of cognitive dysfunction in individuals with CFS. Furthermore, to this date no specific pattern of cerebral abnormalities has been found that uniquely characterizes CFS individuals. There is insufficient clinical evidence that demonstrates that neuropsychological testing is useful in clinical decision making or will improve management of CFS.

COMPUTERIZED NEUROPSYCHOLOGICAL TESTING

Neuropsychological testing is administered through a variety of modalities, including computers. There is a broad array of tests administered using computerized neuropsychological testing, including Automated Neuropsychological Assessment Metrics (ANAM), CogState®, HeadMinder®, ImPACT™, Conners' Continuous Performance Test-II (CPT-II), Green's Word Memory Test (WMT), and Wisconsin Card Sorting Test. Computerized neuropsychological tests must meet the same psychometric standards of adequate reliability and validity as examiner-administered neuropsychological tests. The American Psychological Association's standards for educational and psychological testing is generally considered an authoritative source on the development and validation of educational and psychological tests and assessments.

Many of the computer-based neuropsychological tests were developed to evaluate sports-related concussion/mild traumatic brain injury (MTBI). Neuropsychological testing utilized in sports-related concussion/MTBI is distinctly different from the more traditional models of neuropsychological testing described above. Meehan et al. (2012) concluded that when used appropriately by trained personnel, computerized neuropsychological testing is a valuable component of a comprehensive concussion/MTBI management program. The American Academy of Pediatrics (AAP) published a clinical report (Halstead et al, 2010) for sports-related concussion in children and adolescents stating that neuropsychological testing is one of several tools in the assessment of an athlete with concussion/MTBI, but does not independently determine whether an athlete has experienced a concussion/MTBI or when he or she may safely return to play. Computer-based neuropsychological tests have also been adapted for testing in other conditions associated with cognitive impairment, such as multiple sclerosis, Parkinson's disease, and dementia. Computer-based neuropsychological test results, however, must be interpreted in the context of relevant history, other test findings, other clinical assessments, and data available from other disciplines and should not be used alone for making a diagnosis.
References


American Academy of Clinical Neuropsychology (AACN) practice guidelines for neuropsychological assessment and consultation. Clin Neuropyschol. 2007;21(2):209-231.

American Academy of Neurology. Press release. AAN issues updated sports concussion guideline: athletes with suspected concussion should be removed from play. [AAN Web site]. 03/18/2013. Available at: https://www.aan.com/pressroom/home/pressrelease/1164. Accessed April 05, 2019.

American Academy of Orthopaedic Surgeons. American Association of Orthopaedic Surgeons (AAOS). Information statement. Concussion (mild traumatic brain injury) and the team physician: a consensus statement. [AAOS Web site]. September 2011. Available at: http://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1029%20Concussion%20(Mild%20Traumatic%20Brain%20Injury)%20and%20the%20Team%20Physician%20-%20A%20Consensus%20Statement.pdf. Accessed April 05, 2019.

American Academy of Neurology (AAN). AAN Position: Sports Concussion. AAN Policy 2013-8. [AAN Web site]. March 2013. Available at: https://www.aan.com/siteassets/home-page/policy-and-guidelines/policy/position-statements/18_sportsconcussion_v203.pdf. Accessed April 05, 2019

American Academy of Neurology (AAN). Summary of evidence-based guideline update: evaluation and management of concussion in sports. [AAN Web site]. 03/18/2013. Available at:
http://www.neurology.org/content/80/24/2250.short?sid=f56293e4-1a37-42fb-a623-e40ed990f838 Accessed April 05, 2019

American Educational Research Association, American Psychological Association, and National Council on Measurement in Education. Standards for Educational and Psychological Testing.2nd ed. Washington, DC: Amer Educational Research Assn; 1999.

American Psychiatric Association (APA). Practice guideline. Treatment of patients with Alzheimer's disease and other dementias. Am J Psychiatry. 2007;164(12):5-56.

American Psychological Association (APA). Guidelines for the evaluation of dementia and age-related cognitive decline. [APA Web site]. January 2012. Available at: http://www.apa.org/pi/aging/resources/dementia-guidelines.pdf. Accessed April 05, 2019

Baars MA, van Boxtel MP, Jolles J. Migraine does not affect cognitive decline: results from the Maastricht aging study. Headache.2010;50(2):176-84.

Barkley R A, Murphy K R . Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Archiv Clin Neuropsychol.2010;25(3):157-173.

Bartok JA, Martin EM. Neuropsychological assessment. In: Jobe TH, Gaviria M, Kovilparambil A, eds. Clinical Neuropsychiatry. Malden, MA: Blackwell Science, Inc.; 1997: 36-41.

Braun M, Deer T, Kaufmann P, et al. Neuropsychology Model LCD Taskforce, a national workgroup representing The American Academy of Clinical Neuropsychology (AACN), the American Psychological Association (APA) Division of Clinical Neuropsychology, and the National Academy of Neuropsychology (NAN). [AACN Web site]. June 2011. Available at:
https://theaacn.org/wp-content/uploads/2015/10/neuropsychology_model_lcd-1.pdf. Accessed April 05, 2019.

Bauer RM, Iverson GL, Cernich AN, et al. Computerized neuropsychological assessment devices: a joint position paper of the american academy of clinical neuropsychology and the national academy of neuropsychology. [NAN Web site]. 01/28/2012. Available at:
https://www.nanonline.org/docs/ResearchandPublications/PositionPapers/Computerized%20Neuropsychological%20Assessment%20Devices%20-%20Joint%20Position%20Paper%20of%20the%20American%20Academy%20of%20Clinical%20Neuropsychology%20and%20the%20National%20Academ.pdf. Accessed April 05, 2019.

Centers for Disease Control and Prevention (CDC). Chronic fatigue syndrome. Information for healthcare professionals. [CDC Web site]. October 2010. Available at: http://www.cdc.gov/cfs/hcp.html. Accessed November 05, 2018.

Centers for Disease Control and Prevention (CDC). FAQs about baseline testing. [CDC Web site]. 02/16/2015. Available at: https://www.cdc.gov/headsup/basics/baseline_testing.html. Accessed April 05, 2019.

Centers for Medicare and Medicaid Services (CMS). Medicare Fee-For-Service Frequently Asked Questions. [CMS Web site]. 06/07/2018. Available at: https://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers/Downloads/FFS-FAQs.pdf. Accessed April 05, 2019.

Cernich A, Reeves D, Sun W, et al. Automated neuropsychological assessment metric sports medicine battery. [Science Direct Web site]. February 2007. Available at:
http://www.sciencedirect.com/science/article/pii/S0887617706001600#. Accessed April 05, 2019.

Claypoole KH, Noonan C, Mahurin RK, et al. A twin study of cognitive function in chronic fatigue syndrome: the effects of sudden illness onset. Neuropsychology. 2007;21(4):507-513.

Echemendia RJ, Iverson GL, McCrea M, et al. The American Academy of Clinical Neuropsychologists (AACN). Role of neuropsychologists in the evaluation and management of sports-related concussion: an inter-organization position statement. Clin Neuropsychol.2011 ;25(8):1289-1294.

Edgerton, Jane E. American Psychiatric Glossary. 7th Edition. Washington, DC: American Psychiatric Press; 1994.

Filipek PA, Accardo PJ, Ashwal SS, et al. Practice parameter: screening and diagnosis of autism: report of the quality standards subcommittee of the American Academy of Neurology and the Child Neurology Society.  Neurology.2000;55(4);468-479.

Halstead ME, Walter KD, Council on Sports Medicine and Fitness. Clinical Report: sports-related concussion in children and adolescents. [American Academy of Pediatrics Web site]. September 2010. Available at: http://pediatrics.aappublications.org/content/126/3/597.long. Accessed April 05, 2019.

Haavik J, Halmoy A, Lundervold AJ, et al. Clinical assessment and diagnosis of adults with attention-deficit/hyperactivity disorder. Expert Rev Neurother.2010;10(10):1569-1580.

Heilbronner RL, Sweet JJ, Attix DK, et al. Official position of the American Academy of Clinical Neuropsychology (AACN) on serial neuropsychological assessments: the utility and challenges of repeat test administrations in clinical and forensic contexts. [AACN Web site]. 11/24/2010. Available at: http://www.tandfonline.com/doi/pdf/10.1080/13854046.2010.526785.
Accessed April 05, 2019.

Howieson DB, Lezak MD. The Neuropsychological Evaluation. In: Yudofsky SC, Hales RE, eds. The American Psychiatric Press Texbook Of Neuropsychiatry. 3rd ed. Washington, DC: American Psychiatric Press Inc.; 2005: 181-199.

Howieson DB, Lezak MD. The Neuropsychological Evaluation. In: Yudofsky SC, Hales RE, eds. The American Psychiatric Press Texbook Of Neuropsychiatry. 5th ed. Washington, DC: American Psychiatric Press Inc.; 2007: 215-244.

Jonsdottir S, Bouma A, Sergeant J A, et al. Relationships between neuropsychological measures of executive function and behavioral measures of ADHD symptoms and comorbid behavior. Archiv Clin Neuropsychol. 2006;21(5);383-394.

Law WA, Mapou RL, Spector J, Kay GG. Neuropsychological and Psychological Evaluation. In: Levenson JL, ed. The American Psychiatric Press Textbook of Psychsomatic Medicine.1st ed. Washington, DC: American Psychiatric Press Inc.; 2005: 15-36.

Malik AB. Neuropsychological Evaluation. [Medscape Web site]. 03/11/2015. Available at: http://emedicine.medscape.com/article/317596-overview. Accessed November 05, 2018.

Meehan WP, d'Hemecourt P, Collins CL, et al. Computerized neurocognitive testing for the management of sport-related concussions. [American Academy of Pediatrics Web site]. January 2012. Available at:
http://pediatrics.aappublications.org/content/129/1/38.full?sid=a3a9da46-f9ed-45e9-bfbc-95b25c2e4412. Accessed April 05, 2019.

Michels TC, Tiu AY, Graver CJ, et al. Neuropsychological evaluation in primary care. Am Fam Physician.2010;82(5):495-502.

Michiels V, Cluydts R. Neuropsychological functioning in chronic fatigue syndrome: a review. Acta Psychiatr Scan.2001;103(2):84-93.

Moser RS, Iverson GL, Echemendia RJ, et al. National Academy of Neuropsychology (NAN) position paper. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch Clin Neuropsychol.2007;22(8):909-916.

O'Bryant SE, Marcus DA, Rains JC, Penzien DB. Neuropsychology of migraine: present status and future directions. Expert Rev Neurother.2005;5(3):363-370.

Pineda DA, Puerta IC, Aguirre DC, et al. The role of neuropsychological tests in the diagnosis of attention deficit hyperactivity disorder. Pediatric Neurology. 2007;36(6):373-381.

Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921.

Podell K, Lovell M. Neuropsychological Assessment. In: Coffey CE, Cummings JL, eds. The American Psychiatric Press Textbook of Geriatric Neuropsychiatry.2nd ed. Washington, DC: American Psychiatric Press, Inc.; 2000: 143-164.

Pritchard A E, Nigro C A, Jacobson L A, et al. The role of neuropsychological assessment in the functional outcomes of children with ADHD. Neuropsychology review.2012;22(1):54-68.

Rosenstein LD. National Academy of Neuropsychology. [Neuropsychology Web site]. Available at: http://www.neuropsych.net/uploads/NeuropsychAssessment.pdf. Accessed April 05, 2019.

Sadock, Sadock and Ruiz. Kaplans and Sadock's Comprehensive Textbook of Psychiatry. 10th ed. New York, NY: Lipincott Williams and Wilkins Publishing; 2017.

US 108th Congress 2003-2004. H.R. 1350: Individuals with Disabilities Education Improvement Act of 2004. [govtrack.us Web site]. 2004. Available at: http://www.govtrack.us/congress/bill.xpd?bill=h108-1350. Accessed April 05, 2019.

Woodhouse J, Heyanka DJ, Scott J, et al. Efficacy of the ANAM General Neuropsychological Screening battery (ANAM GNS) for detecting neurocognitive impairment in a mixed clinical sample. Clin Neuropsychol.2013;27(3):376-385. Epub 2013 Feb 1.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

96132, 96133, 96136, 96137, 96138, 96139, 96146


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

See Attachment A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References

Attachment A: Neuropsychological Testing for Neurologically Based Conditions
Description: ICD-10 Codes




Policy History

07.03.08i
04/24/2019The policy has been reviewed and reissued to communicate the Company’s continuing position on Neuropsychological Testing for Neurologically Based Conditions.
01/01/2019Inclusion of a policy in a Code Update memo does not imply that a full review of
the policy was completed at this time.

This policy has been identified for the CPT HCPCS code update, effective 01/01/2019.

The following CPT codes have been deleted from this policy:

96118, 96119, 96120

The following CPT codes have been added to this policy:

96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146

______________________________________

Note: on 03/06/2019 the following CPT codes were deleted from this policy: 96130, 96131. These psychological testing codes were added to this policy in error as part of the 01/01/2019 CPT/HCPCS code update. Retroactively effective to 01/01/2019, these codes have been deemed inappropriate for the purposes of this policy.

On 3/13/2019 the following CPT code was deleted from this policy: 96121, Retroactively effective to 01/01/2019, this code has been deemed inappropriate for the purposes of this policy.

07.03.08h
11/21/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Neuropsychological Testing for Neurologically Based Conditions.
10/01/2018Inclusion of a policy in a Code Update memo does not imply that a full review of
the policy was completed at this time.

This policy has been identified for the ICD-10 CM code update, effective 10/01/2018.

The following ICD-10 CM codes have been added to this policy:

F12.23, F12.93, Z13.40, Z13.41, Z13.42, Z13.49

The following ICD-10 CM code has been removed from this policy:

Z13.4

07.03.08g
03/27/2018This policy has undergone a routine review, and the medical necessity and not medically necessary criteria have been revised to include additional detailed indications/conditions/circumstances for neuropsychological testing.

Applicable not medically necessary ICD-10 CM codes have been added to the policy due to criteria qualifications. Claims submitted for neuropsychological testing must include a primary ICD-10 diagnosis code that represents a neurologically based medical condition.


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 01/01/2019
Version Issued Date: 01/02/2019
Version Reissued Date: 04/24/2019

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