Commentary on the use of 96119 in billing for neuropsychological services

Objective: This commentary seeks to outline the problematic issues with the use of 96119 in billing for neuropsychological evaluations. Issues covered include billing for the provider’s time when using technicians as well as the use of trainees when billing Medicare. Method: Resources from the Centers for Medicare and Medicaid Services (CMS) were reviewed along with a search of available documentation from regional carriers and the general literature. Conclusions: There has been much confusion in the professional community regarding billing for neuropsychological evaluation services when utilizing technicians and/or trainees. Much of this confusion has stemmed from discrepancies in interpretation of testing codes between the American Medical Association and CMS. Ultimately, clinicians must use codes according to the requirements of the payor, whether Medicare, Medicaid, or a private third-party payor. Failure to do so can be construed as fraud and result in unwanted penalties.