Occupational Therapy Guidance for use of CPT code 96125
• Occupational therapy evaluations include an occupational profile, medical and therapy history, relevant assessments, and development of a plan of care, which reflects the therapist’s clinical reasoning and interpretation of the data. Occupational therapists should Code 97165 for a low complexity occupational therapy evaluation, 97166 for a moderate complexity occupational therapy evaluation, 97167 for a high complexity occupational therapy evaluation and 97168 for a occupational
therapy re-evaluation.
• A comprehensive evaluation must be completed in order to complete an appropriate, patient centered care plan.
• CPT code 96125 is a standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.
Speech Language Pathology Guidance for use of CPT code 96125
Per the American Speech & Hearing Association (ASHA) SLP’s should bill CPT code 96125 (standardized cognitive performance testing, per hour) if a standardized test is used and the combined time it takes to conduct the evaluation, interpret the results, and write the evaluation report is at least 31 minutes to report the first hour, 91 minutes to report the second hour, and so on. 96125 is a separate and distinct
evaluation code from 92523.
To meet the requirements of using 96125, which is a time based code it is mandatory to utilize a standardized test in your assessment. If the test utilized has screening tool in the test description then it does not constitute as a standardized test. For example the Montreal Cognitive Assessment, (MOCA) is described as a “rapid screening instrument for mild cognitive dysfunction ” therefore it may not be reported with 96125. Also the Saint Louis University Mental Status Examination (SLUMS ) contains
“screening” in the test description therefore it also should not be reported with 96125.
A few things to remember….
• There are two codes to report cognitive treatment: 97127 and G0515. 97127 is an untimed code which may be billed only once per day however Medicare will not accept 97127. G0515 is a 15 minute
time based code which was developed specifically for use by the Medicare program.
• CPT code 92507( speech, language, voice, communication treatment) may also be appropriate if the focus of the treatment is cognitive communication and if treatment goals are language-based.
However if the focus of treatment is primarily cognitive function, SLP’s should report 97127 or G0515 per the payer instructions.
It is critical to establish medical necessity for a cognitive evaluation and provide clear ongoing documentation to support the need for skilled care.
• 96125 can be billed on the same day as ANY other SLP evaluation with use of -59 modifier http://www.asha.org/Practice/reimbursement/coding/CCI-Edit-Tables-SLP/
• SLP’s can bill 96125 as the initial evaluation on the first day of service; see below for new CPT code choice
• If more than one evaluation code is used on the day of the evaluation, all minutes must be coded as evaluation codes and the minutes must be sufficient to support a comprehensive evaluation.
Outstanding Questions
Per the ASHA website: CPT 96125 is "standardized cognitive performance testing." How do I determine
that the tests I select are acceptable (i.e., standardized)?
A standardized test is administered and scored in a consistent manner. These tests may be normreferenced (results are interpreted based on established norms and compare test-takers to each other) or
criterion-referenced (results are interpreted based on the person's performance/ability to complete tasks
or demonstrate knowledge of a specific topic).
If an SLP completes a cognitive evaluation using informal, not standardized cognitive assessment (not
qualifying for 96125), which code should be used?
• There is no appropriate alternative billing for a cognitive-only evaluation that does not include
standardized tests, and SLP’s are encouraged to include standardized measures to support the clinical
and medical necessity of their intervention and guide their POC under all evaluation codes.
What code is appropriate to bill for a cognitive-communication assessment?
• CPT 92523 may be appropriate if the SLP is assessing cognitive -communication skills in conjunction
with a full speech and language evaluation. However speech and language should be the dominant
focus.
• Occupational therapy evaluations include an occupational profile, medical and therapy history, relevant assessments, and development of a plan of care, which reflects the therapist’s clinical reasoning and interpretation of the data. Occupational therapists should Code 97165 for a low complexity occupational therapy evaluation, 97166 for a moderate complexity occupational therapy evaluation, 97167 for a high complexity occupational therapy evaluation and 97168 for a occupational
therapy re-evaluation.
• A comprehensive evaluation must be completed in order to complete an appropriate, patient centered care plan.
• CPT code 96125 is a standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.
Speech Language Pathology Guidance for use of CPT code 96125
Per the American Speech & Hearing Association (ASHA) SLP’s should bill CPT code 96125 (standardized cognitive performance testing, per hour) if a standardized test is used and the combined time it takes to conduct the evaluation, interpret the results, and write the evaluation report is at least 31 minutes to report the first hour, 91 minutes to report the second hour, and so on. 96125 is a separate and distinct
evaluation code from 92523.
To meet the requirements of using 96125, which is a time based code it is mandatory to utilize a standardized test in your assessment. If the test utilized has screening tool in the test description then it does not constitute as a standardized test. For example the Montreal Cognitive Assessment, (MOCA) is described as a “rapid screening instrument for mild cognitive dysfunction ” therefore it may not be reported with 96125. Also the Saint Louis University Mental Status Examination (SLUMS ) contains
“screening” in the test description therefore it also should not be reported with 96125.
A few things to remember….
• There are two codes to report cognitive treatment: 97127 and G0515. 97127 is an untimed code which may be billed only once per day however Medicare will not accept 97127. G0515 is a 15 minute
time based code which was developed specifically for use by the Medicare program.
• CPT code 92507( speech, language, voice, communication treatment) may also be appropriate if the focus of the treatment is cognitive communication and if treatment goals are language-based.
However if the focus of treatment is primarily cognitive function, SLP’s should report 97127 or G0515 per the payer instructions.
It is critical to establish medical necessity for a cognitive evaluation and provide clear ongoing documentation to support the need for skilled care.
• 96125 can be billed on the same day as ANY other SLP evaluation with use of -59 modifier http://www.asha.org/Practice/reimbursement/coding/CCI-Edit-Tables-SLP/
• SLP’s can bill 96125 as the initial evaluation on the first day of service; see below for new CPT code choice
• If more than one evaluation code is used on the day of the evaluation, all minutes must be coded as evaluation codes and the minutes must be sufficient to support a comprehensive evaluation.
Outstanding Questions
Per the ASHA website: CPT 96125 is "standardized cognitive performance testing." How do I determine
that the tests I select are acceptable (i.e., standardized)?
A standardized test is administered and scored in a consistent manner. These tests may be normreferenced (results are interpreted based on established norms and compare test-takers to each other) or
criterion-referenced (results are interpreted based on the person's performance/ability to complete tasks
or demonstrate knowledge of a specific topic).
If an SLP completes a cognitive evaluation using informal, not standardized cognitive assessment (not
qualifying for 96125), which code should be used?
• There is no appropriate alternative billing for a cognitive-only evaluation that does not include
standardized tests, and SLP’s are encouraged to include standardized measures to support the clinical
and medical necessity of their intervention and guide their POC under all evaluation codes.
What code is appropriate to bill for a cognitive-communication assessment?
• CPT 92523 may be appropriate if the SLP is assessing cognitive -communication skills in conjunction
with a full speech and language evaluation. However speech and language should be the dominant
focus.
Referal Sources:
https://kindredrehabjobs.com/wp-content/uploads/2019/03/RHB-FFF-03.08.19-CPT-Code-96125.pdf
This post first appeared on Interventional Radiology Medical Coding - Learn How To Code, please read the originial post: here
