Medicare to bill for CPT code 96125

QUESTION: Who is authorized by Medicare to bill for CPT code 96125 (that was added under CPT effective January 1, 2008)?


ANSWER: CPT code 96125 ( standardized cognitive performance testing (eg, 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) is designated under Medicare as an “always therapy” code. Physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs) may bill this code for patients only when the patient is under a therapy plan of care. (Please note that CPT Changes: An Insider’s View 2008 suggests that when testing like that performed under 96125 is performed by a physician or a psychologist, a code from the 96101-96103 or 96118-96120 series should be reported.)



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