OVERVIEW: PHYSICIAN FEES

Cognitive testing, combined in Screen’s CANS-MCI with an assessment of depression and behavioral risk factors for cognitive decline, is extremely valuable for the emotional and physical well-being of patients.

Under CNS Assessments/Tests, physician fees for these services are captured under CPT codes 96101-96125.

As an example of these fees, in order to compensate physicians for their time involved in reviewing Screen’s Physician Report, incorporating it in the patient’s record, and determining a course of action, Medicare allows physicians to charge $79.20 per test battery (under CPT 96120, Seattle WA) and $53.60 per test battery (under CPT 96103, Seattle WA).

 

MEDICARE BILLING RATES

In Seattle (King County), the following Medicare rates apply:

Table 1. Medicare Payments for CNS Assessments/Tests and Follow-up Patient Visits

HCPC/CPT	Description	Physician Fee (Seattle, WA) **
96120	Neuropsychological testing (e.g., Wisconsin Card Sorting Test, Screen’s CANS-MCI Test Battery), administered by a computer, with qualified health care professional interpretation and report.	$79.20 per test
96119 (Medicaid)	Neuropsychological testing (e.g., Wechsler Memory Scales and Wisconsin Card Sorting Test, Screen’s CANS-MCI Test Battery), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face.	$76.74 per hour
96103	Psychological testing (includes psychodiagnostic assessment of emotionality, personality and psychopathology), administered by a computer, with qualified health care professional interpretation and report.	$53.60 per test

Medicare has additional rates for physician and patient/family follow-up meetings.

 

GEOGRAPHIC EXAMPLES OF 2009 PHYSICIAN FEES FOR HCPC/CPT 96120 AND 96103

The following Medicare rates illustrate the physician fee reimbursements for different geographic areas.

HCPC/CPT 96120 (computer-administered neuropsychological test) and 96103 (computer-administered psychological testing)

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LIMITATIONS ON MEDICARE INFORMATION PROVIDED IN THIS WEBSITE

The information provided on Physician Fees/Medicare Reimbursement is widely available to the general public, and is meant to be broadly informative for physicians; but not definitive.

Since physician fees under Medicare reimbursement routinely change (according to changes in RVUs, conversion factors and GPCIs)—and since the applicability of many of the codes themselves change (HCPC/CPT)—physicians, not Screen Inc., have sole responsibility for ensuring that they are following all billing requirements of Medicare and all other payer requirements.

Please check with your billing experts, Medicare, and/or your insurance carriers before billing for any services.