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Anyone having trouble with Medicare and the new neuropsych codes? 96132 96136 96137..

Billed 96132 (1), 96136 (1), 96137 (3)

Medicare is rejecting my claim stating "Payment is adjusted when performed/billed by a provider of this specialty"
The provider is a PhD, Clinical Psychologist.
I contacted Medicare and the supervisor agreed that this rejection is not accurate. She was unable to put the claim back through and referred me to the AH modifier fact sheet for resolution. This modifier was not required in the past. I resubmitted the claim with the modifier and received the same rejection.

Any input is greatly appreciated!!

Medical Billing and Coding Forum

Cpt 96132

Hello,

I was wondering if anyone had experience with this code? I know it must be a minimum of 31 minutes. Lets say the patient has a neuropsychological testing done on 1/1/19 and the patient and/or family come back and review the results on 1/17/19. Does the clock start at that visit or does it start the day of the test when the doctor is handed the test results and makes his recommendations and comments based on review of the results? Generally it takes the doctor about 10 minutes to review each test and the scoring of that test.

If the doctor documents how long that took and then documents how long he was with the patient and/or family at the follow up and it is 31 minutes or more, is this code appropriate to bill instead of the E/M established follow up?

Any help is appreciated!!
Thanks!

Medical Billing and Coding Forum