Reimbursement for MCI Screen
Reimbursement applies only if the Home Memory Test is administered by a Health Care Professional.
Access to MCI Screen is Available in all 50 States
Billing, Coding and Reimbursement Guide
Revised June 2023
PRODUCT OVERVIEW
- The MCI Screen cognitive assessment battery consists of an electronically guided short battery of five well validated cognitive tests.
- The battery includes tests assessing different cognitive domains including comprehension, short-term memory, working memory, recognition, and judgment.
- By analyzing the patient’s responses on these tests and comparing them to normative data from demographically similar patients, the MCI Screen battery can distinguish mild cognitive impairment from normal aging with 97.3% accuracy.
RELEVANT CPT CODES WHEN ADMINISTERED AND INTERPRETED/REPORTED BY PHYSICIAN OR QUALIFIED HEALTHCARE PROFESSIONALS 96136:
- Test Administration Test administration (face-to-face) and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes (16 minutes to 45 minutes).
- CMS Non-Facility Fee Schedule: $42.70* 96132: Test Interpretation and Evaluation Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (31 minutes to 1 hour 30 minutes). CMS Non-Facility Fee Schedule: $130.13* *
- This is a CMS published National Payment Amount. For your specific reimbursement amount, please consult your local Medicare carrier fee schedule or your contracted insurance carriers.
WHEN ADMINISTERED BY TECHNICIAN AND INTERPRETED/REPORTED BY PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROFESSIONALS 96138:
- Test Administration Test administration (face-to-face) and scoring by technician, two or more tests, any method, first 30 minutes (16 minutes to 45 minutes). CMS Non-Facility Fee Schedule: $34.23* 96132.
- Test Interpretation and Evaluation Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour (31 minutes to 1 hour 30 minutes).
- CMS Non-Facility Fee Schedule: $130.13* *This is a CMS published National Payment Amount. For your specific reimbursement amount, please consult your local Medicare carrier fee schedule or your contracted insurance carriers.
ICD10 EXAMPLE CODES*
- I67.9 (Cerebrovascular disease, unspecified)
- R41.2 (Retrograde amnesia) R41.3 (Other amnesia)
- F06.8 (Other specified mental disorders due to known physiological condition)
- G30.9 (Alzheimer's disease, unspecified)
*The ICD-10 codes above are listed as examples and more specific code(s) may be used as appropriate. The final determination of the ICD-10 code(s) must be the physician’s responsibility.
- Some Medicare carriers have adopted Local Coverage Determination(s) (LCDs) which include a very specific list of ICD-10 Diagnosis Codes to be used for Psychiatry and Psychological services which include CPT Codes 96132, 96137, and 96138. It is suggested that you check to see if your specific carrier has adopted such a policy before billing for these procedures.
CODING AND PAYMENT AMOUNTS
- Payment amounts vary by payer and by geographic location. it is always a best practice to review these codes with your billing department or agency and use the most appropriate code for your practice. While Center for Medicare and Medicaid Services (CMS) has its standard fee schedule, actual reimbursement rates in your geographic area may vary.
The CMS website provides geographically-adjusted reimbursement information: http://www.cms.gov/apps/physician-fee-schedule/overview.aspx
Choose the Most Accurate Test
Accuracy means correctly identifying a cognitive problem (sensitivity) without incorrectly classifying a normal response as impaired (specificity). The higher the sensitivity and specificity are, the more accurate the results.
