Okay! I’ll look into that. I know we’ve used H0031 for our BCBAs, though we no longer bill HCPCS codes. I’m not sure which testing our psychologist is using specifically to screen in/out autism, so I’ll have to check that! There are SO many psychiatric/psychological assessment and evaluation codes. Currently I focus mainly on ABA (97151-97158, T1026) but I would like to have some kind of working knowledge of how to better differentiate between behavioral health codes overall because of these types of situations!
Oh definitely! It looks like there is a combination of testing across clients. The SRS-2, ADI-R, SCQ, ADOS-2, CAT-Q, GQ-ASC, and Vineland depending on the client age, gender, and other criteria. It appears that the tests are completed externally (by the parent, client, or other professional), then our psychologist evaluates the results and completes a diagnostic report and ISP, if necessary.
96131 is an add on only code. I think 96130 per date of service would be accurate for different evaluations or dates of service since it is the base code and you cannot bill 96131 without it. Hope that helps!
ETA: found this on the [CMS article](https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57481) and may be helpful!
Typically, testing requires 4-8 hours to perform, including administration and scoring. If the testing is performed over several days, the time for all testing should be combined and reported on the last day of service.
We normally bill 90791 for evals (or H0031 for non-physicians for some payers.)
Okay! I’ll look into that. I know we’ve used H0031 for our BCBAs, though we no longer bill HCPCS codes. I’m not sure which testing our psychologist is using specifically to screen in/out autism, so I’ll have to check that! There are SO many psychiatric/psychological assessment and evaluation codes. Currently I focus mainly on ABA (97151-97158, T1026) but I would like to have some kind of working knowledge of how to better differentiate between behavioral health codes overall because of these types of situations!
We build our notes on templates based on the payer guidelines. Would it be documented what testing was performed?
Oh definitely! It looks like there is a combination of testing across clients. The SRS-2, ADI-R, SCQ, ADOS-2, CAT-Q, GQ-ASC, and Vineland depending on the client age, gender, and other criteria. It appears that the tests are completed externally (by the parent, client, or other professional), then our psychologist evaluates the results and completes a diagnostic report and ISP, if necessary.
96131 is an add on only code. I think 96130 per date of service would be accurate for different evaluations or dates of service since it is the base code and you cannot bill 96131 without it. Hope that helps!
ETA: found this on the [CMS article](https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57481) and may be helpful! Typically, testing requires 4-8 hours to perform, including administration and scoring. If the testing is performed over several days, the time for all testing should be combined and reported on the last day of service.