BH Neuropsychological Testing, Psychological Testing, and Neurobehavioral Status Exam Form

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Neuropsychological Testing, Psychological Testing, and
Neurobehavioral Status Exam – Behavioral Health Policy
Updated Revision Effective: 10/1/2025 Policy Number:

UM060POL

Approval Date: 8/14/2025

Line(s) of Business:

Commercial
Medicare Advantage
Medicaid (BeHealthy)

Description

Neurobehavioral Status Exam is a clinical assessment of cognitive functions and behavior, and may include an interview with the patient, other informants, and/or staff, as well as integration of prior history and other sources of clinical data with clinical decision-making, further assessment and/or treatment planning and report. Evaluation domains may include language, memory, acquired knowledge, attention, planning and problem solving, and visual-spatial abilities. When it precedes a neuropsychological or psychological evaluation, the clinical assessment would determine the type of tests and how those tests should be administered.

Neuropsychological Testing provides measurements of brain function that are objective, valid, and reliable. Information from neuropsychological assessments directly impacts medical management of patients by providing information about diagnosis, progression or course of conditions, prognosis, and treatment of disorders that are known to impact central nervous system (CNS) functioning.

Psychological Testing involves the use of reliable and research-validated methods (including but not limited to clinical interviewing) and standardized tests to evaluate cognitive, behavioral, and emotional functioning, intellectual abilities, personality, and psychopathology

Line of Business

Commercial:
For Neurobehavioral and Psychological Testing see the Policy section below.
For Neuropsychological Testing use InterQual®* Criteria Neuropsychological and Developmental Testing

Medicaid – BeHealthy:
Medical necessity review is performed by the Massachusetts Behavioral Health Partnership (MBHP).

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Medicare:
For Neurobehavioral and Psychological Testing see the Policy section below.
For Neuropsychological Testing use InterQual®* Criteria Neuropsychological and Developmental Testing. Medicare does not have a National Coverage Determination (NCD) or a Local Coverage Determination (LCD) for Neuropsychological and Developmental Testing.

*To obtain InterQual® SmartSheets™: If you are a registered Health New England provider click here: https://www.hnedirect.com/login/. If you so not have access to the portal call (413) 787-4004 to obtain a copy.

Policy

Medicare and Commercial:

More than 3 hours of Neurobehavioral Testing will be reviewed for medical necessity.

Up to 9 hours of Psychological Testing is covered with prior authorization. Requests for more than 9 hours will be reviewed for medical necessity.

For Neuropsychological Testing use InterQual® Criteria Neuropsychological and Developmental Testing.

To obtain InterQual® SmartSheets™: If you are a registered Health New England provider click here: https://www.hnedirect.com/login/. If you so not have access to the portal call (413) 787-4004 to obtain a copy.

Coding Guidance

Code
Description
PA 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour No 96121 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure) Required for more than 2 units. 96130 Psychological 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 Yes 96131 Psychological 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; each additional hour (List separately in addition to code for primary procedure) Yes 96132 Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of Yes

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Code
Description
PA 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 96133 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; each additional hour (List separately in addition to code for primary procedure) Yes 96136 Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes Yes 96137 Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure) Yes 96138 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes Yes 96139 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure) Yes CPT® Copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Note: CPT/HCPCS codes are included for informational purposes and may not be all inclusive. Inclusion or exclusion of a CPT/HCPCS code(s) does not signify or imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member’s specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee of payment. Other policies and coverage determination guidelines may apply.

Policy Implementation

Approved by the Medical and Pharmacy Policy Committee

Kate McIntosh MD MBA

Chief Medical Officer

Saad Usmani MD MBA

Medical Director

Date Update 2/2/2011 Initial Policy Date 12/2023 Moved to new template with no changes to criteria.
Changed name from Neuropsychological Testing to Neuropsychological Testing, Psychological Testing, and Neurobehavioral Status Exam
1/2024 Line of Business section added 2/2024 Medicare criteria updated to InterQual Clarified Neurobehavioral Testing and psychological testing- no change to criteria.
7/2025 Reviewed with no changes

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Medical Criteria Disclaimer

Property of Health New England. All rights reserved. The treating physician or primary care provider must submit to Health New England the clinical evidence that the patient meets the criteria for the treatment, testing or surgical procedure. Without this documentation and information, Health New England will not be able to properly review the request for prior authorization. The clinical review criteria reflect how Health New England determines whether certain services or supplies are medically necessary. Health New England established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
Health New England expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by Health New England, as some programs exclude coverage for services or supplies that Health New England considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. Health New England has adopted the herein policy in providing management, administrative and other services to its Health Plan.