About Cookies on this site

This site uses Cookies to improve your online experience. By continuing to use this site without changing your cookie preferences we will assume that you are agreeing to our use of cookies. For more information, or to change your cookie preferences, visit our cookie policy.

Accept
Choose your platform and buy
Try if one month free of charge with 10 licenses.
What is the account for?
Welcome to CogniFit! Welcome to CogniFit Research!

Register your email below to begin to take care of your brain.

You are going to create a patient management account. This account is designed to give your patients access to CogniFit evaluations and training.

You are going to create a research account. This account is specially designed to help researchers with their studies in the cognitive areas.

You are going to create a student management account. This account is designed to give your students access to CogniFit evaluations and training.

You are going to create a family account. This account is designed to give your family members access to CogniFit evaluations and training.

You are going to create a personal account. This type of account is specially designed to help you evaluate and train your cognitive skills.

You are going to create a patient management account. This account is designed to give your patients access to CogniFit evaluations and training.

You are going to create a family account. This account is designed to give your family members access to CogniFit evaluations and training.

You are going to create a research account. This account is specially designed to help researchers with their studies in the cognitive areas.

You are going to create a student management account. This account is designed to give your students access to CogniFit evaluations and training.

loading

For users 16 years and older. Children under 16 can use CogniFit with a parent on one of the family platforms.

By clicking Sign Up or using CogniFit, you are indicating that you have read, understood, and agree to CogniFit's Terms & Conditions and Privacy Policy.

Don't miss Black Friday Sales! 2 days left!
50% OFF using the code BLACKFRI22Click here

corporativelanding_Medical-Billing-Codes_social_picture
  • Reimbursement for CogniFit neuropsychological tests and cognitive rehabilitation is generally well-accepted by most payers

  • Most payers consider computerized neurocognitive assessment procedures medically necessary

  • Neurocognitive testing such as CogniFit helps clinicians better understand the nature of their patient’s illness

Start Now
loading

Patient #141

Cate Brown

catebrown@mail.com

59 years old

Last activity: 02/01/2016 | 4:09 min

Registration date: 01/01/2013

Total number of logins: 23

Inhibition

598

Focused Attention

608

Phonological Short-term Memory

468

Spatial Perception

405

Set up a new training session

Custom Training

Session length

15 min

Personalized Training

Memory

Concentration

Reasoning

65 and Over

Reading Comprehension

Perception

Driving

Darwin Science Institute

Participants: 135

Groups: 24

60 and Over

Control Group

Participants: 11

Add participants

60 and Over

Normal Group

Participants: 11

Add participants

Memory Test

Control Group

Participants: 5

Add participants

Memory Test

Normal Group

Participants: 5

Add participants

Create New Group

Name

Type of group

Control Group

Normal Group

Save

Settings: Manual

Daniel Foster

Memory Test

Control Group

0
Personalized Training
1
Memory
0
Concentration
1
Reasoning
0
Driving
0
65 and Over
0
Perception
1
Reading Comprehension
2
Delay between training sessions (hours)
General Cognitive Assessment (CAB)

Number of training regime iterations

5

Send

Student #231

Paul Perkins

DaVinci High School

12 years old | Right handed

ADHD

DaVinci High School

Students: 357

Calculation

Logic

Writing

Reading

Working Memory

565

Naming

411

Visual Perception

355

Visual Short-Term Memory

392

Processing Speed

450

Focused Attention

298

Concentration
Cognitive training
Cognitive Skills
Focused Attention
Spatial Perception
Visual Scanning
Send this training session to Paul Perkins
Strengths
Natural Sciences
Language and Literature
Art

Disclaimer

CogniFit has compiled this information for your convenience. The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content on this document is informational only, general in nature, and does not cover all situations or all payers' rules and policies. These guidelines provide no specific guarantees for reimbursement and are subject to obsolescence as Medicare and other payers amend their policies. Each unique combination of healthcare provider, procedure, and patient condition must be independently considered in terms of applicable coding and reimbursement. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures. It is the responsibility of the medical provider and or the medical provider's staff to make the final determination about what constitutes an appropriate procedure and/or diagnostic code(s). CogniFit specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on this information.

Neuropsychological and neurological tests

Estimated national average reimbursements are systematically and significantly higher than CogniFit’s cost per cognitive assessment.

CPT / HCPCS CodesDescription
90791Psychiatric Evaluation - exam (no medical services) for the elicitation of a complete medical and psychiatric history, a mental status examination, integrated biopsychosocial assessment, and an evaluation of the patient's ability and capacity to respond to treatment on an initial plan of treatment. Non-Prescriber.
90792Psychiatric Evaluation - exam (no medical services) for the elicitation of a complete medical and psychiatric history, a mental status examination, integrated biopsychosocial assessment, and an evaluation of the patient's ability and capacity to respond to treatment on an initial plan of treatment. Prescriber.
96112Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory, and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
96116Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., 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
96121Each additional hour (List separately in addition to code for primary procedure)
96125Testing & Interpretation - Standardized cognitive performance testing (e.g. Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.
96127Brief emotional / behavioral assessment (e.g., limited (e.g., Pediatric Symptom Checklist, Vanderbilt AD/HD, SCARED, PHQ-9, depression inventory, ADHD attention-deficit/hyperactivity disorder scale), with scoring and documentation, per instrument.
96130Psychological 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
96131Each additional hour (List separately in addition to code for primary procedure)
96132Neuropsychological 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
96133Each additional hour (List separately in addition to code for primary procedure)
96136Psychological or Neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes
96137Each additional 30 minutes (List separately in addition to code for primary procedure)
96138Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
96139Each additional 30 minutes (List separately in addition to code for primary procedure)
99483 Category I: Evaluation and Management "Cognitive Assessment and Care Plan Services" Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian e.g., spouse, informant. etc. in the office or other outpatient, home or domiciliary or rest home, with all the following required elements:

  1. Cognition-focused evaluation including a pertinent history and exam. Use of standardized instruments to stage dementia.
  2. Medical decision making of moderate or high complexity. (defined by the E/M guidelines).
  3. Functional assessment including decision-making capacity.
  4. Medication reconciliation and review for high-risk medications, if applicable.
  5. Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized instrument(s).
  6. Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and willingness of caregiver to take on caregiving tasks.
  7. Evaluation of safety, including motor vehicle operation, if applicable.
  8. Address palliative care needs, if applicable and consistent with beneficiary preference.
  9. Creation of a care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed;
  10. care plan shared with the patient and /or caregiver with initial education and support.

The American Medical Association (AMA) and the Center for Medical Services (CMS) are the governing agencies that generally set the procedure codes and how they are used. Regional or local insurance companies such as Medicare third-party administrators, Blue Cross/Shield or large national carriers generally follow these rules but there can be regional differences or variance.

Even though the patient may not qualify for Medicare most payers design their coverage rules according to CMS criteria. The value of neurocognitive testing is well recognized as CMS has sent out several memos mandating coverage for these codes. Generally, there is widespread reimbursement or coverage for these procedure codes used for CogniFit assessments

Many patients that are not covered for cognitive testing e.g. Medicare, Private Carriers will pay out-of-pocket to have their neurocognitive function measured. Patients that have a family history of cognitive impairment e.g., dementia, Alzheimer’s disease, Parkinson’s disease, etc. will be candidates for this clinical service.

Cognitive rehabilitation

CPT / HCPCS Codes Description
97127(G0515 is the code used for Medicare) Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact

The CPT code 97127 code is untimed and can only be billed once per day regardless of the length of the session. Note that Medicare does not accept CPT code 97127 but recognizes its own 15-minute G-code, G0515, for cognitive therapy. Check with non-Medicare payers regarding implementation of 97127. You should also make sure reimbursement rates are reflective of a session, and not 15-minute units.

While cognitive training by itself is not typically covered by insurance, it may be possible for a health care provider to incorporate cognitive training as a component of their therapeutic interventions and have the services covered by the client’s insurance company. A treatment plan is required, progress must be documented and this type of therapy has restrictions for its use with specific patient populations. In addition, the patient needs to be qualified to show that he or she can possibly benefit from this form of treatment. Currently, neurological disorders, strokes, cancer treatment (medicines used to treat cancer are toxic to the brain) and traumatic brain injuries are generally covered. Alzheimer’s is usually not covered. Insurance coverage varies according to insurance company and state. Providers who typically use these codes include: psychologists, speech language pathologists, occupational therapists, physicians in rehabilitative medicine, neurologists, psychiatrists, and other related medical specialists.

Matching CPT Codes with ICD or DSM Codes

Coverage for neurocognitive procedures can vary by payer. The CPT procedure code and ICD -DSM codes need to “match” according to each payers requirements. Contacting the payer's provider representative(s) can assist in the appropriate or correct coding. ICD and DSM Code coverage can vary from plan to plan. Clinicians should consult with their office’s coding and billing staff to determine the combination of codes that will work best for testing services.

Suggestions for Documentation

CMS (Recovery Audit Program) and other payers have active and ongoing audit programs to recover fraudulent claims. Coding experts have expressed the following tips to help a practice be prepared for an audit.

  • Technical Component - Label which Tech or Admin or Computer admin, Number of Tests.
  • Professional Component - Label Activities: Testing by Professional, Interpretation, Report, or Integration of findings which may include history, prior records, interview(s), and compilation of tests.
  • Testing Time – Minimum documentation should be: Date(s) & Total Time Elapsed, Maximum: Date(s) Start and Stop Times; Testing Time Backup - Scheduling System (e.g., schedule book; agenda, etc.), Testing Sheet with Lists of Tests with Start/Stop Times, Keep Time Information as long as records are kept. *Medical Necessity can vary by Payer. CogniFit reports contain an automatic Time and Date stamps.

Denial of Coverage

Most payers consider computerized neurocognitive assessment procedures medically necessary because the assessment procedure aids in the assessment of neurocognitive impairment due to medical or psychiatric conditions. Neurocognitive testing such as CogniFit helps clinicians better understand the nature of their patient’s illness, in making recommendations regarding coping with and compensating for their neurocognitive difficulties, and encourages treatment adherence. If for some reason the carrier or plan denies coverage it is important to educate and inform the carrier or plan’s personnel about the importance of covering the procedure.

Please type your email address