Your resource for assessing the addiction risk in your patients seeking pain relief
Yes, Medicare and Insurances Pay
There are three CPT codes that can be used to bill for TestSTAT’s computer administered Pain Management Evaluation (PME). One is used when the patient takes the test on the computer unassisted, for example at home. There are two other codes is for “assisted” computer administered testing; e.g., if a patient takes a test on a computer in your office with yourself or a technician attending. The technician makes sure everything is set up, answers questions and helps with data input if needed, and personally measures BP, height, weight, etc. A technician can monitor several test takers at the same time.
Testing
Psychological testing is a diagnostic procedure that is considered medically necessary if it has an impact on a patient’s plan or care and thus treatment. To this end the testing should yield information for treatment goals, efficacy (e.g., targeting) treatment, and patient disposition. Tests are diagnostic procedures and therefore the incident to provisions do not apply.
Psychological testing be performed or overseen by a qualified health professional or QHP. Currently the categories of QHP include: physician, nurse practitioner, physician’s assistant or a psychologist. There are three CPT codes that can be used, each billed under the QHP by the hour unit. 31 minutes or more is billed as a unit, thus spending 1 hour 35 minutes would be billed as 2 hour units:
• CPT 96102 is billed per unit by a QHP for tests administered face-to-face by a technician with interpretation and reporting by the QHP.*
• CPT 96103 is billed per unit for tests administered by a computer with QHP interpretation of test results and reporting.
• CPT 96101 is billed per unit for tests administered face-to-face, with interpretation and report preparation by the QHP. This code is also used for additional time spent integrating other clinical data such as previously done 96102 and 96103 into an overall report.
Interpretation and reporting is aided by the report that TestSTAT provides upon scoring the results of the computer administered testing. As there is substantial need for assistance during the testing; e.g., taking BP measures, height, weight, and providing direct support and guidance throughout the procedure we recommend the QHP use an assistant and bill 96102. If the QHP provides the direct face-to-face assistance s/he should bill 96101. Feedback to the patient and treatment planning is done in the context of the QHP’s typical appointment (e.g., a therapy visit, E&M, etc.) on the same day or at an additional appointment.
Billing is by the unit and a unit is 31 minutes or more, for example if the test administration takes around 45 minutes, as ours typically do, you would bill a single unit. If the testing takes 91 minutes you bill for two units.
Reimbursement rates vary according to area and insurance, but Medicare Part B allows, in rural Massachusetts, about; $30/hour for psychological testing administered by a computer, $70/hour when a technician does the testing and $101/hour if the QHP does the testing him or herself.
An Income Model
In in-house setup could use up two or three computers or tablets in your office. You need internet connectivity (wifi). Reports are generated in PDF form and are several pages long. Print the report and use a physician extender or personally go over them with the patient in a separate and reimbursable appointment. Hire a $15/hour technician with basic skills in computer use (e.g., typing in identifying data) and train them to measure height, weight and BP, etc. Have all new and existing patients in whom you are considering using opioids, or want to assess for tobacco/ETOH use, or evaluate their pain, or examine for depression/anxiety, etc. take the test. Dedicate two specific days/evenings (when office use is low) of the week. Two technician assisted testings per hour across two eight-hour testing days, would result in 32 assessments (96102) per week generating $2240 – $200 for staff = $2040/week. TestSTAT charges about $15 per test so that yields $1560/week net or $78,000/year. Once skilled, a technician might manage three testings per hour generating as much as $3360 – the same $200 for staff – TestSTAT charges = $2440/week or $122,000/year.
Another option is to have a nurse practitioner or PA give the test, perhaps on slow clinic/practice days. They are reimbursed at a higher rate (96101). At two testings per hour, they would generate $1600 per day minus TestSTAT’s cost = $1360 per day. A nurse practitioner at $100,000 per year costs $400/day, so s/he would generate close to $1000 per day. An ideal situation would be to offer a wellness/pain testing service to other clinics or to other practitioners in a large group practice.
The PQRS Advantage?
The PQRS nightmare foisted upon all practitioners that bill traditional Medicare is no joke. Not complying this and next year will result in a 5% reduction in your allowed Medicare reimbursement rate. Add that to the 2% sequester reduction we have been living with, and in 2017 you could be facing a 7% reduction in the already low rates Medicare allows you. Medicare wants you to be using nine different screening measures of ETOH abuse, depression, pain, etc. on 50% of more of your Medicare patients to avoid the penalties. Fortunately, the TestSTAT computer assessment incorporates many PQRS measures appropriate for use in all clinical specialties. See the next section for details. While Medicare pays nothing for these measures they require on your patients, when there are pulled from a psychological testing, they can then be billed by physicians, NPs and PAs as described above. The psychological test procedure codes (96101, 96102 and 96103) all incorporate many PQRS measures when the TestSTAT instrument is used.
Want More Information?
We are looking for beta testers for our web-ready instruments. If you would like to co-develop these products with us, contact Dr. GPE by clicking on the link at the bottom of this page.
*If the interaction between the patient and the technician is limited to installing the program and checking that the patient is able to complete the test and providing some basic assistance, than CPT 96103 should be billed. If greater levels of interaction are required, though the test may be computer administered, than the appropriate technician code (CPT 96102) should be used. Measures designed for use in the doctor’s office that involve substantial patient/technician interaction warrant CPT 96102. Adapted from AMA CPT Assistant, November, 2006.