Effective January 1, 2019, the American Psychological Association (APA) has released updated CPT codes for Developmental, Psychological and Neurological testing. You may refer to https://www.apaservices.org/practice/reimbursement/health-codes/testing for additional information and also review the January NC Medicaid Bulletin for additional reference.
As a result of the change the following Medicaid and state testing codes have been replaced and are end-dated effective December 31, 2018: 96101, 96111 and 96118. The new testing codes that have been added for Medicaid services effective January 1, 2019 are: 96112, 96113, 96121, 96130, 96131, 96132, 96133, 96136, 96137, and 96146. Please see Alliance Medicaid Rate sheet https://www.alliancehealthplan.org/wp-content/uploads/Medicaid-Rate-Sheet-Jan-2019.pdf.
As indicated in the earlier communications, Alliance Health will work with providers around retrospective claims and authorization requests for services. In order to be considered for retrospective authorizations and payment, please submit any retrospective authorization requests for these codes by April 30, 2019. Any claims related to the retrospective authorizations for psychological testing codes will need to be submitted no later than May 31, 2019.
Contract amendments are in the process of being sent to all affected providers via Docusign.