Reimbursement is available in the USA and is not applicable to other countries terms and conditions vary for each State and provider.

WHY do payers reimburse a DriveABLE Cognitive Assessment?

Reimbursement for the DriveABLE Cognitive Assessment Tool (DCAT) is generally well accepted by most payers in the USA. CMS/Medicare provided guidance in 2006 mandating coverage for the current billing codes. Generally, most payers follow CMS's guidance and this continues to be the case with payment for neurocognitive assessment procedures. Practitioners understand that payer rules for reimbursement can vary greatly; but in general, neurocognitive assessment procedures are billable and reimbursable.

Most payers consider computerized neurocognitive assessment procedures medically necessary in the assessment of neurocognitive impairment resulting from a medical condition. DriveABLE is a computerized neurocognitive assessment to evaluate drivers at-risk due to any medical or neurological disorder. DriveABLE seeks to protect safe drivers from misidentification, based solely on their medical condition or age, and accurately identify unsafe drivers to protect them, their families and other road users. The presence of one or more of the following red flag medical conditions indicates a driver at-risk. The patient’s driving may be (or may become) compromised and therefore qualify for neurocognitive assessment using DriveABLE.

HOW do I bill for assessment procedure services?

EVALUATION AND MANAGEMENT

 

INITIAL OFFICE VISIT

CPT CODE: 99213 to 99215 OR 99203 to 99205

 

SECOND OFFICE VISIT - Neurocognitive Assessment

 

NEUROBEHAVIORAL STATUS EXAM CPT CODE: 96116

 

Testing Neurocognitive Function CPT CODE: 96119

 

THIRD OFFICE VISIT

DETERMINATION OF COMPETENCY FOR DRIVING CPT CODE: 99213 to 99215

 

 

Neurocognitive testing, such as DriveABLE, helps clinicians better understand the nature of their patient's medical condition. The DCAT offers objective, precise, standardized measurements every time. It is one of the only assessments available worldwide which uses actual on-road driving ability as it's criterion measure, and therefore is critical to support evidence-based decisions and recommendations regarding driving competency.

 

  Assessment Codes

 

  96103

Testing & Interpretation Psychological testing, administered by a computer, with qualified health care professional interpretation and report.

  96116

Neurobehavioral status exam, per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report.

  96118

Testing & Interpretation Neuropsychological testing per hour of the qualified healthcare professional time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.

  96118

Additional Professional 96118 is also used in those circumstances when additional time is necessary to integrate other sources of clinical data, including previously completed and reported technician- and computer-administered tests.

  96119

Testing & Interpretation Neuropsychological testing, with qualified healthcare professional’s interpretation and report, administered by technician, per hour of technicians time, face-to-face.

 

The American Medical Association's (AMA) Current Procedural Terminology (CPT) Editorial Panel has established the coding for services related to Central Nervous System function assessment. The "Central Nervous System Assessments / Tests” billing codes (96101-96125) are the set of codes used when billing for a DriveABLE assessment. The DriveABLE Cognitive Assessment Tool or DCAT is a software-based assessment system used to evaluate whether an individual’s cognitive abilities necessary for driving have been compromised by a medical condition and/or medication use.

Driving requires the complex interaction of several mental abilities including memory, attention, judgment, decision-making and identification of hazardous situations to be successful. The DCAT is composed of six tasks which look at this interaction and, through the weighted analysis of 22 individual measures, gives a result indicative of the probability the individual would fail an on-road test specifically designed to measure competence decline.

The DCAT is also used in combination with validated paper and pencil based testing and billed using the same codes. In general, Payers expect that the administration of these testing services will generate material that will be formulated and integrated into a report. Neurocognitive testing such as DriveABLE helps clinicians better understand the nature of their patient's medical condition. The DCAT offers objective, precise, standardized measurements every time. It is one of the only assessments available worldwide which uses actual on-road driving ability as its criterion measure and therefore is critical to support evidence-based decisions and recommendations regarding driving competency. There are generally two possible procedure coding events related to the DriveABLE Cognitive Assessment Tool:

  1. Testing, interpretation, and reporting event
  2. The time a clinician takes INTEGRATING the test results into other sources of clinical testing data

Disclaimer: 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. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that DriveABLE Assessment Centres Inc. assumes will have been made prior to assigning codes or requesting payments. 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. This information represents no promise or guarantee by DriveABLE Assessment Centres Inc. concerning coverage, coding, billing, and payment levels. DriveABLE Assessment Centres Inc. specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on this information.