APA Services
Psychological or Neuropsychological Testing Sample Billing/Services SummaryClinical Interview/AssessmentCPT? Code 90791(Untimed)orBase: 96116(1st 60 mins)Add-on: 96121(each addtl 60 mins)Interview (Face-to-Face)(Start/Stop), (Date, Day #)XX minutesDocumentation (Non-Face-to-Face)(Start/Stop), (Date, Day #)XX minutesTotal Time:XX minutes (X hours, XX minutes)Total Units:1**?Testing Evaluation ServicesBase: 96130 or 96132(1st 60 mins)Add-on: 96131 or 96133(each addtl 60 mins)Record Review and Clarify Referral Question (Start/Stop), (Date, Day #)XX minutesIntra-Session Clinical Decision Making (Start/Stop), (Date, Day #)XX minutesPatient Symptom Management (Start/Stop), (Date, Day #)XX minutesClinical Decision Making/Battery Modification (Start/Stop), (Date, Day #)XX minutesIntegration/Report Generation (Start/Stop), (Date, Day #)XX minutesInteractive Feedback Session(Start/Stop), (Date, Day #)XX minutesPost-Service Work (Start/Stop), (Date, Day #)XX minutesTotal Time:XX minutes (X hours, XX minutes)Total Units:1**?Test Administration and ScoringBase: 96136 and/or 96138(1st 30 mins)Add-on: 96137 and/or 96139(each addtl 30 mins)Test Administration (Face-to-Face)(Start/Stop); (Start/Stop), (Date, Day #)XX minutesScoring (Non-Face-to-Face) (Start/Stop), (Date, Day #)XX minutesTotal Time:XX minutes (X hours, XX minutes)Total Units:1**?Diagnosis(es): (ICD-10) ................
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