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What billing codes are practices using for clients that would be taking ADHD testing such as Tova on the computer?

Kelli Feucht- ACS 3 years ago in Codes/Rates/Diagnosis Modules updated by Richard Sethre, Psy.D., L.P. 3 years ago 1

Providers have clients come to office to take a 20-40 minute ADHD test using TOVA, which is a computerized test.  We would like to bill to insurance, has anyone ever billed for these types of services, if so what code(s) are you using?

This is, I think, an excellent question.  If you can't figure out how to bill for a service like this, it will hurt your bottom line.  The answer, however, it - like many billing issues - requires consideration of several factors, particularly whether the clinician billing for the service is a psychologist or other "qualified health provider" whose scope of practice includes testing. Also, the answer may be different for different insurance payers.  Also, it makes a difference if you are administering only the TOVA as opposed to administering it as part of a comprehensive assessment.  


The most basic answer is:  The TOVA is administered by computer.   If the clinician responsible for the administration is a qualified health professional and administers the testing in compliance with the insurance company's guidelines for billing with 96103, then the 96103 code would be the logical choice.   


It is advisable to check the testing policies for the insurance company, as some exclude ADHD testing as a covered benefit (they think that there is a lack of research that supports the benefits of testing, and advocate that it is adequate to assess ADHD symptoms by interviewing and use of rating scales).