Learn which CPT codes, modifiers, and ICD-10 codes are commonly used for BrainCheck cognitive testing, plus tips for smooth claims.
Overview
BrainCheck supports reimbursement for cognitive testing and care planning through widely recognized CPT codes. This article provides details on the most relevant codes, modifier rules, and diagnosis examples to help ensure claims are processed without delays.
CPT Codes for BrainCheck
Code | Service | Description | Time Requirement | Notes |
96136 | Assess Administration | Neurocognitive test administration by a medical professional | First 30 minutes (minimum 16 minutes) | For provider or NPP administered BrainCheck testing |
96138 | Assess Administration | Neurocognitive test administration by a technician | First 30 minutes (minimum 16 minutes) | For staff-administered BrainCheck testing |
96132 | Assess Interpretation | Test interpretation, medical decision making | First hour (minimum 31 minutes) | Used when provider or NPP interprets results and makes clinical decisions |
99483 | Care Plan | Cognitive care planning (separate visit) | Standalone visit, billable once every 6 months (180 days) | Includes assessment, care plan, and discussion with patient/caregiver |
Key Billing Tips: Modifiers & ICD-10 Codes
Use -59 modifier on 96138 and 96132 when billing with an E/M code.
If additional procedures are billed with BrainCheck, apply -25 modifier to the E/M code and -59 modifier to 96138 and 96132.
When billing an office visit on the same day as BrainCheck, use a separately identifiable ICD-10 code from the BrainCheck ICD-10 list.
Payer-specific rules: Aetna, BCBS, and Humana have internal edits requiring a 25 modifier on the E/M code.
ICD-10 Code Examples
Mental & Behavioral Disorders
Dementia (F02-)
Amnestic disorder (F04-)
Post concussion syndrome (F07.81)
Alcohol dependence with alcohol-induced persisting dementia (F10.27)
Major depressive disorder, recurrent (F33-)
Altered mental status (R41.82)
Diseases of the Nervous System
Huntington’s disease (G10-)
Parkinson’s disease (G20-)
Alzheimer’s disease (G30-)
Mild cognitive impairment (G31.84)
For a full list of ICD-10-CM codes, refer to your Medicare MAC LCD/Billing Article here: Full ICD-10 List (Google Sheet)
Aetna users: See Aetna policy 0158 for approved ICD-10 codes meeting medical necessity.
Billing Workflow Best Practices
Include method of administration (in-person vs telehealth).
Attach the BrainCheck report to the patient’s EHR.
Ensure diagnosis codes match payer medical necessity requirements.