Use this step-by-step checklist to strengthen your prior authorization requests for BrainCheck services and prevent unnecessary denials.
Confirm Clinical Information
Ensure the clinical note/order supports your request.
Have it ready for quick reference.
Clinical Assessment
Presenting Problems & Symptoms: Whatâs driving the need for testing?
Duration of Symptoms: The longer the duration, the stronger the case.
Other Pertinent History: Any additional details that strengthen the request.
ICD-10 Diagnosis
Ensure the diagnosis is accurateâmedical necessity is essential for approval.
Diagnostic Testing vs. Other Methods
Clarify why testing is needed over alternatives (interviews, consults, medical records).
Example: BrainCheck Screen General Impression â âFurther Testing Recommended.â
Impact on Treatment Plan
Explain how the test results will affect the treatment plan.
Testing Administrator
Specify who is performing the testing:
96136 = Provider
96138 = Technician
CPT Code Requested
List codes 96136, 96138, and 96132.
Avoid 99483 â it does not require prior authorization and can cause denial.
Total Units
Request 1 unit per CPT code (MUE = 1).
Specify Names of Tests
BrainCheck Assess includes:
Trails A (Attention)
Trails B (Mental Flexibility)
Stroop (Executive Function)
Digit Symbol Substitution (Processing Speed)
Immediate & Delayed Recognition (Memory)
Medical Records
Ensure all relevant details are documented in the medical records to support the request.
Pro Tip: Attach the BrainCheck Screen⢠report as supporting documentation.
Sample Request Language
Example:
Patient presented with husband and son. Symptoms started in her mid-70s, progressing over time. She notices word-finding difficulty. She states she does not misplace things, but her family says otherwise. She does not forget names, but her husband reports otherwise. Husband reports episodes of confusion and that she has left the stove on several times.