This article provides a practical overview of how to bill for BrainCheck services, including commonly used CPT codes, time and documentation requirements, and special billing scenarios. It is intended to support providers and billing teams, but payer rules may vary by state and plan.
General Billing Guidelines
When submitting claims for neurocognitive testing services:
Time does not need to be continuous or occur on the same day to meet CMS time requirements
A minimum of 16 minutes is required for a 30-minute service
A minimum of 31 minutes is required for a 1-hour service
Always confirm payer-specific rules, prior authorization requirements, and documentation expectations
Common CPT Codes
Neurocognitive Testing
96138 – Neurocognitive test administered by a technician (first 30 minutes)
96136 – Neurocognitive test administered by a medical professional (first 30 minutes)
Test Interpretation and Medical Decision-Making
96132 – Test interpretation and medical decision-making (first hour)
Cognitive Care Planning
99483 – Cognitive care planning
Must be billed as a separate visit
Cannot be billed with any other CPT codes
Can only be billed once every 6 months (180 days)
Billing Multiple Codes Together
96138 or 96136 + 96132
When billing neurocognitive testing and interpretation together:
Billed separately or on the same day
No modifiers required
The same ICD-10 code may be used for both CPT codes
Billed on the same day as an E&M visit
Modifier 59 must be appended to 96138 or 96136 and 96132
The E&M visit must have a separately identifiable ICD-10 code
Time Requirements
96138 – Neurocognitive Test Administered by a Technician
Minimum time: 16 minutes
Time may include:
Adding or confirming the patient in the BrainCheck platform
Introducing and explaining BrainCheck to the patient
Reviewing testing best practices
Active patient testing time
Providing assistance during testing
Completing documentation related to test administration
96132 – Test Interpretation and Medical Decision-Making
Minimum time: 31 minutes
Time may include:
Reviewing relevant medical history and records, including recent AWVs
Reviewing and interpreting test results
Medical decision-making and treatment plan updates
Documentation and reporting
Communicating results to the patient, family, or caregivers
Documentation Requirements
Required for 96132
Reason for testing
Tests administered (for example, Trails A/B, Stroop)
Test results and interpretation
Recommendations and interventions
Diagnosis or ruled-out diagnosis
Summary of feedback provided to the patient and/or caregivers
Total time spent
Required for 96138 and 96136
Medical reason for testing
ICD-10 code
Total time spent with the patient
Tip: If you are not using EHR integration, the Download Report feature in the Assess report can help cover many documentation requirements and save time.
Medicare Annual Wellness Visits (AWV)
BrainCheck administration codes (96136 or 96138) may be billed on the same day as an AWV
Test interpretation and MDM (96132) should be performed and billed at a separate visit from the AWV
ICD-10 Code Guidance
Use specific ICD-10 codes whenever possible
Avoid general or unspecified diagnosis codes to reduce the risk of claim denials
Who Can Bill 96132
The following provider types may bill for test interpretation and medical decision-making:
Physicians
Doctoral-level clinical psychologists
Clinical nurse specialists
Nurse practitioners
Physician assistants
Special Billing Scenarios
Hospice Patients
Modifier GV is required when billing BrainCheck for a hospice patient using the hospice diagnosis
Modifier GW is required when billing with a diagnosis unrelated to the hospice condition
Telehealth
Modifier 93 is required when billing 96136 or 96138, and 96132 via audio only.
Modifier 95 is required when billing 96136 or 96138, 96132, and required for 99483 via audio + video.
Claim Denials Review
If a claim is denied, follow these steps:
Self-review
Confirm ICD-10/medical necessity documentation, CPT time requirements, complete paperwork (10 care plan components required), and prior authorization if applicable.
Audit: Review the claim against the Billing Audit Checklist.
Escalate: Upload the rejection notice to eBridge and email support@braincheck.com for guidance. Note: audit checklist must be completed first — we cannot process or reprocess claims on your behalf.
Important Disclaimer
Billing rules vary by payer, state, and region. BrainCheck recommends confirming requirements directly with each insurance payer before submitting claims.