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Same-Day Texas CANS 2.0 Assessments and Psychological and Neuropsychological Testing for STAR Health

Date: 06/25/21

Please note: This article is an update to the previous article. Same-Day Texas CANS 2.0 Assessments and Psychological and Neuropsychological Testing for STAR Health, posted on April 29, 2019.

Superior HealthPlan, the Department of Family and Protective Services (DFPS), Texas Health and Human Services (HHS) and a group of psychologists discussed the intent and provision of the Texas Child and Adolescent Needs and Strengths (CANS 2.0) Comprehensive (Child Welfare) Assessment and psychological or neuropsychological testing. This discussion was to ensure clarity and consensus on how these different services should work together within the STAR Health program. This communication provides that clarification, including requirements for the appropriate provision of the CANS 2.0 Assessment, as well as other medically necessary psychological and neurological testing services.  

Effective June 1, 2019, a CANS 2.0 Assessment (CPT 90791, Modifier TJ) and Psychological or Neuropsychological Testing Evaluation (CPT 96130-96133), and/or Test Administration and Scoring (CPT 96136-96139) services should not be provided on the same day.

If both are billed on the same day, the testing evaluation(s) and/or test administration and scoring will be denied with a request for documentation to substantiate the appropriateness of the psychological or neuropsychological testing performed on the same day as the CANS 2.0 Assessment. Please see below for directive and guidance regarding expectations of the requests for, and provision of, the CANS 2.0 Assessment and ‘same-day’ psychological or neuropsychological testing.

When should a CANS 2.0 Assessment be performed?

The CANS 2.0 Assessment is meant to be the uniform screening tool for all children entering foster care. The CANS 2.0 Assessment should be completed for every child 3-17 years of age who is in DFPS care. The initial assessment should be completed within 30 days of a child entering into foster care and then re-administered annually thereafter.

What are the required elements of a CANS 2.0 Assessment?

  • Presenting problems, if any.
  • Prior mental health or substance use disorder diagnoses and any prior treatment (included in the Clinical Impressions or background needs narrative section of the CANS 2.0 Assessment).
  • Other pertinent medical, social and family history (a CANS 2.0 Assessment rater could create a comments box for the section or include in the Background Needs section).
  • Results of mental status examination, if indicated, and clinical observations (included in the Clinical Impressions section of the CANS 2.0 Assessment).
  • Recommendations, including expected long-term and short-term goals.

When should psychological or neuropsychological testing be provided?

Psychological or neuropsychological testing evaluation and/or test administration and scoring should not be considered a uniform or required assessment for all children and youth in foster care. If those services are needed, they should be scheduled after the completion of the CANS 2.0 Assessment.

A child’s placement or move to a new placement should not be uniformly dependent upon psychological testing being completed. However, these services could be necessary to address emergent symptoms, treatment complications or complex placement decisions, such as when a youth requires a more structured environment or is ready to move to a less restrictive setting.

Psychological or neuropsychological testing should be completed for children and youth who are identified as having a specific need for further evaluation that is necessary to help determine their plan of care. For example, if there is indication or concern that the child or youth has intellectual or other developmental disabilities, then psychological testing may be an appropriate next step after completion of the CANS 2.0 Assessment.

Are there any exceptions which allow CANS 2.0 Assessment and psychological or neuropsychological testing to be completed on the same day?

There may be exceptions when it is in the best interest of the child to have both an initial CANS 2.0 Assessment and psychological or neuropsychological testing evaluation completed on the same day. A provider must contact Superior for authorization for these exceptions to ensure that claims billed are appropriately and timely reimbursed. A few examples of exceptions that will be honored and reimbursed for authorized services are listed below:

  • Court orders requesting psychological or neuropsychological testing evaluation on the same day as the CANS 2.0 Assessment.
  • Indication or concern of an intellectual or developmental disability that should be addressed immediately.

For questions or more information, please reach out to your dedicated Account Manager or contact Provider Services at 1-877-687-1196.