Is Neuropsychological Testing Covered by Insurance?

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Is Neuropsychological Testing Covered by Insurance?

Yes, neuropsychological assessments may be covered by your insurance provider, but this may depend on the type of test and your specific insurance coverage. Depending on the diagnosis, certain health insurance companies will cover a portion of neuropsychological testing. Any policy copays, coinsurance, and deductibles still apply with insurance coverage for neuropsychological evaluations.

A neuropsychological assessment is usually necessary when your memory or reasoning appears to have changed. Early cognitive deficits can be reliably identified and distinguished from normal aging using neuropsychological testing.¹

Your doctors will use various standardized tests to evaluate multiple cognitive processes, including reasoning, executive functions, memory, attention, language, perception, sensorimotor control, motivation, mood and personality, and quality of life.²

Test results help doctors identify which of the following might be the root of your problems:³

• Diseases such as dementia, multiple sclerosis, or Parkinson’s
• Traumatic brain injury
• Emotional illnesses like anxiety or depression
• Normal aging-related alterations to the brain

How to Verify Insurance Coverage for Neuropsychological Testing

With multiple mental health offices in Tennessee, Athena Care is in-network with most major insurance plans. To determine your insurance coverage for neuropsychological assessments, call your insurance company or contact us below. One of our care coordinators can help you navigate your insurance coverage and get the care you need.

Rather than dealing with the headaches of calling your insurance provider for more details about insurance benefits for mental functioning assessments, allow our highly qualified care coordinators to do it. A care coordinator will review your insurance and thoroughly explain your options. Rest assured that all information shared and discussed remains confidential.

Requirements, Eligibility & Process

Most insurance coverage for mental functions testing exists if it is medically required for a diagnosis. Therefore, most insurance companies won’t cover neuropsychological testing in cases of attention and learning issues. In addition, some insurance companies won’t cover a neuropsychological test if you have undergone a similar assessment within the past twelve to twenty-four months.

If you are told that you have insurance benefits for neuropsychological testing, it’s important to inquire whether or not you’ll need a pre-authorization. Many insurance policies require a note from your doctor stating that neuropsychological testing is “medically essential.” In other words, the doctor requests more expert examinations to offer the most appropriate medical care.

In some instances, getting the insurance company to agree to cover these treatments can be facilitated by a medical doctor referring a patient for a neuropsychological evaluation and framing the request as “medical.”⁴

Referrals for neuropsychological testing that are expressly worded to achieve one or more of the following referral goals are most frequently covered:

• Diagnostic clarification
• Evaluating treatment outcomes
• Creating approved treatment planning

It’s also essential to determine if the providing psychologists are in-network or out-of-network, as this can also affect insurance coverage for mental health conditions.

Your insurance coverage for neuropsychological assessments, the tests carried out, the complexity of your case, the time required, where you live, and other factors will affect the final cost.

In addition, there are various CPT codes listed on the final billing, which describe the type of screening and assessment used in your evaluation. For example, 91605 refers to an aphasia assessment. These codes will also affect the final cost.⁵

How Much Do Neuropsychological Assessments Cost Without Insurance?

Neuropsychological testing services can cost anywhere from $700 to more than $3,000 on average. Furthermore, a private session may cost $200 to $300 per hour.⁶