Medicare coverage is determined by the Centers for Medicare and Medicaid Services (CMS); if a coverage determination has not been adopted by CMS, this policy applies.
Neuropsychological tests are usually performed to evaluate neurological or neuropsychiatric disorders such as traumatic brain injury and brain concussion, multiple sclerosis and cerebral vascular accidents. The results often provide valuable information about the patient's neurocognitive functioning. Neuropsychological tests are also designed to evaluate a member's ability in concentration, memory, reading, comprehension, judgment, and ability to interpret and process information. Visual perception, movement, coordination and a psychological profile may also be performed. These tests make up a part of the overall medical evaluation, and the results aid in the development of a treatment plan.
Psychological tests are designed to measure a member's level of intelligence, personality, academic function and/or dimensions of psychopathology and attitudes and behavior. These tests make up a part of the overall evaluation process with results aiding in diagnosis and development of a treatment plan.
Neuropsychological and psychological testing coverage
Neuropsychological testing is covered as a medical benefit. Prior authorization is not required for participating providers. Its purpose is to identify cerebral dysfunction manifesting as behavioral, cognitive or emotional difficulties, and so it is used predominantly for medical-surgical or comorbid conditions. See policy for details.
Psychological testing is covered by the member's behavioral health benefit when medically necessary. Prior authorization is not required for participating providers. See policy for details and limitations.
Neuropsychological and psychological testing authorizations
Prior authorization is not needed for neuropsychological or psychological testing as part of a pre-surgical or pre-medical program if the associated medical services have been prior authorized.
Neuropsychological and psychological testing billing
See the medical policy for covered and non-covered codes.
- Autism services
- Clinical guidelines
- Coordination of care
- Discharge process
- Electroconvulsive therapy
- Medicaid behavioral health
- Mental health services
- Neuropsych/psychological exams, testing
- Psychological E&M of non-mental-health disorders
- Substance use disorder services
- Transcranial magnetic stimulation