Does insurance cover a neuropsychological evaluation for children and adults?

We currently accept most insurance plans. Generally, insurance will cover evaluations if deemed medically necessary. Neuropsychological assessment is usually covered if your child is having learning or behavior problems and has a history of brain injury or has a current medical problem that may be affecting brain development. Most insurance plans will deny coverage for assessment used to establish an educational diagnosis. As a courtesy, we will file your primary claim with your insurance company. However, insurance companies do not guarantee coverage despite what is stated to us at the time of verification. 

 

You can always verify coverage with your insurance company independently if this is of concern, as you are ultimately responsible for any uncovered charges.

CPT Codes used for neuropsychological evaluation: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139 and also sometimes 90791, 96130, 96131. 

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Neuropsychological assessment is usually covered for adults when there is a concern about memory loss, attention problems, or any changes in cognitive functioning. These can occur after brain injuries/concussions, strokes or heart disease (such as heart attacks), or when there is a family risk of dementia/Alzheimer's disease. Most often, your primary care physician or your neurologist will refer you to see us and we will obtain the necessary authorization from your insurance company before your testing appointment. Sometimes, we may need additional information from you or your physician to obtain this authorization, so we may request records from you other medical providers. 

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We also accept private pay if you are paying without insurance. Payment is due at the time of the exam. 

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