The Cost of an Evaluation

Psychological evaluations (this term will be used in this article to encompass evaluations for psychological, neuropsychological, learning disorders, and developmental disorders) involve administration of applicable tests, scoring the tests, and interpretation of tests;  our team then writes a comprehensive report to describe and summarize this information.  Thus, our invoices will typically note a 3-day range of service.  The first day or days will be the day/s you were in the office to complete the testing.  The next two days represents the time we spend scoring, interpreting, and writing the report for testing. 

The vast majority of our clients use insurance to help pay for the cost of their evaluation.  Insurance companies and the thousands of insurance plans that exit all differ in their coverage of psychological evaluations.  Some may not cover the cost of psychological evaluations; however, it has been our experience that most insurance companies include psychological evaluations as a covered benefit. To gain clarification regarding your insurance plan’s coverage of psychological evaluations, call your insurance company to ask the following questions:

·      How Much Does it Cost for A Mental Evaluation? Is the cost of psychological testing covered? (Some companies will ask what CPT codes the evaluator is requesting.  You can tell them: 96130, 96131, 96132, 96133, 96136, 96137.  These codes cover both psychological and neuropsychological testing)

·       Is there a deductible that needs to be met before insurance will cover costs?

·       What portion will be reimbursed, what exactly will be my financial responsibility?

·       Is a referral needed from a primary care physician?

·       Is pre-authorization required? If yes, many insurance plans have medical necessity criteria that will need to be satisfied for the insurance company to authorize payment for testing.

It is important to understand the answers to these questions before you proceed with psychological testing.  This will ensure that you know exactly what cost you will be responsible for once the evaluation has concluded. Once our team finishes writing your evaluation report, we will submit a bill to your insurance company. It may take your insurance company anywhere from 2 weeks to 3 months to communicate with our practice to let us know how much we need to collect from you for the evaluation.  Thus, you may not receive an invoice from our practice for up to 4 months given the timing of your insurance company.

Also, please be aware that many insurance companies do not cover testing for ADHD or learning disorders.  Each insurance company’s justification for why they will not cover testing for those disorders is different; be prepared for a possible denial in authorization for testing.  

Information regarding our cash prices for evaluations (not covered by insurance) is available upon request. We are in-network for the following insurance companies: Medicaid, Medicare, Cigna, United, BCBS, Aetna, Tricare, Tri-West, CCHA, ComPsych, and Colorado Access.

About Ryan Cole