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Blue Cross Blue Shield (BCBS) Neuropsychological Testing Coverage Information For Subscribers and Providers

The use of psychological testing has become increasingly popular as a tool to diagnose and treat mental health conditions. Many insurance plans, including Blue Cross Blue Shield (BCBS), offer coverage for these services. However, it’s important to understand the terms of your policy before seeking out a provider or requesting authorization for psychological testing services.

If you have Blue Cross Blue Shield (BCBS) insurance, you may be wondering if your policy covers psychological and neuropsychological testing services. You’ll want to know what the criteria are for medical necessity if prior authorization is needed, and which CPT service codes providers use when billing for these services. Additionally, if BCBS doesn’t cover your psychological testing, then you’ll need to know what your other options are. In this article, we’ll address these questions and more so that you have a better understanding of how Blue Cross Blue Shield covers psychological and neuropsychological testing services. By the end, you’ll be equipped with all the information you need to understand BCBS coverage for psychological and neuropsychological testing.

blue graphic with white letters that lets the reader know these are common questions about bcbs and psychological testing services with that insurance carrier

BCBS Psychological Testing FAQ Table of Contents

Does Blue Cross Blue Shield Cover Psychological Testing?

When it comes to coverage of psychological testing services, Blue Cross Blue Shield (BCBS) follows the same criteria as other insurance companies. The specific coverage you receive will depend on your particular BCBS policy and the type of psychological testing service being performed. Generally speaking, BCBS will cover some types of psychological tests if they can be medically justified. This means that the testing must be clinically necessary to diagnose and treat a medical condition or injury. Your provider must also document why the testing is medically necessary in order for BCBS to provide coverage for it. In some cases, prior authorization may be required before your provider can bill BCBS for the services. It’s important to note that this applies to both psychological and neuropsychological testing services.

How Do I Find a Blue Cross Blue Shield Provider That Specializes In Psychological and Neuropsychological Testing Services?

If you have a Blue Cross Blue Shield (BCBS) insurance policy and need to find a provider that specializes in psychological and neuropsychological testing services, the best place to start is by searching online for “Blue Cross Blue Shield Psychological Testing Providers”. You can also contact your local BCBS office to ask if they have a list of providers that specialize in these services. Additionally, your provider may have access to resources such as the BCBS Provider Directory or the BCBS Network of Care website, which can help you locate a provider that specializes in psychological testing services.

In addition to searching the BCBS Provider portal, you can also find a provider on Psychology Today or by searching google for “Psychological Near Me”. Please be aware that not all providers in the search results will be able to provide this service to you. Psychological testing is an extremely unique specialty that requires many years of study and practice by the provider. Not only is it difficult to find a provider that is able to conduct a psychological assessment, but finding a high-level provider is even more difficult. 

What Is Blue Cross Blue Shield's Criteria For Medical Necessity?

Blue Cross Blue Shield neuropsychological testing criteria is considered medically necessary only when certain conditions are met. According to the Michigan Blue Cross Blue Shield Website, the psychological testing criteria must meet requirements in two distinct categories which we’ll discuss below. Please note that the criteria below consists of the verbiage used by Blue Cross themselves, any interpretations or questions should be directly addressed with your BCBS subscriber representative, who can be reached by calling the customer service line on the back of your insurance card.

Intensity Of Service – Must meet all of the following:

  1. Testing is administered and interpreted by a licensed psychologist or other qualified mental health provider (as defined by applicable State and Federal law and scope of practice). Technician administered and/or computer assisted testing may be allowed under the direct supervision of a licensed psychologist or other qualified mental health provider. Neuropsychological testing must be supervised and interpreted by a licensed psychologist with specialization in neuropsychology.
  2.  The requested tests must be standardized and have nationally accepted validity and reliability.
  3. The requested tests must have normative data and suitability for use with the member’s age group, culture, primary language and developmental level.
  4. The requested time for administration, scoring and interpretation of the proposed testing battery must be consistent with the time requirements indicated by the test publisher

Service Request Criteria – Must meet all of the following:

  1.  An initial face-to-face complete diagnostic assessment has been completed.
  2. The purpose of the proposed testing is to answer a specific question or questions (identified in the initial diagnostic assessment) that cannot otherwise be answered by one or more comprehensive evaluations or consultations with the member, family/support system and other treating providers review of available records.
  3. The proposed battery of tests is individualized to meet the member’s needs and answer the specific diagnostic/clinical questions identified above.
  4. The member is cognitively able to participate appropriately in the selected battery of tests.
  5. The results of the proposed testing can reasonably be expected to contribute significantly in the development and implementation of an individualized treatment plan.

 

Do I Need a Prior Authorization For Psychological Testing Services With A Blue Cross Blue Shield Insurance Policy?

The answer depends on your particular BCBS policy, the type of test being performed, and the medical necessity of the testing. Generally speaking, your healthcare provider will need to get prior authorization from your BCBS plan before they can bill for these services. This is because some types of tests may be considered expensive or unnecessary, depending on the individual’s medical condition and/or symptoms. In order to receive coverage for psychological testing services under a BCBS policy, your provider must document that the test is medically necessary.

What CPT Service Codes Do Providers Use For Psychological and Neuropsychological Testing?

The last thing to consider when it comes to coverage of psychological and neuropsychological testing services through Blue Cross Blue Shield (BCBS) is the CPT service codes used by providers when billing for these services. Generally speaking, providers use CPT codes to indicate the type of service being provided. It’s important for providers to use the correct CPT code when submitting claims in order to receive appropriate reimbursement from BCBS. In some cases, BCBS may require additional documentation such as diagnosis codes or medical records in order to review and process a claim for psychological testing services. If you have questions about the CPT codes used for psychological and neuropsychological testing services, your provider can explain these in further detail.

We structure all psychological assessments into three distinct appointments and bill a combination of the codes below. If you have a deductible to pay into, expect the contracted rate for the entire service to be in the $2300-$2700 range.

  1. Intake: CPT 90791
  2. Testing, Scoring, Interpretation, and Write-Up will be a combination of the following CPT codes with varying units: 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139
  3. Feedback: 90837

Reimbursement rates go through continual adjustments and will vary by plan and by year. Therefore, the price of psychological testing your provider communicates to you is only an estimate and the final cost is only clear after the claim gets processed by the insurance company. 

What Happens If Blue Cross Blue Shield Doesn't Cover My Psychological Testing?

Finally, it’s important to be aware of the cost-sharing requirements of your Blue Cross Blue Shield (BCBS) insurance policy when seeking coverage for psychological and neuropsychological testing services. If your BCBS plan has a deductible, you may have to pay this amount out-of-pocket before your provider can begin billing for these services. Additionally, you will likely be responsible for any applicable copayments or coinsurance amounts once your deductible has been met. It’s important to understand all of the cost-sharing requirements associated with your BCBS plan so that you can plan accordingly for any expenses related to psychological testing.

If the insurance company denies a claim and does not pay out, the patient is always responsible for paying the medical bill. It is important to carefully review the reasons for the denial of the claim and to consider appealing the decision if you believe it was made in error.

If you are unable to pay the bill, you may be able to negotiate a payment plan with the healthcare provider. You may also be able to seek assistance from charitable organizations or government programs if you are unable to afford the cost of your medical care. It is also a good idea to carefully review your insurance policy to understand the reasons for the denial and to ensure that you are receiving the coverage to which you are entitled.

Your provider should be able to provide you with a detailed estimate of the costs associated with these services prior to beginning any testing. Be sure to ask as many questions as needed so that you can make an informed decision about your care.