15 Truths About Neuropsychological Testing and What To Expect
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There are many things to consider when deciding whether neuropsychological testing is right for you. You may wonder how the assessment process works, what’s involved and why there are so many evaluation variables. In addition, you may be concerned about the cost of neuropsychology services and most of all, how they can help or not help in your situation. To answer these very questions, we’ve compiled a list of 15 informative truths about neuropsychological evaluations that our clients have expressed concerns about or asked specific questions about. With the right information, clients and patients can feel comfortable knowing what to expect and get the most out of the testing experience.
What is Neuropsychological Testing?
Neuropsychological testing is a process by which a trained professional can evaluate an individual’s level of functioning in these main areas: memory, attention and concentration, and language. Neuropsychological tests are often used to determine the root cause of identifiable issues and to provide an accurate diagnosis.
The results of the assessment are compiled in a lengthy diagnostic report which ultimately helps your therapist or specialist physician determine what type of treatment option is best for you. And because neuropsychological tests are designed to measure brain function, it serves as a healthy baseline and allows an individual to get to know themselves or a loved one at a granular level. It’s an important tool in helping clinicians understand what is happening in the brain and why a person may be experiencing certain symptoms.
Why is Neuropsychological Testing Recommended?
Neuropsychological testing is one of the most common assessment methods used in clinical psychology. Neuropsychologists use this type of testing to understand how the brain works and how it can be impacted by injury, illness, or disease.
Neuropsychological tests can be administered as part of a comprehensive evaluation or as a standalone test. Their purpose is to help determine how well a patient is functioning in their daily life, what areas need improvement, and what treatment options are best for them.
Neuropsychological testing measures a variety of cognitive skills including:
Attention: How well someone focuses on tasks and keeps track of information
Memory: How well someone remembers information and events that have happened to them over time
Executive functions: These are higher-level cognitive skills that control planning and problem-solving, such as organizing tasks and remembering important details while working on projects.
The results aren’t always clear-cut. Even though neuropsychologists try their best to interpret them accurately, they don’t always agree with each other about what they mean — or whether there are any problems at all. This is why finding a competent and experienced clinician is extremely important. Not all assessments are equal and getting on the schedule with an accomplished and skilled clinician is key.
Who is Qualified To Perform a Neuropsychological Evaluation?
Neuropsychologists are trained professionals who specialize in assessing and treating people with brain injuries and other neurological disorders. They have gone through extensive training in psychology and have taken courses in neurology as well.
Neuropsychologists and Psychologists are not medical doctors; they do not diagnose or treat physical illnesses or injuries. Instead, they use their knowledge of psychology and neurology coupled with the DSM manual, to determine and diagnose the root cause of symptomology; they also use this information to help guide the correct treatment plan through therapy or recommendations to other specialists. A psychologist that holds access to a vast network of trusted local medical professionals should always be the preferred choice.
How to Find a Great Neuropsychological Testing Provider?
Finding a provider to get neuropsychological testing completed is easy, but finding a good provider to get an evaluation can be difficult.
The first step to finding a good provider is to ask around. Ask friends, family members, or co-workers if they have ever used a provider before and what they thought of them. You can also search online reviews sites such as Yelp or Google Reviews to see what others say about their experiences with different providers.
One thing that you may want to consider when searching for a provider is whether or not they have experience with the population that fits your criteria. Most great providers will provide as much information as they can to their clients through their websites or over the phone. If possible, try to meet with your professional before agreeing to any type of test being performed on yourself or a loved one. This will allow you both time to get comfortable with each other before starting any type of testing process. A quick paid consultation call can alleviate some of your worries.
When searching for an excellent provider use the roadmap and sources below:
Online sources to find a great psychological testing provider
1) Google: Googling terms such as “Neuropsychological testing near me” will provide you with a good list of providers in the local area. Make a list of 5-10 providers and give them a call. Ask them the same questions and visit their websites! This will help narrow down your list and get on a schedule with a provider you trust the most.
2) Your Doctor
4) Yellow Pages
What are some red flags when seeking a psychological assessment provider?
If you’re looking online for providers, there are several red flags to look out for:
1. Fuzzy or incomplete information on their websites or social media accounts. This shows poor attention to detail.
2. Lack of information on their website and over the phone. Unable to answer basic questions or provide a concrete outline of their process.
3. Lack of transparency around insurance. Providers who take insurance make no guarantees of payment by the carrier. Although most view this as a bad thing, it’s not. Who would you want to work with? A provider that makes no mention of a claim denial (which results in surprise bills) or one who tells you the truth from the start?
How Long Does a Full Neuropsychological Testing Take to Complete?
Neuropsychological testing is not a quick process, it’s a process that takes time and effort. Neuropsychologists must gather information from several sources, including the client, their family, and other medical professionals who may have seen the person before. It takes many hours of involved clinician time. The length of time it takes for neuropsychological testing varies depending on how many tests are administered and how quickly an individual responds to tasks. Tests can take anywhere from one hour to several days depending on how many neurocognitive batteries need to be administered. Typically on average a full (not a partial) neuropsychological assessment, if done the right way, takes approximately 12-15 hours to complete and is spread across 3 or more appointments.
Appointment #1 – Intake
This is where the psychologist gathers background information on the client. This is a very important step and it’s advised that the client prepares to answer all questions truthfully and in detail. The intake usually lasts about an hour.
Appointment #2 – In-person testing
Expect to come into the office for approximately 4-7 hours. Once the client is done with the administration of the battery, the psychologist will begin back-end analysis and report production
Protocol Analysis and Diagnostic Report Production
This is an extremely important step and could take just as long to complete as the in-person testing. A good psychologist will score and analyze all the information to make an accurate assessment of the client to produce an accurate diagnosis. Report production can take as little as 3 business days (if the clinician is working around the clock) or 6 weeks and possibly longer (if they’re waiting on insurance claims to process).
Appointment #3 – Feedback
Once the diagnostic report from your neuropsychological assessment is produced, the client is encouraged to schedule their last appointment in the series so that your psychologist can go over the results, answer all your questions, and clear up any confusion about their recommendations.
Neuropsychological testing can be a nerve-wracking experience, especially if you don’t know what to expect. After all, it involves being in a room with someone who’s asking you to do things you’ve never done before — and that can be scary.
But it doesn’t have to be that way. If you know what to expect during the test and how long it will take, then you’ll feel more confident and relaxed when you’re there.
Can Neuropsychological Testing Be Done Virtually Using A Telehealth Platform?
Neuropsychological testing is the only way to get a complete picture of your brain health and make an accurate diagnosis. Therefore it is not possible to complete these via telehealth or teletherapy platforms. The psychologists must be physically in the room. Some clinics are starting to offer online versions, but beware, these are not neuropsychological assessments and instead, screeners are used to making an educated guess. They may be much cheaper, but know that they’re not officially recognized as the batteries and protocols administered during a psychological evaluation.
What Tests Are Commonly Used During A Neuropsychological Assessment?
The tests or protocols used in a neuropsychological assessment will vary depending on the symptoms you are experiencing and the designed clinician battery.
Neuropsychologists commonly use the following tests:
Cognitive assessments – These tests measure specific areas of cognition (thinking skills) such as attention, memory, and language.
Memory assessments – Memory tests measure how well someone recalls information they have learned over time. They often involve recalling lists of words or pictures and comparing them with similar lists later on.
Executive function assessments – Executive function includes planning, organizing, and regulating behavior such as delaying gratification or controlling impulses. Tests of executive function often involve making quick decisions while ignoring distractions and remembering how choices were made.
Behavioral assessment: This is an evaluation of how well an individual interacts with others, including their social skills and their ability to control impulsive behaviors.
Personality assessment: This is an evaluation of how an individual behaves when interacting with others in different situations.
Attention Tests – Measure your ability to pay attention and focus on tasks.
Language Tests – Assess your ability to use words and understand what others say.
Visuospatial Skills Tests – Evaluate how well you see objects in three dimensions (3D) or two dimensions (2D).
How To Prepare For A Neuropsychological Testing Appointment.
Truthfully, there is no way to study or prepare yourself for what is to come. This is done by design. The best thing anyone can do to prepare themselves for their in-person appointment is to get plenty of rest the night before. If you’re traveling a long distance to your appointment, you should get lodging the night before. Adequate sleep, hydration, and a healthy breakfast are key.
What Conditions Are Diagnosed By Neuropsychological Assessments?
The following conditions are commonly diagnosed via neuropsychological testing:
ADHD: Attention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that causes inattention, hyperactivity, and impulsiveness. A neuropsychological assessment can help identify ADHD and determine the severity of symptoms.
Autism Spectrum Disorder (ASD): ASD is a group of developmental disorders characterized by difficulties with social interaction, verbal and nonverbal communication, and repetitive behaviors or interests. A neuropsychological assessment can help diagnose ASD and determine if there are any cognitive differences among individuals on the spectrum.
Learning Disabilities: Learning disabilities affect people differently from one another; however, they all have some sort of difficulty processing information through their senses (vision or hearing), understanding spoken language
Language disorders or speech disorders (SLDs)
Cognitive developmental delay (CDD)
Brain injury or head trauma
Neurodegenerative diseases like Alzheimer’s disease and Parkinson’s disease
and other conditions per DSM criteria!
How Much Does A Neuropsychological Testing Cost?
The cost of neuropsychological testing varies widely based on several factors, including the type of tests and time involved, if insurance is involved, and the demand for a highly sought-after experienced clinician. Clients must remember that there aren’t that many clinicians out there that specialize in testing services and the ones that are great at what they do are usually scheduled out for many months in advance.
Neuropsychological testing costs when insurance is involved
Factors driving the price when carriers are involved are contracted rates, deductibles, and out-of-pocket maximums. Almost all carriers have different contracted rates for the service, some may pay $150-200 per hour, while others may reimburse a provider at a much lower scale. This is the main reason why many providers are in-network with just a few carriers or none at all.
Neuropsychological testing costs when a provider doesn’t take insurance
Again this all depends on many factors but one thing is certain, excellent clinicians don’t discount their work. The good news is, that you can still get credit for the service even if you pay out of pocket! In instances when a client has insurance but the provider is not in-network, the provider can supply the client with a superbill invoice. The client then is equipped to submit the reimbursement invoice to their carrier for credit against the client’s out-of-network portion of their benefit plan.
Typical private pay out-of-pocket hourly rates will be in the $150-275 range, sometime, even more, when expedited testing services are requested.
Total costs for a full neuropsychological evaluation will hover in the $2,500-5,000 + dollar range.
Do Insurance Carriers like Blue Cross Blue Shield Cover Neuropsychological Testing Services?
This is quite a loaded question and the answer is not so clear cut. If we’re being honest, the answer is both a Yes and No. Let us explain.
As the provider verifies the benefits with a carrier, they provide the insurance representative with the billable CPT codes for the service. The rep will let the provider know if the service is a covered benefit and if there is a deductible that applies. Some plans may require pre-authorization before an appointment and this may result in the carrier denying the service leaving the client to pay out of pocket.
In addition, insurance companies never guarantee payment to the provider until the claim is filed. It sounds crazy but it’s true! There are instances where a carrier can deny the claim after they confirm that the service is a covered benefit under the client’s plan.
It is extremely important to find a provider that is transparent about all these possible outcomes and it is equally as important to make a financial commitment to your provider in any event of a claim taking the wrong turn. As a client, you must understand that the service contract is between you and the provider and not between the insurance carrier and the provider. The contract between the carrier and provider, only dictates the actual rate, payment on the other hand as you can see, is unfortunately never a guarantee.
How much do insurance cover and pay for neuropsychological testing?
The amount your carrier will cover for your neuropsychological assessment will range between 0-100%. This will all be driven by your plan’s contract and how your carrier processes the claim. If you have a deductible that applies, you can expect to pay the full contracted rate for the service. If you have a coinsurance portion, expect to pay the coinsurance percentage while the carrier covers the rest. Common coinsurance % range anywhere from 10%-50%
How to get insurance to pay for neuropsychological testing?
The best way to have insurance pay for testing services is to verify that it’s a covered benefit. Clients can easily do this by calling member services at the number located on the back of the card and providing them with the billable CPT codes for the services. It is highly advisable to document this call by writing down who you spoke to, the date/time of the call, and the details of the call. But always remember, there is absolutely no guarantee provided by your carrier to your provider.
What CPT Codes Do Providers Use When Billing For Neuropsychological Testing Services?
The CPT testing codes and the explanations that most providers use to bill for neuropsychological testing services are below, these are codes you should be providing to your insurance company when calling member services.
The CPT codes below and their descriptions were obtained from the APA.
90791 – Intake
96130 – Psychological testing evaluation services by a physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96131 – Add on, Each additional hour (List separately in addition to code for primary procedure)
96132 – Neuropsychological testing evaluation services by a physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96133 – Add on, Each additional hour (List separately in addition to code for primary procedure)
96136 – Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes
96137 – Add on, Each additional 30 minutes (List separately in addition to code for primary procedure)
96138 – Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
96139 – Add on, Each additional 30 minutes (List separately in addition to code for primary procedure)
90837 – Feedback, Psychotherapy 60 minutes with patient.
To summarize, please provide them with the following and ask if this is a covered service. 90791, 90837, 96130, 96131,96132, 96133, 96136, 96137, 96138, and 96139. Please note that not all codes will be billed, but typically there will be a combination on some of the above in various quantities.
How Pay For Neuropsychological Testing Services When There’s No Insurance or Your Provider is Out-of-Network?
Neuropsychological testing services are not cheap service by any means. Clinicians spend years in school and even longer in practice to gain expertise and hone their skills. When it comes to affordability however there are a few different options.
1) Care Credit – if your provider is in their network, Care Credit will allow you to pay your provider and then select from a number of various repayment plans. They make it nice and affordable with flexible terms.
2) Credit Cards – Be sure to have a game plan for paying down the balance as soon as possible. Some cards have extremely high interest rates when the balance goes unpaid!
Neuropsychological testing is a valuable tool for both patients and medical professionals. It can help patients by empowering them to make sound, well-informed decisions regarding their healthcare and treatment. Although it might be difficult to decide on who you want to work with and who will benefit you the most. A lot of companies can boast about the experience they have, but only a few can truly deliver accurate diagnostic results by doing everything that needs to be done. If this is something that concerns you, just review these eighteen truths about neuropsychological testing services and things might become clearer in your mind as to how to proceed. With the information that we have provided you here, you will be able to move forward with confidence and find the provider that fits your requirements and delivers the service you deserve.TC
Dr. Kat Lewitzke PsyD LP is a licensed clinical psychologist practicing in the State of Michigan. She has a private practice specializing in psychological testing and therapy services for children, teens, and adults. She is the host of the Psych Confidential Podcast which is available on all platforms such as Apple, Spotify, and Amazon.