Neuropsychological and Psychological Assessments: A Step-by-Step Overview of The Testing Process

Deciding whether neuropsychological testing is the right choice for you can be a complex process. You might be curious about the assessment process, how long it takes, how to find diagnostic services near you, and the potential costs. Most importantly, you might be wondering how these services can assist you. To address these concerns, we’ve compiled a list of 15 key facts about neuropsychological evaluations to arm clients with the right information so you can feel at ease knowing what to expect and how to maximize the benefits of the testing experience.

Understanding Neuropsychological Testing 

These comprehensive assessments are conducted by skilled professionals to measure an individual’s cognitive abilities in areas such as memory, attention, concentration, and language. Such evaluations are crucial for identifying the root causes of specific issues and providing a credible diagnosis for these underlying problems..

The results of the assessment are compiled into a detailed diagnostic report. This report aids your therapist or specialist physician in determining the most suitable treatment option for you. The administered protocols measure brain function and provide a valuable baseline for understanding an individual’s cognitive abilities. They are instrumental in helping clinicians understand what is happening in the brain and why a person may be experiencing certain symptoms.

The Purpose of a Neuropsychological Evaluation

Evaluations are advised to gain a holistic grasp of a person’s cognitive and behavioral characteristics. They are particularly beneficial for individuals grappling with conditions like bipolar disorder, traumatic brain injury, cognitive disorders, autism spectrum disorder, Parkinson’s disease, learning disability, or other degenerative disease. Such an evaluation is crucial in discerning the distinctive array of cognitive strengths and shortcomings. When performed by skilled and qualified health care professionals, these assessments lay the foundation for a personalized treatment plan. Moreover, the diagnostic report can be shared with other health care professionals, further enhancing the scope of the outlined treatment recommendations.

The in-depth assessment can:

1. Aid in making a differential diagnosis: This assists in determining if observed mental and behavioral changes are directly linked to the movement disorder, mental health conditions like depression or bipolar disorder, other neurological issues, or are side effects of treatment.

2. Guide pre-and post-neurosurgical procedures evaluations: The results of the evaluation can provide valuable insights into whether a treatment, such as deep brain stimulation, is suitable for an individual. Moreover, it can shed light on how the treatment has influenced mental functions and behavior.

3. Establish a reference point for future evaluations: The baseline evaluation helps doctors and healthcare professionals understand if there is any decline in functioning due to disease progression or document any changes, for better or worse, resulting from certain interventions such as medication, surgical treatments, or deep brain stimulation (DBS).

4. Identify areas of daily life needing assistance: The evaluation can highlight daily tasks, like financial management, where the patient might need help. It also helps determine the rehabilitation potential of the individual, evaluating whether they might benefit from cognitive or behavioral treatments to boost cognitive functioning, occupational therapy, or a specific pharmacotherapy plan.

A neuropsychological assessment provides critical insights into cognitive and behavioral aspects in individuals with conditions such as Parkinson’s disease, Alzheimer’s disease, and other developmental disabilities. Through detailed assessment and analyses of medical history, the medical team can derive vital information on optimal treatment approaches or in detecting potential brain tumors.

Administering Neuropsychological Tests: Duration and Method

A thorough neuropsychological evaluation typically takes between two to five hours to complete. However, the process can extend up to eight hours or even span multiple sessions, based on the complexity of the patient’s condition and the issues to be addressed. Factors such as fatigue, confusion, and motor slowing can lengthen the evaluation time.

The ultimate aim of the clinician is to ensure that the evaluation captures the patient’s best possible performance under ideal conditions. Thus, it’s a thorough process meticulously conducted to yield the most accurate and beneficial results.

What Motivates People To Seek Neuropsychological Testing Services?

Individuals might be motivated to seek testing services for several reasons:

• Diagnostic Clarification: If someone has symptoms that might suggest a neurological or cognitive disorder, the service can provide a clearer understanding of the issue. This could be particularly helpful in cases where symptoms might overlap between different conditions, making it difficult to identify the underlying problem.
• Treatment: Testing can help determine the best course of treatment for various cognitive or mental health conditions. It provides detailed information about an individual’s cognitive strengths and weaknesses, which can be used to tailor treatment plans to their specific needs.
• Progress Tracking: For individuals already diagnosed with a cognitive or neurological condition, testing can be used to track the progress of their treatment or to monitor the course of their condition over time.
• Educational and Occupational Accommodations: The results can be used to qualify individuals for certain educational or occupational accommodations. This is particularly relevant for individuals with conditions like ADHD or learning disorders.
• Legal Reasons: In some cases, testing might be required for legal purposes, such as determining someone’s competence to stand trial or to make certain legal decisions.
• Research Participation: Individuals might also seek an assessment if they’re interested in participating in research studies related to cognitive or neurological conditions.

To illustrate the entire process visually please take a look at our neuropsychological testing graphic below:

Who Performs Neuropsychological Evaluations?

Neuropsychologists are trained professionals who specialize in assessing and treating people with brain injuries and other neurological disorders. They have undergone extensive specialized 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, along with the DSM manual, to determine and diagnose the root cause of symptoms. They also use this information to guide the correct treatment plan through therapy or recommendations to other specialists. A psychologist with access to a vast network of trusted local medical professionals should always be the preferred choice.

Examples of Neuropsychological Assessment Instruments

1. Common Neuropsychological Tests:

• Stroop Color and Word Test

• Controlled Oral Word Association Test (COWAT)

• Wisconsin Card Sorting Test (WCST)

• Ruff Figural Fluency Test

• Hooper Visual Orientation Test

• Judgment of Line OrientationRey Osterrieth Complex Figure (RCFT)

• Trail Making Test (TMT)

• Grooved Pegboard Test

• Boston Naming Test

• Delis-Kaplan Executive Functioning System (D-KEFS)

2. Cognitive Assessment Instruments:

• Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV)

• Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV)

• Differential Abilities Scale – Second Edition (DAS-II)

• Stanford-Binet Intelligence Test – Fifth Edition (SB-V)

3. Academic Achievement Test Batteries:

• Scholastic Abilities Test for Adults (SATA)

• Wechsler Individual Achievement Test – Third Edition (WIAT-III)

• Comprehensive Mathematical Abilities Test (CMAT)

• Kaufman Test of Educational Achievement – Second Edition (KTEA-II)

• Woodcock-Johnson Tests of Achievement – Fourth Edition (WJA-IV)

• Gray Oral Reading Tests – Fifth Edition (GORT-5)

• Nelson Denny Reading Test – Forms G and H

• Gray Silent Reading Test (GSRT)

4. Visual Motor Skills Evaluation Tools:

• Test of Visual-Motor Integration

• Test of Motor Coordination

• Test of Visual Perception

5. Psychological Process Testing Instruments:

• Wide Range Tests of Memory and Learning – Second Edition (WRAML-2)

• Woodcock-Johnson Tests of Cognitive Ability – Fourth Edition (WJC-IV)

• NEPSY-II – A Developmental Neuropsychological Battery, Second Edition

• The Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2)

• Clinical Evaluation of Language Fundamentals – Fourth Edition (CELF-4)

• Comprehensive Assessment of Spoken Language (CASL)

• Delis-Kaplan Executive Functioning System (D-KEFS)

• Test of Problem Solving – Third Edition (TOPS-3)

• Peabody Picture Vocabulary Test, Fourth Edition (PPVT-IV)

• Integrated Visual and Auditory Continuous Performance Test (IVA-CPT)

• Test of Everyday Attention for Children (TEA-Ch)

• SCAN-3 Test of Auditory Processing in Children – Third Edition

6. Behavior Rating Scales:

• Behavior Assessment System for Children-Second Edition (BASC-2) – Parent, Teacher, Child

• Behavior Rating Index of Executive Functions (BRIEF)

• Conners 3 Rating Scales (Parent, Teacher)

7. Adaptive Behavior Assessment Tools:

• Scales of Independent Behavior – Revised

• Vineland Adaptive Behavior Scales

8. Autism Spectrum Disorder Assessment Tools:

• Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)

• Autism Diagnostic Interview – Revised (ADI-R)

• Autism Spectrum Rating Scale

• Social Responsiveness Scale (SRS)

• Social Communication Questionnaire (SCQ)

• The High Functioning Autism Spectrum Screening Questionnaire (ASSQ)

How to Find a Psychological Testing Provider?

Finding a service provider is straightforward, but finding a great provider can be challenging.

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 review 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. Does the provider only see adult patients? or do they hold experience that allows them to see children and teens too? 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. Testing providers confident in their skill set offer quick psychological testing consultation calls to alleviate client worries.

Online sources to find a great psychological testing provider

1. Google: Googling related terms that are near will provide you with a good list of providers in the local area. Narrow that list down to a list of 5-10 providers and give them a call. Ask them the same questions and visit their websites! This will help target your list and get on a schedule with a provider that’s the best fit for you and one that you trust the most.

2. Your Doctor

3. Psychology Today

4. Yellow Pages

5. Friends and Family

How Long Does a Full Neuropsychological Evaluation Take To Complete From Start To Finish ?

It’s crucial to understand that while the testing process is not invasive, it is not swift either. It requires a considerable investment of time and effort.

Psychologists 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 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 neuropsychological assessment, if done the right way, takes approximately 12-15 hours to complete and is spread across 3 appointments.

Appointment #1 – Intake: This is also referred to as the initial evaluation where the psychologist gathers background information and medical history 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 be in 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 and effective treatment recommendations. 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 treatment recommendations.

Neuropsychological exams 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 intimidating.

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 Exam Be Done Virtually Using A Telehealth Platform?

To attain a comprehensive understanding of your brain’s functioning for an accurate diagnosis, these tests must be conducted in person.

Thus, it’s not ethically feasible to carry out these evaluations through telehealth or teletherapy platforms. The psychologists must be physically present in the same room. Some clinics may propose online alternatives, but it’s important to realize that these are not authentic neuropsychological assessments. Instead, they often use screening tools to formulate educated estimations. While these may be more affordable, please note that they are not officially acknowledged as the formal tests and procedures administered during a proper psychological evaluation.

What Tests Are Commonly Used During A Psychological 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 Assessment.

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 consider 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:

• ADHD: Attention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that causes inattention, hyperactivity, and impulsiveness.

• 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.

• 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)

• Traumatic Brain Injury

• Spinal Cord injury or Head Injury

• Neurodegenerative diseases: Like Alzheimer’s disease and Parkinson’s disease

• Genetic Disorders

• Emotional Issues

• Neurodevelopmental Disorders

• and other conditions per DSM criteria!

How Much Do Neuropsychological Assessments Cost

The cost of neuropsychological testing can vary significantly 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. Depending on the level of detail and time spent on your assessment, out-of-pocket private pay costs will be in the $1,500-$5,000 range. If your provider is not in-network with your insurance carrier, they may provide you with a superbill invoice for out of network credit from your carrier.

Potential 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.

Costs without 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 Cover 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)

How To Pay For Psychological Assessment 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!

What Does a Neuropsychological Report Look Like?

This is a question that clients ask often. To help clients understand the process better we provided a complete redacted example of a neuropsychological report.

In conclusion, 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.  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.