Neuropsychological Testing - (EN0258)

Evernorth covers neuropsychological testing only when results will inform clinical decision‑making for patients with documented significant cognitive/behavioral decline and reasonable suspicion of specified CNS conditions (e.g., dementia, TBI/concussion, stroke, CNS infection, demyelinating disease, epilepsy, brain tumor, exposure‑related encephalopathy, autism), and explicitly excludes baseline screening, routine/asymptomatic screening, educational/vocational/academic uses, monitoring without significant change, and computerized tests lacking professional interpretation. Coverage requires detailed clinical documentation (symptoms, timing, suspected diagnosis, prior correction of reversible causes, justification that testing will affect treatment/level of care), testing/interpreting clinician qualifications, and submission of the policy’s specified CPT and ICD‑10 codes; repeat testing is allowed only for significant clinical change.

"Neuropsychological testing is medically necessary when ALL of the following criteria are met: (1) The information obtained will be used for clinical decision-making; (2) There are symptoms indicati..."