Psychological and Neuropsychological Tests

Neuropsychological and psychological testing is covered when there is known or suspected CNS involvement and when test results will directly impact diagnosis, prognosis, treatment planning, surgical decision-making, rehabilitation, or functional capacity assessments, including in children with developmental deficits. Testing is not covered for routine screening, purely educational/vocational purposes, self-administered screeners, when the patient cannot validly participate (e.g., intoxication), or when repeat testing lacks justification; documentation must show medical necessity, identify the performing provider, and justify testing hours (especially >8 hours).

"Neuropsychological testing is medically necessary when deficits are detected on standard mental status testing or clinical interview and further assessment is needed to establish or characterize co..."