Psychological and Neuropsychological Testing

This policy covers standardized psychological and neuropsychological testing to establish or clarify diagnoses, assess cognitive or personality functioning, inform treatment planning, evaluate safety or surgical readiness (e.g., bariatric or epilepsy surgery), and assess neurologic conditions or post‑traumatic brain injury in adults and children when testing will guide clinical management. Coverage requires testing be requested after a thorough diagnostic evaluation, use nationally normed instruments, be medically necessary when screening or chart review is insufficient, and is subject to member benefit/contract terms; tests must be administered by appropriately licensed clinicians and routine, non‑individualized batteries, brief screening inventories, excessive testing, irrelevant measures, or testing during recent active substance abuse are not covered.

"Standardized psychological testing when needed to establish, clarify, or determine severity of a diagnosis and this information cannot be adequately obtained from diagnostic screenings or review of..."