Insurance Overview
Introduction
We accept many insurance plans as an in-network provider. It is crucial that we receive current and accurate insurance information from you prior to your appointment. Failure to do this may result in us being unable to bill your insurance for your evaluation. We are happy to bill your insurance as a courtesy, but please be aware that you are responsible for your bill.
You will find a list of our current accepted insurances below. Please be aware, although we may be in-network with your insurance company, coverage and benefits vary by plan. Neuropsychological evaluation is a specific and complex area of practice, and each health insurance company covers it differently. The most complete information for coverage specific to your plan can be obtained by calling your insurance company.
Some health insurance companies and/or plans require Preauthorization to be obtained before performing a neuropsychological evaluation. Should this be necessary, we will work with your referring provider to submit the authorization request on your behalf.
CPT Coding and Insurance-Specific Information
Detailed Coding and Insurance Billing Information
For the most accurate and comprehensive information regarding your specific insurance coverage and potential financial responsibility, please contact your insurance provider directly. The following section is meant to help give you some information that you may be asked to provide your insurance carrier when determining your benefits for a neuropsychological evaluation. Please be aware that this is a very specific area of practice, and each insurer classifies it differently. Some insurances require preauthorization across the board for neuropsychological evaluations, and some insurance companies have plan- or diagnosis-specific preauthorization requirements.
For most insurances, in most cases, a neuropsychological evaluation is covered under your mental health benefits. Other insurances cover neuropsychological evaluation under either medical benefits or mental health benefits based on your diagnosis code. For the insurance plans that we are currently contracted with, only Blue Cross considers neuropsychological evaluations under their medical benefits all, or nearly all, of the time.
You will want to have the following information handy when contacting your insurance to determine your coverage and benefits for a neuropsychological evaluation:
- CPT Codes for neuropsychological evaluation. These are the Procedure Codes; the codes your insurance company uses to identify what procedure or service is being rendered. This is how they know what was performed and what to pay. These will also be what they will ask for to determine whether or not a preauthorization is required. The following are the four (4) procedure codes we use for a neuropsychological evaluation:
+ 96132
+ 96133
+ 96136
+ 96137
-Your diagnosis code. This is the diagnosis code your doctor has referred you to Dr. Trueblood with. It can be anything from Major Depressive Disorder (DX Code F32.1), Multiple Sclerosis ( DX Code G35), Cognitive Impairment (DX Code: G31.84), or many, many others.
*It is important to note that although all plans from the Affordable Care Act are required to cover mental health services, there are some plans such as short term and indemnity plans that do not cover mental health services. If you have one of these plans, there may be no mental health coverage available to you.
Worker's Compensation and Motor Vehicle Insurance: We do accept most worker's compensation and motor vehicle insurances, and will contact the company directly to inquire about coverage and claim status. We do not accept payment on medical lein, or at the close of a pending legal case. Payment, if not authorized by the worker's compensation or motor vehicle company, will be due at the time of service.
