When insurance usually covers testing
Insurance plans cover services they consider medically necessary. For psychological testing, that generally means testing to diagnose a mental health condition and guide treatment, such as evaluations for ADHD, autism, depression, anxiety, or trauma when symptoms are affecting your daily life.
What insurance usually doesn't cover
- Learning disorder testing. Insurance does not cover it, because it isn't considered medically necessary.
- Testing only for educational purposes or accommodations, without a clinical question to answer.
- Extra services and fees, such as the same-day results fee at WPS.
Questions to ask your insurer
Call the member services number on the back of your insurance card and ask:
- Is psychological testing a covered benefit? Ask about these procedure (CPT) codes:
- 96132 and 96133: neuropsychological evaluation services, the codes Walker Psychological Services typically uses for testing. 96132 is the first hour and 96133 each additional hour.
- 96136 and 96137: test administration and scoring.
- 90791: the intake (diagnostic interview).
- Some plans also list 96130 and 96131 (psychological evaluation services). Ask about them too, so you know your coverage either way.
- Is the provider in network? Give them the psychologist's name. If not, ask what your out-of-network benefits are.
- What is my deductible, and how much have I met? Testing often happens early in the year, before a deductible is met.
- What is my copay or coinsurance for outpatient mental health services?
- Is prior authorization required? Some plans need approval before testing begins.
- Are there limits on the number of testing hours covered?
Write down the date, the representative's name, and a call reference number. Keep in mind that a quote of benefits is not a guarantee of payment. Final coverage depends on your plan's terms when the claim is processed.
Plans we're in network with
For psychological testing, Dr. Walker is in network with Aetna, Anthem Blue Cross Blue Shield, Carelon Behavioral Health, Cigna (testing only), Curative, First Health, UnitedHealthcare / Optum / UBH, and UMR. Out-of-network benefits may apply for other plans. If your plan requires prior authorization, let us know when you book, and we will tell you what your plan needs.
If insurance won't cover your testing
Self-pay options are available, and self-pay clients are entitled to a Good Faith Estimate of costs before services begin. See Insurance and Fees or call the office at (720) 446-9438.