Pending Policies - Mental Health


Psychological and Neuropsychological Testing

Number:PSY301.020

Effective Date:11-15-2017

Coverage:

*CAREFULLY CHECK STATE REGULATIONS AND/OR THE MEMBER CONTRACT*

NOTE: State legislation may apply for specific diagnoses (e.g. Autism Spectrum Disorders and sports related concussions).

NOTE: Some types of testing are commonly excluded under most benefit plans. Members should refer to their benefit summary plan descriptions for a complete list of exclusions.

1. Psychological testing may be considered medically necessary when a and b noted below are met:

a) Testing is conducted for purposes of establishing or clarifying a diagnosis (e.g., differentiation of mood disorders, determining presence or extent of cognitive deficits) when this information cannot be adequately obtained from diagnostic screenings, treatment history, or input from family and other support systems; AND

b) Testing is to determine which treatment options will result in the most optimal clinical outcome for the member.

2. Neuropsychological testing may be considered medically necessary when the above criteria for psychological testing are met AND there is reason to believe the individual suffers from neurocognitive deficits that might be expected to interfere with the individual’s ability to function successfully. Deficits are likely, but not limited to, one or more of the following areas:

a) Memory,

b) Information processing,

c) Executive functions,

d) Personality,

e) Intelligence,

f) Motor skills, OR

g) Reasoning.

3. Psychological or neuropsychological testing is considered not medically necessary when:

a) Testing is not preceded by a face-to-face diagnostic evaluation, either by the requesting provider or referring provider.

b) The referral question can be answered by other clinical measures, such as a detailed diagnostic interview, review of records, or prior treatment history.

c) Tests are not relevant to the clinical question(s).

d) Test instruments are in excess of what is required to answer the clinical question.

e) The requested hours for test administration, scoring, interpretation, and generating report are excessive given the established standards of practice, Tests in Print guidelines, and test publisher guidelines.

f) Testing is routinely administered to all patients for admission to outpatient or inpatient services.

g) Testing is not individualized to a patient’s unique clinical profile but rather based on a pre-determined battery of tests.

h) Testing is performed when there is evidence of active substance abuse within the last 7 days.

i) Neuropsychological testing is requested to determine or confirm routine psychiatric diagnoses (e.g. mood, anxiety, personality disorder; post-traumatic stress disorder (PTSD); and obsessive-compulsive disorder (OCD) spectrums).

j) Neuropsychological testing is requested when there is no medical history of:

Organic brain dysfunction (i.e. brain tumor, anoxia, seizure disorder)

Neurological injury (i.e. stroke, open or closed traumatic brain injury)

Cognitive decline due to neuro-degenerative disease or other medical conditions (i.e. dementia, Parkinsons, multiple sclerosis)

Central Nervous System infection

Cognitive decline due to medical treatments (i.e. HIV, chemotherapy), or

Other relevant medical history

        k)  Testing is performed to determine medication effectiveness or to guide medications dosage level.

NOTE:

1. Testing services must be provided by a medical or mental health provider who is licensed in their state of practice to administer, score and interpret psychological testing.

a) Behavioral health providers must follow their state regulations for credentialing requirements to administer different types of assessments.

b) Projective tests must be administered and interpreted by a licensed psychologist or by an individual authorized to perform testing under supervision of a licensed psychologist.

2. The requesting provider or referring health provider must have:

a) Completed a thorough initial face to face diagnostic evaluation with the member; AND

b) Documented the referral question, based on the findings of this assessment (i.e. unclear diagnosis, unexplained cognitive changes); AND

c) Submitted the request for testing within 30 days after the diagnostic evaluation.

3. The selected test(s) must address the specific referral question(s).

4. Approval is only applicable to standardized tests that are based on published, national, normative data with scoring resulting in standardized or scaled scores.

5. The proposed time for administration of the selected tests may not exceed the administration time established by the test’s publishers, Tests in Print guidelines, plus appropriate time to score, interpret and generate reports (as determined by Current Procedural Terminology guidelines).

6. Some types of testing are commonly excluded under most benefit plans. Members should refer to their benefit summary plan descriptions for a complete list of exclusions. Examples of types of testing that are usually not a covered benefit include, but are not limited to:

a) Educational testing (i.e. learning disability).

b) Employer/Government mandated testing.

c) Testing to determine eligibility for disability benefits.

d) Testing for legal purposes (e.g., custody/placement evaluations, forensic evaluations, and court mandated testing).

e) Testing for vocational purposes (e.g., interest inventories, work-values inventories, and career development).

7. Testing may be authorized once within one calendar year. If more than one request is submitted within a 12-month period, there must be supporting medical documentation provided by the psychologist or physician to indicate that cognitive changes are suspected or that the initial testing did not effectively address the clinical question (i.e. provide diagnostic clarification, accurately measure cognitive status etc.). Repeat testing may be subject to a medical necessity review.

Description:

Psychological Testing

Psychological testing refers to formal assessment methods psychologists and mental health providers use to better understand an individual’s psychological or cognitive functioning, assess personality factors, determine or clarify a diagnosis, and develop appropriate treatment planning. (19) Psychological testing is recommended when other methods such as diagnostic screenings and treatment/medical history do not yield the sufficient information necessary to determine the most optimal treatment options for a member. A unique advantage of standardized, norm referenced assessments is that they can provide empirical evidence as to where an individual stands relative to their peers. It is important that psychological assessment be utilized in conjunction with other available measures such as interviews, observation, medical history and all other pertinent information that relates to an individual.

Neuropsychological Testing

Neuropsychological testing focuses on the relationship between the brain/central nervous system and cognitive/behavioral health. Neuropsychological testing is commonly administered when there is reason to believe that there has been a change in an individual’s neurocognitive status. Often these changes happen because of a variety of neurological and medical disorders that can alter cognitive functioning such as traumatic brain injury, dementia related diagnoses, and other factors that alter an individual’s neurological status or cognitive functioning. (17) Clinical applications of neuropsychological assessment include; diagnosis/differential diagnosis, measurement of functional potential and recovery, course of degenerative disease and measurement of treatment effectiveness. (21)

Rationale:

There are several professional organizations whose mission is to promote the highest standards of practice in the fields of psychological and neuropsychological assessment through scientific research (i.e., The American Academy of Clinical Psychology, American Psychological Association [APA] Division of Clinical Neuropsychology, American Board of Clinical Psychology (ABCN), National Academy of Neuropsychology (NAN), American Board of Neuropsychology (ABN), APA Division of Evaluation Measurement and Statistics). Health Care Services Corporation considers the recommendations and policies of these organizations as well as other scientific research when making determinations about coverage.

Dementia/Alzheimer’s Disease: The American Psychological Association predicts that in 2010 approximately 40 million people in the United States were over the age of 65 (6). This number is expected to double by the year 2050. Approximately 10 percent of adults 65 and older and 50 percent of adults 90 and older have dementia and it is projected that these numbers will continue to increase (1). Alzheimer’s disease and vascular dementia, and dementia with Lewy Bodies account for a majority of dementia cases. Due to the impact of dementia on judgment, speech and memory, the assessment of dementia often relies heavily on objective measures such as caregiver/family responses and less so on subjective responses from the patient. (39) While neuropsychological assessment is helpful in determining level of cognitive impairment, it is not recommended that it be done on a routine basis for all patients with a suspected diagnosis of dementia. (1) In such cases briefer assessments may be preferred (i.e. Montreal Cognitive Assessment (MoCA), Mini Mental Status Examination, Functional Activity Questionnaire). (1) Salmon and Bondi found that neuropsychological assessment was effective in differential diagnosis between Alzheimer disease and normal aging patterns, however the sensitivity of the assessments was diminished for the very-old (over 80) vs. the young-old (under 70). (36) Another factor that affects the sensitivity of neuropsychological assessments in the elderly is diminished sensory capacity such as vision and hearing which can negatively affect performance. (26)

Section Summary: Dementia/Alzheimer’s Disease. Routine neuropsychological assessment is not recommended for all cases of suspected dementia; as less extensive cognitive screenings can be effective in guiding treatment.

Traumatic Brain Injury (TBI): Traumatic brain injuries range from mild to severe, with recovery dependent on severity and location of injury, age of individual, pre-morbid health, medical care received, and quality of rehabilitation (5, 9). About 15% of individuals who suffer a TBI fall in the moderate to severe range. (5)

The pediatric population is especially vulnerable to the long term effects of TBI. Babikian and Asarnov did a meta-analysis of 24 articles pertaining to long term effects of pediatric head injury. (9) Results indicated that children with severe head injuries showed deficits in intellectual functioning, attention and executive skills even 2 years post injury. The authors conclude that the effects of TBI in children are long lasting and persist for years. In a similar study comparing children with severe TBIs to children with orthopedic injuries the authors found that children with poorer pre-morbid function showed greater decline post injury in the domains of neuropsychological skills, academics, adaptive behavior. (18)

Section Summary: Traumatic Brain Injury. Literature strongly supports that neuropsychological testing provides valuable information about an individual’s brain functions following a traumatic brain injury and can serve as an integral part of rehabilitation and recovery.

Concussion/Head Injury: In the last 2 decades there has been an increasing awareness and concern about head injuries sustained through participation in sports activities. It is estimated that there are 1.6-3.8 million sports related concussions a year. This number is potentially higher because there are likely many unreported head injuries. (16) The Center for Disease Control (CDC) estimated this number to be 300,000 a year when looking at concussion with loss of consciousness. (27) Many states have considered developing legislation requiring that athletes who sustain a potential concussion not be allowed to return to the sport until they have been cleared by a qualified health care professional. Another approach that some professional, college and high school sports organizations are taking is to perform a baseline neuropsychological evaluation on athletes that targets areas of brain functioning that could be affected by a concussion (i.e., memory, attention, reaction time and speed of processing). Should the athlete suffer a concussion, follow up testing will reveal whether there is a difference between baseline functioning and post-concussive functioning. (27)

The following organizations all take the position that neuropsychologists be considered among the qualified health care providers to assess and clear the athlete to return to sport; American Academy of Clinical Neuropsychology, American Board of Professional Psychology, American Psychological Association Division 40 (Neuropsychology) and the National Academy of Neuropsychology. (16)

Section Summary: Concussion/Head Injury. Literature supports the use of neuropsychological evaluations in the diagnosis and treatment of sports related concussions.

Attention Deficit Hyperactivity Disorder (ADHD): According to the American Psychiatric Association, attention deficit hyperactivity disorder is one of the most commonly diagnosed childhood psychiatric conditions. (33) In 2002 The U.S. Centers for Disease Control reported that 1.6 million elementary age children had ADHD. (20) ADHD is often comorbid with other disorders such as oppositional defiant disorder, conduct disorder, and diminished executive functioning. (33) ADHD in the adult population is gaining increasing attention, especially as comorbid disorders may follow individuals from childhood into adulthood. A meta-analysis of 24 empirical studies conducted by Schoechlin and Engel found inconclusive results as to the effectiveness of neuropsychological testing in the assessment of ADHD, in part because examiners differed from one another in their choice of neuropsychological tests. (37) Gualtieri and Johnson argue that neuropsychological batteries are an indirect measure of ADHD and no single test alone is sufficient to make a confident diagnosis of ADHD. (20)

Section Summary: Attention Deficit Hyperactivity Disorder. Neuropsychological assessment should be used in the assessment of ADHD only when there is a remarkable medical, psychiatric, or neurologic history or when the findings of a standard psychological assessment indicate a need for a more detailed assessment. (33)

Pre-surgical Evaluations: Pre-surgical psychological evaluations are often requested by a medical provider to assess whether a patient is psychologically ready and cognitively capable of undergoing a surgical procedure, adjusting to the aftermath of the procedure, and following up with treatment recommendations. Snyder (2009) reports that many patients report an increase in their self-awareness as a result of having to address the issues raised in the psychological evaluation. (41) Bariatric surgery is one such common procedure that often requires a psychological evaluation prior to being accepted as a candidate for the surgery. Psychological evaluations can identify risk factors such as suicidal ideation, tendency for impulsive behavior, psychiatric diagnoses, level of maturity, and coping skills among others. Pre-surgical psychological evaluations should be accompanied by assessments in other areas such as behavioral patterns, cognitive strengths, developmental progression, level of social support and motivation level. (8)

Section Summary: Pre-surgical Evaluations. Pre-surgical psychological evaluations may help predict patient readiness for bariatric surgical procedure.

Computerized Assessments: Computer based assessments are being increasingly used in place of examiner administered assessments. The American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology take the position that computer neuropsychological assessment devices (CNAD) are expected to meet the same standards and in establishing reliability, validity, and normative data as examiner based assessments. (11) Therefore, test developers maintain the burden of establishing validity, reliability, normative data, technical specifications of the device, determining test user qualifications, and all other ethical considerations.

Section Summary: Computerized Assessments. Examiners must be able to provide evidence that a CNAD meets the established test standards before using it in practice.

Educational: The National Association of School Psychologists (NASP) takes the position that children suspected of having a learning disability (LD) should undergo a comprehensive evaluation completed by a school psychologist and other qualified school based professionals followed by multi-tiered individualized interventions that address the child’s specific learning needs. (31) In some cases the child will succeed based on this level of intervention. In other cases a child may continue to experience learning difficulties and require further evaluation. The National Academy of Neuropsychology (NAN) states that school based evaluations are restricted in their ability to assess brain functioning and may not be able to identify the etiology of cognitive difficulties. (40)

Section Summary: Educational. Assessment for educational purposes such as educational placement, determining presence or absence of a specific learning disability, and measurement of academic progress may be a benefit exclusion and therefore not covered. These services should be available through the school system. Neuropsychological evaluations should only be considered when traditional school based interventions are unsuccessful, when there are other medical factors to consider such as traumatic brain injury, and when the etiology of the child’s symptoms remains unknown.

Repeat Testing: Certain clinical situations warrant that an individual be assessed repeatedly across a given time frame. Common diagnoses for which this may be appropriate include developmental disorders, traumatic brain injury, and dementia. The purpose of repeat testing is to monitor the progression of clinical symptoms over time to assess whether there is improvement or decline. The American Academy of Clinical Psychology recommend that neuropsychologists recognize the impact of practice effects on performance and be knowledgeable about which tests are most and least immune to practice effects. (22) The risk of practice effects is diminished among individuals with severe brain damage or cognitive dysfunction. This is especially true in the pediatric population where a child is both trying to recover from the losses associated with the brain injury and gain age-appropriate skills associates with maturation.

Section Summary: Repeat Testing. Repeat testing is warranted when the examiner can provide evidence that cognitive change is likely and needs to be documented.

Forensic: Psychological/neuropsychological evaluations done for forensic purposes differ from traditional clinical practice in that these evaluations are typically performed at the request of a third party. (30) Thus the practicing clinician does not have the same obligation to the examinee as they would if they were evaluating for clinical purposes. Forensic evaluation typically takes place when a psychologist is asked to provide expert psychological testimony in legal, contractual, or administrative matters. Thus the results of the assessment are not for the purposes of treatment planning. The American Psychological Association (APA) Specialty guidelines for Forensic Psychology state that the practice of forensic psychology, while different from the practice of traditional psychology is guided by the same ethical principles and code of conduct. (4)

Section Summary: Forensic. Psychological assessment, when done for forensic purposes may be a benefit exclusion and therefore not covered.

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

CODING:

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

CPT/HCPCS/ICD-9/ICD-10 Codes

The following codes may be applicable to this Medical policy and may not be all inclusive.

CPT Codes

96101, 96102, 96103, 96116, 96118, 96119, 96120, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146

HCPCS Codes

None

ICD-9 Diagnosis Codes

Refer to the ICD-9-CM manual

ICD-9 Procedure Codes

Refer to the ICD-9-CM manual

ICD-10 Diagnosis Codes

Refer to the ICD-10-CM manual

ICD-10 Procedure Codes

Refer to the ICD-10-CM manual


Medicare Coverage:

The information contained in this section is for informational purposes only. HCSC makes no representation as to the accuracy of this information. It is not to be used for claims adjudication for HCSC Plans.

The Centers for Medicare and Medicaid Services (CMS) does not have a national Medicare coverage position. Coverage may be subject to local carrier discretion.

A national coverage position for Medicare may have been developed since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

1. Adelman, A.M. and M.P. Daly. Initial Evaluation of the Patient with Suspected Dementia. American Family Physician (2005) 71 (9): 1745-1750.

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Arlington, VA: American Psychiatric Publishing.

3. American Psychiatric Association: Practice Guideline for the Psychiatric Evaluation of Adults (3rd ed.). 2015. Washington D.C. American Psychiatric Association. Available at <http://psychiatryonline.org> (accessed 2017 January 6).

4. American Psychological Association. APA’s Specialty Guidelines for Forensic Psychology. American Psychologist, (2013) Vol 68, No.1: 7-19.

5. American Psychological Association. Rehab for the brain after Traumatic injuries. (2011). Available at <http://www.apa.org> (accessed 2017 January 6).

6. American Psychological Association. Guidelines for the evaluation of dementia and age related cognitive change. American Psychologist. 2012 January, Vol.67, No.1: 1-9. Available at <http://www.apa.org> (accessed 2017 January 6).

7. APA's guidelines for test user qualifications: An executive summary. (2001). Turner, Samuel M.; DeMers, Stephen T.; Fox, Heather Roberts; Reed, Geoffrey American Psychologist, Vol 56(12), Dec 2001: 1099-1113. doi: 10.1037/0003-066X.56.12.1099.

8. American Society for Metabolic and Bariatric Surgery. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. June 2016. Available at <https://asmbs.org> (accessed 2017 January 6).

9. Babikian, T. and R. Asarnov. Neurocognitive outcomes and recovery after pediatric TBI: Meta-analysis review of the literature. Neuropsychology 2009 Vol. 23, No.3: 283-296.

10. Baron, I. S., Wills, Karen, Rey-Casserly, C., Armstrong, K., and Westerveld, M. Pediatric Neuropsychology: Toward Subspecialty Designation. The Clinical Neuropsychologist, 2011 25:6: 1075-1086.

11. Bauer, R.M., Iverson, G.L., Cernich, A.N., Binder, L.M., Ruff, R.M. and Naugle, R.I. Computerized neuropsychological assessment devices: Joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology. Archives of Clinical Psychology 27 (2012) 362-373.

12. Behavioral Health Levels of Care, Milliman Care Guidelines (16th ed.). (2012). Seattle, WA: Milliman, Inc. Available at < http://careweb.careguidelines.com> (accessed 2017 January 6).

13. Board of Directors. American Academy of Clinical Neuropsychology (AACN) Practice Guidelines for Neuropsychological Assessment and Consultation. (2007) The Clinical Neuropsychologist, 21:2: 209-231.

14. Brenner, L.A. Neuropsychological and neuroimaging findings in traumatic brain injury and post-traumatic stress disorder. Dialogues in Clinical Neuroscience. 2011; 13 (3): 311-323.

15. Camara, W. J., Nathan, J. S., and Puente, A. E. Psychological Test Usage: Implications in Professional Psychology: Report to the APA Practice and Science Directorates. Professional Psychology: Research and Practice. 2000, Vol.31, No.2, 141-154. Available at < http://antonioepuente.com> (accessed 2017 January 6).

16. Echemendia, R. J., Iverson, G.L., McCrea, M, Broshek, D.K., Gioia, G.A., Sautter, S.W., Macciocchi, S.N, and Barr, W.B. Role of neuropsychologists in the evaluation and management of Sport-related concussion: An inter-organization position statement. Archives of Clinical Psychology 2012 Jan 27(1): 119-122.

17. Encyclopedia of mental disorders: Neuropsychological testing. Available at <http://www.minddisorders.com> (accessed 2017 January 6).

18. Fay, T.B., Yeates, K.O., Wade, S.L., Drotar, D, Stancin, T. and Taylor, H.G. Predicting longitudinal patterns of functional deficits in children with traumatic brain injury, Neuropsychology 2009, Vol. 23, No. 3: 271-282.

19. Framingham, J. What is Psychological Assessment? (2011). Psych Central. Available at <http://psychcentral.com> (accessed 2017 January 6).

20. Gualtieri, C.T and Johnson, L.G. ADHD: Is objective diagnosis possible? Psychiatry 2005 November: 44-53.

21. Harvey, P.D. (2012) Clinical applications of neuropsychological assessment. Dialogues in Clinical neuroscience, Vol. 14, No. 1: 91-199.

22. Heilbronner, R.L. Ph.D., Sweet, J. J., Attix, D.K., Krull, K.R., Henry, G.K. and Hart, R.P. Official position of the American Academy of Clinical Neuropsychology on serial neuropsychological assessments: the utility and challenges of repeat test administrations in clinical and forensic contexts. The Clinical Neuropsychologist (2010) 24:8: 1267-1278.

23. Joint Committee on Testing Practices. Code of Fair Testing Practices in Education. (2004). Available at <https://www.apa.org> (accessed 2017 January 6).

24. Kosaka, B. Neuropsychological assessment after mild traumatic brain injury: A clinical overview. British Columbia Medical Journal (2006) 48 (9): 447-452.

25. Martin,J. BSc (Hons), Hamshere, M.L., Ph.D., Stergiakouli, E. Ph.D., O’Donovan, M.C., F.R.C.Psych., Ph.D., and Thapar, A. F.R.C.Psych., Ph.D. Genetic Risk for Attention Deficit/ Hyperactivity Disorder Contributes to Neurodevelopmental Traits in the General Population. Biological Psychiatry 2014. Available at: <http://dx.doi.org> (accessed 2017 January 6).

26. Morris, R.G., Worsley, C. and Matthews, D. Neuropsychological assessment in older people: Old principles and new directions. Advances in Psychiatric Treatment. 2000, 6: 362-370.

27. Moser, R.S., Iverson, G.L., Echemendia, R. J.., Lovell. M. R., Schatz, P., Webbe, F.M., Ruff, R.M., Barth, J.T., Broshek, D.K., Bush, S.S., Koffler, S.P., Reynolds, C.R. and Silver, C.H. National Academy of Neuropsychology Position Paper: Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Archives of Clinical Neuropsychology 22, (2007): 909-916.

28. Murphy, L. L., Geisinger K. F., Carlson, J. F., &. Spies, R. A. (2011). Tests in Print VIII. The Buros Institute for Mental Measurements, Lincoln, NE.

29. Murphy, F.C. and B.J. Sahakian. Neuropsychology of bipolar disorder. The British Journal of Psychiatry (2001) 178: s120-127.

30. National Academy of Neuropsychology. Official statement: Independent and court-ordered forensic neuropsychological examinations. (2003). Available at <https://www.nanonline.org> (accessed 2017 January 6).

31. Bethesda, MD: Author. National Association of School Psychologists. Identification of Students with Specific Learning Disabilities (Position Statement). (2011).

32. Bethesda, MD: Author. National Association of School Psychologists. (2011). Students with Attention Deficit Hyperactivity Disorder (Position Statement).

33. Practice parameters for the assessment and treatment of children and adolescents with Attention-Deficit/Hyperactivity Disorder. Journal of American Academy Child and Adolescent Psychiatry (2007) 46 (7): 894-921.

34. Rabin, L. A., Wang, C., Katz, M. J., Derby, C. A., Buschke, H. and Lipton, R. B. Predicting Alzheimer's Disease: Neuropsychological Tests, Self-Reports, and Informant Reports of Cognitive Difficulties. Journal of the American Geriatrics Society 2012 June; 60(6): 1128–1134.

35. Randolph, C., McCrea, M. & Barr, W.B. Is neuropsychological testing useful in the management of sport-related concussion? Journal of Athletic Training 2005; 40(3), 139-154.

36. Salmon, D.P. and M.W. Bondi. Neuropsychological assessment of dementia. Annual Review of Psychology (2009) 60: 257-282.

37. Schoechlin, C. and R.L. Engel. Neuropsychological performance in adult attention-deficit hyperactivity disorder: Meta-analysis of empirical data. Archives of Clinical Neuropsychology 20 (2005): 727-744.

38. Schretlen, D.J., Cascella, N.G., Meyer, S.M., Kingery, L.R., Testa, S. M, Munro, C.A., Pulver, A.E., Rivkin, P, Rao, V.A., Diaz-Asper, C.M., Dickerson, F.B., Yolken, R.H. and Pearlson, G.D. Neuropsychological functioning in bipolar disorder and schizophrenia. Biological Psychiatry. 2007 July 15; 62(2): 179-186.

39. Sheehan, B. (2012) Assessment scales in dementia. Therapeutic Advances in Neurological Disorders, 5 (6): 349-358.

40. Silver, C.H., Blackburn, L.B., Arffa, S., Barth, J. T., Bush, S.S., Koffler, S.P., Pliskin, N.H., Reynolds, C.R., Ruff, R. M., Troster, A.I., Moser, R.S. and Elliott, R.W. The importance of neuropsychological assessment for the evaluation of childhood learning disorders. Archives of Clinical Neuropsychology 21 (2006): 741-744.

41. Snyder, A. G. (2009). Psychological assessment of the patient undergoing bariatric surgery. The Ochsner Journal (9): 144-148.

42. Spies, R.A., J. F. Carlson, J.F. & K. F. Geisinger, K.F. (2010). The eighteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements.

Policy History:

Date Reason
11/15/2017 Document updated with literature review. Additional not medically necessary criteria have been added for neuropsychological testing in the absence of relevant medical history. The NOTE section of the coverage has had additional information added regarding supporting documentation for repeat testing.
4/1/2016 Reviewed. No changes.
9/15/2015 Document updated with literature review. The following change was made to Coverage: Time period in the not medically necessary statement regarding evidence of active substance abuse was changed from 30 days to 7 days.
10/15/2014 New medical document. Psychological or neuropsychological testing may be considered medically necessary when all of the conditional criteria are met. Conditions for which psychological and neuropsychological testing are considered not medically necessary are listed in the coverage section.

Archived Document(s):

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