Health and Psychology

Health and psychology


Medical Necessity for Testing

Posted by Margaret Donohue on November 19, 2015 at 7:55 PM

Many people think their insurance covers psychological or neuropsychological testing.  Insurance will stipulate that psychological or neuropsychological testing if it meets criteria for medical necessity.  That doesn't mean that a physician or a school or a teacher thought the testing would be necessary.  It means that psychological or neuropsychological testing meets the strict criteria set forth by the insurance company.  

Medical necessity means that there is no other agency or organization that can provide testing at state or federal expense.  So that eliminates testing for:

  • educational placement 
  • disability 
  • Regional Center services
  • Gifted placement

 It means that psychological or neuropsychological testing will produce a change in diagnosis or treatment plan and is the most cost efficient method of obtaining that information.  So an MRI or CT scan may be able to rule out memory problems related to brain disease or defect.

  • Schools provide psychological testing for placement in special education including gifted classes.  
  • Schools can evaluate for ADD/ADHD and learning disorders to determine accommodations
  • Regional Center provides their own testing to confirm the need for services
  • Social Security Disability provides testing to document disability for benefits

If you are interested in obtaining insurance benefits to cover psychological or neuropsychological testing GET AN AUTHORIZATION NUMBER from the insurance company.  

If you are interested in having psychological or neuropsychological testing feel free to contact our office.  We have access to a large number of psychological and neuropsychological tests at reasonable fees.  If you are eligible to use a free service we will advise you of that.  Feel free to contact us.  Our main office number is 818-223-4116.  My cell phone is 818-389-8384 Margaret Donohue, PhD.


Categories: General Psychology, Diagnosis

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