This policy version was replaced May 2, 2022. To find the newest version, go to https://www.bluecrossmn.com/providers/medical-policy-and-utilization-management, read and accept the Blue Cross Medical Policy Statement, then select “Blue Cross and Blue Shield of Minnesota Medical Policies.” This will bring up the Medical Policy search screen. Enter the policy number without the version number (last 3 digits).

Assessment of psychological, behavioral, cognitive, and neurological conditions may necessitate the administration of psychological or neuropsychological tests. The need for psychological or neuropsychological testing is determined according to whether such testing is essential for identifying a condition, determining the degree /severity of functional impairment that would result in treatment change or the results of such testing are a critical determinant in treatment planning.

The specific nature of the testing procedure proposed, and the intensity or extensiveness of that testing procedure, should correspond to the specific condition that is being evaluated. Conditions that are primarily behavioral or emotional in nature might require psychological assessment in some cases, but would not typically be expected to require cognitive or neuropsychological testing specifically in order to clarify diagnosis. Testing that is solely exploratory in nature, not based on a specific diagnostic concern or not intended for a specific treatment decision, is generally not necessary.

Both the nature and intensity of psychological and neuropsychological testing must be considered prior to the testing procedure. Therefore, the specific testing procedures proposed should be appropriate for the condition being evaluated, and the time requested for such testing should be efficient and consistent with the amount of time typically needed for such tests, as determined by standard industry estimates. Situations in which more time is needed than is typically required for testing may require additional explanation.

Psychological Testing

Psychological testing is necessary only when specific assessment procedures are required to clarify the diagnostic or treatment implications of conditions related to emotional distress, mood disturbance, anxiety disorders, developmental delay, or specific behavioral patterns.

Psychological testing is not necessary as part of every psychological evaluation, and is often not required in psychological counseling unless specific measures are needed to determine the patient’s diagnosis or co-morbid condition, or to make a choice between specific treatment approaches. Similarly, while a psychological evaluation may be indicated prior to some surgical procedures, such as bariatric surgery or implantation of a spinal cord stimulator, psychological testing per se is not clinically indicated based on presurgical status alone.

Neuropsychological Testing

Neuropsychological tests are designed to measure neurocognitive ability and functional status in the domains of cognition, learning and memory, language visual processing, visual-motor integration, abstract reasoning, spatial reasoning, processing speed and sensory-perceptual functioning.

Neuropsychological tests are often used to assess congenital or acquired neurological disorders that directly or indirectly affect neurocognitive ability dependent upon cortical and/or subcortical brain functions. Neuropsychological testing may assist in differentiating psychiatric from neurological disorders, in staging disease, and in assessing neurocognitive functioning prior to medical procedures that may result in neurological changes.

I.   Specific considerations for determinations regarding psychological testing include the following:

• Psychological testing may be considered MEDICALLY NECESSARY AND APPROPRIATE when ALL of the following criteria are met:
  • Testing is supervised and interpreted by a licensed physician, or psychologist following a face-to-face evaluation; AND
  • Testing is used to rule-in or rule out the presence of at least one of the following:
    1. A thought disorder, severe emotional distress or other psychiatric diagnosis when this information is not available from one or more comprehensive medical or behavioral health evaluations with the member and other sources as appropriate (e.g. family members, other health care providers, school records);
    2. An intellectual disability or intellectual developmental disorder;
    3. Psychological comorbidities in patients with attention-deficit/hyperactivity disorder (ADHD) when signs or symptoms are suggestive of other mental health or neurocognitive disorders (e.g. developmental delay, cognitive features of Fetal Alcohol Spectrum Disorders) that require cognitive testing in order to identify.  ADHD alone does not typically require cognitive testing unless such disorders are suspected.  Provider interpretation of substantive rating scales of up to one hour is considered medically necessary. 
    4. Prior to a surgical procedure only where there is a known or suspected behavioral health condition that could compromise the surgical outcome. AND
  • A specific diagnostic or treatment question still exists which cannot be answered without the results of psychological testing; AND
  • The results of the testing will impact the medical/psychiatric/psychological treatment of the patient; AND
  • Testing instruments and time allotted for each instrument are appropriate for and limited to the unique clinical presentation of the individual; 

• Psychological testing is considered NOT MEDICALLY NECESSARY for all other indications including but limited to the following:
  • Use of testing for screening or solely for exploratory purposes in the absence of signs/symptoms of a specific behavioral health condition for which testing is essential
  • Diagnosis and management of ADHD in the absence of signs or symptoms suggestive of other mental health or neurocognitive disorders
  • Testing instruments and requested hours for test administration, scoring, interpretation, and generating reports are outside established standards of practice
  • Testing is performed while an individual is abusing substances or having acute withdrawal symptoms
  • Testing performed consists of brief self-administered or self-scored inventories or screening tests including but not limited to the Beck Depression Inventory, Beck Anxiety Inventory, Eating Attitudes Test (EAT-26) Hamilton Rating Scale for Depression or Patient Health Questionnaire (PHQ-9)
  • Testing is predominately for career aptitude, vocational or academic/educational planning
  • Testing in the setting of a court referral or solely for forensic purposes
  • Testing for research purposes

II.  Specific considerations for determinations regarding neuropsychological testing include the following:

• Neuropsychological testing may be considered MEDICALLY NECESSARY AND APPROPRIATE when ALL of the following criteria are met:
  • Testing is supervised and interpreted by a licensed physician or psychologist following a face-to-face evaluation; AND
  • Testing is used to rule-in or rule-out the presence of a specific neurocognitive disorder or other specific neurological or psychiatric diagnosis when this information is not available from one or more comprehensive medical or behavioral health evaluations with the member and other sources as appropriate (e.g. family members, other health care providers, school records); AND
  • The results of the testing will impact the medical/psychiatric/psychological treatment of the patient; AND
  • Presence of a clinical condition which may require the use of neuropsychological testing, including but not limited to:
    1. Cerebrovascular disease/stroke when there is evidence of cognitive or neurologic impairment
    2. Complex neuropsychiatric or neurodevelopmental condition (e.g., autism spectrum disorder, intellectual disability, or psychosis when neurological signs are known or suspected. 
    3. Confirmed space-occupying brain lesion including but not limited to brain abscess, brain tumor or arteriovenous malformations within the brain
    4. Demyelinating disorders including multiple sclerosis
    5. Encephalopathy including acquired immunodeficiency syndrome (AIDS) encephalopathy, human immunodeficiency virus (HIV) encephalopathy, hepatic encephalopathy, Lyme disease encephalopathy (including neuroborreliosis), Wernicke's encephalopathy or systemic lupus erythematosus (SLE) encephalopathy
    6. Extrapyramidal disease (e.g. Parkinson’s, Huntington’s disease)
    7. Genetic disorder that may result in cognitive or neurologic impairment (e.g., Turner, Klinefelter, Rett, Fragile X or 22q11.2 deletion, [velocardiofacial or DiGeorge] syndromes, Duchenne muscular dystrophy, neurofibromatosis type 1)
    8. In-born errors of metabolism (e.g., lysosomal or peroxisomal storage disease, Hurler syndrome, adrenal leukodystrophy)
    9. Hypoxic or anoxic brain injury
    10. Neonatal or antenatal complication (e.g., respiratory distress, preeclampsia, in utero exposure to illicit drugs, alcohol, tobacco, environmental toxins)
    11. Neurotoxin exposure (e.g. lead poisoning, cranial irradiation, chemotherapeutic agents)
    12. Seizure disorder including patients with epilepsy and patients being considered for epilepsy surgery
    13. Systemic medical condition known to be associated with cerebral dysfunction in adults or children (e.g., renal disease, cardiac anomalies or congenital heart conditions requiring surgical repair, liver disease and autoimmune disorders such as lupus erythematosus or celiac disease)
    14. Traumatic brain injury (TBI)

• Neuropsychological testing is considered NOT MEDICALLY NECESSARY for all other indications including but limited to the following:
  1. Use of testing for screening or solely for exploratory purposes in the absence of signs or symptoms of a neuropsychological/neurological condition
  2. Diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) in the absence of signs or symptoms suggestive of other mental health or neurocognitive disorders which meet requirements for testing
  3. Requested hours for test administration, scoring, interpretation, and generating reports are outside established standards of practice
  4. Testing is performed while an individual is abusing substances or having acute withdrawal symptoms
  5. Testing is predominately for career aptitude, vocational or academic/educational planning
  6. Testing in the setting of court referral or solely for forensic purposes
  7. Testing for research purposes

Documentation Submission:

Documentation supporting the medical necessity criteria described in the policy must be included in the prior authorization, when prior authorization is required. Please complete and submit the Psychological and Neuropsychological Testing Pre-Authorization Form found at the link below.

Link to Psychological & Neuropsychological Testing Pre-Authorization Form:  Psychological & Neuropsychological Testing Pre-Authorization Form