This Policy version was replaced on April 29, 2024. To find the newest version, go to https://www.bluecrossmn.com/providers/medical-management, select 'See Medical and Behavioral Health Policies', then 'Blue Cross and Blue Shield of Minnesota Medical and Behavioral Health Policies'. This will bring up the Medical Policy search screen. Enter the policy number without the version number (last three 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 medically 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 explanatory documentation..

Psychological Testing

Psychological testing is designed to clarify the diagnostic or treatment implications of conditions related to emotional distress, mood disturbance, thought and perceptual disturbances, anxiety disorders, developmental delay, or specific behavioral patterns.

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 as associated with a known or suspected neurological condition.

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:
    • 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); or
    • An intellectual disability or intellectual developmental disorder; or
    • 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; or
    • Prior to a surgical procedure only as required by surgery protocol or when a mental health issue is suspected that could affect the surgery 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.

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 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.

• Psychological and neuropsychological 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 or symptoms of a specific condition
  • 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
  • Testing instruments and requested hours for test administration, scoring, interpretation, and generating reports that are outside established standards of practice
  • Testing is performed while an individual is abusing substances or having acute withdrawal symptoms
  • Testing is predominately for career aptitude, vocational or academic/educational planning
  • Testing in the setting of court referral or solely for forensic purposes
  • Testing for research purposes
  • The use of brief self-administered or self-scored inventories or screening tests , (e.g., Beck Depression Inventory, Beck Anxiety Inventory, Eating Attitudes Test (EAT-26), Hamilton Rating Scale for Depression or Patient Health Questionnaire (PHQ-9) ) as part of an ongoing treatment process.

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