Neuropsychological evaluations are a significant investment of time and often of money. We think you deserve to understand exactly what you're signing up for before you commit to anything.
If you have a question about coverage, ask before you book. We'll give you a straight answer.
In-network insurance plans
Riverside Psychology is in-network with several major insurance carriers. Being in-network means your evaluation will be billed at contracted rates, reducing your out-of-pocket cost significantly compared to out-of-network providers.
Coverage varies by individual plan, and many plans require prior authorization before an evaluation can begin. We recommend calling the member services number on the back of your insurance card to confirm your specific neuropsychological testing benefit before scheduling.
Our team is glad to help answer questions about whether your plan is accepted and what prior authorization steps may be required.
Accepted Insurance Plans
infoRiverside Psychology is not in-network with any Medicaid plans. Not seeing your plan? Contact us to confirm whether your insurance is accepted and discuss options.
What to expect from your insurance
Understanding how neuropsychological evaluations are billed helps you plan ahead and avoid surprises.
Prior Authorization
Some insurance plans require prior authorization before a neuropsychological evaluation. In some cases, a referral confirming medical necessity may also be required. We recommend reviewing your insurance plan's specific requirements before scheduling to help ensure timely service and coverage approval.
How Evaluations Are Billed
Neuropsychological evaluations are billed using time-based CPT codes that reflect the hours of testing, scoring, interpretation, and report writing. Insurance reimbursement is based on your plan's allowed amount and your applicable deductible and coinsurance. Your explanation of benefits (EOB) will detail what your plan paid and what you owe.
Your Out-of-Pocket Cost
What you ultimately owe depends on your deductible, coinsurance, and out-of-pocket maximum. Some patients owe relatively little once their deductible is met; others with high-deductible plans may pay more. We encourage you to call your insurer in advance to understand your specific cost estimate before scheduling.
Self-pay options
For patients who are uninsured, out-of-network, or prefer to pay out of pocket, self-pay rates are available.
If you'd like to discuss self-pay fees before booking, please contact us directly. We'll give you a clear picture of what to expect.
Not using insurance?
Some patients choose to pay for their evaluation without going through insurance: to keep records private, to avoid the prior authorization process, or because their plan doesn't cover neuropsychological testing.
We believe cost shouldn't be a barrier to getting answers. If you have concerns about affordability, reach out before you decide not to schedule. There may be options worth discussing.
Forensic and IME billing
Forensic neuropsychological evaluations, including independent medical examinations (IMEs) and expert witness engagements, operate under a separate fee structure from clinical evaluations.
Forensic services are billed directly to the referring law firm or insurance carrier, not to the individual being evaluated. Health insurance is not applicable to forensic work.
Contact us for IME fee quotes.
Direct billing to law firms
Invoices for forensic evaluations and expert witness services are sent directly to the retaining party, not to the individual examinee.
Carrier billing for IMEs
Independent medical examination fees are billed to the insurance carrier or employer initiating the referral, consistent with standard IME practice.
Deposition and testimony fees
Expert witness testimony (deposition or trial) is billed at an hourly rate. Retainer arrangements are available for ongoing litigation support.
Common insurance questions
Medicare does cover neuropsychological testing when it is deemed medically necessary. Coverage is provided under Medicare Part B (outpatient) and is subject to your deductible and 20% coinsurance after the deductible is met. Prior authorization is generally not required under traditional Medicare, though Medicare Advantage plans may have different requirements. [CLIENT TO CONFIRM: Medicare acceptance and any plan-specific details]
In most cases, patients can self-refer for a neuropsychological evaluation. A referral from your physician or psychiatrist is not required to schedule. However, having a referral can be beneficial for insurance purposes, as some plans use a referral as part of the prior authorization process or as documentation of medical necessity. If you're unsure, check with your insurer or contact us and we'll help clarify.
If you are unsure whether a referral or prior authorization is needed, please contact your insurance provider directly by calling the number on the back of your insurance card or by checking online through their website. Our office is unable to verify these benefits on your behalf.
If a referral or prior authorization is required, it can be obtained through your primary care provider or an established treating specialist (such as a neurologist, psychiatrist, or therapist). They must submit documentation indicating that the evaluation is deemed medically necessary before insurance will provide coverage for the appointment.
