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Clinical Policy Title: Neuropsychological testing

Clinical Policy Number: 09.01.08

Effective Date: October 1, 2015

Initial Review Date: June 17, 2015

Most Recent Review Date: July 3, 2018

Next Review Date: July 2019

Related policies:

CP# 09.01.02 Immediate post-concussion assessment and cognition testing (ImPACT)

CP# 15.02.02 Cognitive rehabilitation for traumatic brain injury

CP# 08.03.01 Bariatric surgery for children and adolescents

ABOUT THIS POLICY: AmeriHealth Caritas has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas’ clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by AmeriHealth Caritas when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas’ clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas’ clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas will update its clinical policies as necessary. AmeriHealth Caritas’ clinical policies are not guarantees of payment.

Coverage policy

AmeriHealth Caritas considers the use of neuropsychological testing to be clinically proven and, therefore,

medically necessary to determine the functional consequences of known or suspected brain dysfunction

when the following testing and clinical criteria are met (American Academy of Clinical Neuropsychology,

2007 and 1999; Puente, 2006):

Testing criteria (all criteria must be met):

- Standardized neuropsychological testing is based on published national normative data

with scoring that result in standardized or scaled scores. NOTE: Brief rating scales and

standardized questionnaires are not considered neuropsychological testing regardless

of how administered.

- Neuropsychological testing is administered by an appropriately state licensed provider

or by a trained technician who is under the direct supervision of the provider. NOTE:

Provider must have professional training and expertise in the types of

Policy contains:

Neuropsychological test.

Psychometric tests.

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neuropsychological testing/assessments being requested (e.g., board certified

neuropsychologist or neuro-behavioral psychiatrist).

- Neuropsychological testing consists of:

Record review.

Neurobehavioral status exam (CPT 96116).

Test selection.

Test administration (CPT 96118, CPT 96119, or CPT 96120).

Feedback session (CPT 96118).

Clinical criteria (any are considered medically necessary) (Department of Veterans Affairs and

Department of Defense, 2016; Silverman, 2015; American Academy of Child & Adolescent

Psychiatry, 2012; American Psychological Association, 2012; Bolea-Alamanac, 2014; Minden,

2014; Volkmar, 2014; McClellan, 2013; Echemendia, 2012; Wolraich, 2011; Heilbronner, 2009;

Miller, 2009):

- To assist diagnosis when neuropsychological data can provide a more comprehensive

profile of cognitive function along with clinical, laboratory, and imaging data.

- To document cognitive impairment as a requirement of the diagnosis (e.g., post-

concussion syndrome, Alzheimer’s disease, or intellectual disability).

- To quantify cognitive or functional potential, particularly when the information will be

useful in determining a prognosis (e.g., to predict recovery from medical or surgical

treatment that may affect brain function or functional status).

- To determine the member’s ability to comprehend and participate effectively in

complex treatment regimens (e.g., surgeries to modify facial appearance, hearing, or

tongue debulking in craniofacial or Down Syndrome members; transplant or bariatric

surgeries in members with diminished capacity).

- To assess cognitive or functional deficits in children and adolescents based on an

inability to develop expected knowledge, skills, or abilities as required to adapt to new

or changing cognitive, social, emotional, or physical demands.

- To assess the impact of medical therapies that may cause cognitive impairment (e.g.,

radiation, chemotherapy or antiepileptic medications).

- To characterize the cognitive strengths and weaknesses of an individual with a known

or suspected central nervous system disorder, as a guide to treatment or rehabilitation

planning.

- To monitor the progression of cognitive impairment secondary to central nervous

system disorders.

Limitations:

All other uses of neuropsychological testing are not medically necessary, including (Pottie, 2016; Moyer,

2014):

Medical indications (e.g., migraine headaches, myocardial infarction and chronic fatigue

syndrome) without suspected cognitive dysfunction.

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No clinical diagnosis or neurocognitive symptoms/behaviors suggestive of the need for this

testing.

Uncomplicated cases of suspected attention deficit disorder with/without attention deficit

hyperactivity disorder. NOTE: neuropsychological testing may be considered medically

necessary for neurologically complicated cases (e.g., post head trauma and seizures).

Presence of insufficient neurological and cognitive ability that prevents participation in a

meaningful way in the testing process.

When it does not directly contribute to or impact patient management.

Presence of active substance abuse, acute withdrawal symptoms, or recent recovery, which

may invalidate test results.

Screening asymptomatic individuals (e.g. for Alzheimer’s disease or baseline testing for sport-

related concussion).

Non-medical purposes (e.g., educational or vocational purposes that do not establish medical

management, driving risk, or forensic applications, or to solely evaluate malingering).

Up to 10 hours of neuropsychological testing is authorized for a member with acute brain insult when brain

damage is suspected; up to eight hours of neuropsychological testing is authorized for members with other

neurological conditions and suspected or demonstrated cognitive impairment (e.g., brain tumor in

remission or slowly progressing, dementia, multiple sclerosis).

The need for retesting will be reviewed on an individual, case-by-case basis to determine medical necessity.

Repeat testing is generally limited to one testing episode per 12 months, but may be performed earlier to

evaluate unexpected changes in neurocognitive symptoms occurring within the last four months, to

evaluate response to new treatment or when retesting is planned as part of the treatment plan to reassess

functioning.

Neuropsychological testing is generally not considered medically necessary for pre-surgical clearance.

However, an evaluation by a psychologist or psychiatrist may be required in certain circumstances (see CP

#08.03.02 Bariatric surgery for adults).

Neuropsychological testing requested for the evaluation of a mental health diagnosis (e.g., serious

psychiatric illness, alcohol and/or drug abuse) is considered medically necessary through the mental health

benefit. If neuropsychological testing or physical therapy is requested for evaluation of a medical diagnosis

(e.g., traumatic brain injury, stroke, differentiation of brain damage from a depressive disorder, epilepsy,

hydrocephalus, Alzheimer's disease, Parkinson disease, multiple sclerosis, or autoimmune deficiency

syndrome), it is considered medically necessary under the medical benefit.

Alternative covered services:

Psychological testing (CPT 96101, 96102, 96103).

Assessment of aphasia (CPT 09105).

Developmental screening (CPT 96110).

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Developmental testing (CPT 96111).

Background

Neuropsychology is a clinical field with specialized knowledge and training in the applied science of brain-

behavior relationships (American Board of Professional Psychology, 2015). Clinical neuropsychologists

employ psychological and behavioral methods to evaluate patients’ cognitive and emotional strengths and

weaknesses, and relate these findings to normal and abnormal central nervous system functioning.

Neuropsychological testing, also called psychometric assessment, provides an objective assessment of the

presence of brain damage, injury, or dysfunction and any associated functional deficits (Schwarz, 2014). In

other words, neuropsychological testing provides unique information on abilities, motivation, and potential

for future outcomes. Neuropsychological tests are performance-based in that they are structured to require

individuals to exercise their skills in the presence of an examiner/observer (Harvey, 2012).

Neuropsychological evaluations vary in content depending on their purpose but typically assess multiple

neurocognitive and emotional functions. They comprise measures that can be standardized or targeted to

the individual, scored objectively, and have established psychometric properties. The American Academy of

Clinical Neuropsychology (2007) lists the following primary cognitive domains:

Intelligence.

Academic functioning (e.g., reading, writing and math).

Receptive and expressive language skills (e.g., verbal comprehension, fluency, confrontation

naming).

Problem-solving and reasoning abilities.

Simple and complex attention.

Working memory.

Speed of processing.

Learning and memory (e.g., encoding, recall, and recognition).

Visuospatial skills.

Fine motor skills.

Executive functioning.

Ideally, assessments should also include measures designed to assess personality, social-emotional

functioning, and adaptive behavior (Harvey, 2012). Testing can be performed on an outpatient or inpatient

basis; the duration of testing depends on the question for which the referring practitioner seeks an answer

as well as clinical complexity. An evaluation generally takes between two and five hours to complete, but

can take up to eight hours. Measures typically are administered by paper and pencil, although computer-

based assessments are increasingly employed. Because of the influence of demographic variables (age, sex,

years of education, and race), scores are compared with normative samples that resemble those of the

patient’s background as closely as possible (Schwarz, 2014).

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Interpretation of test scores depends on expectations of how a patient should perform in the absence of

neurologic or psychiatric illness (i.e., based on normative data and performance-based estimates of

premorbid functioning). The overall pattern of intact scores and deficit scores can be used to form specific

impressions about an individual’s diagnosis, cognitive strengths and weaknesses, and strategies for

intervention (Schwarz, 2014).

Searches

AmeriHealth Caritas searched PubMed and the databases of:

UK National Health Services Centre for Reviews and Dissemination.

Agency for Healthcare Research and Quality’s National Guideline Clearinghouse and other

evidence-based practice centers.

The Centers for Medicare & Medicaid Services.

We conducted searches on May 15, 2018. Search terms were: "Neuropsychological Tests (MeSH)” and the

free text phrase “neuropsychological test.”

We included:

Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and

greater precision of effect estimation than in smaller primary studies. Systematic reviews use

predetermined transparent methods to minimize bias, effectively treating the review as a

scientific endeavor, and are thus rated highest in evidence-grading hierarchies.

Guidelines based on systematic reviews.

Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple

cost studies), reporting both costs and outcomes — sometimes referred to as efficiency studies

— which also rank near the top of evidence hierarchies.

Findings

Neuropsychological testing is well-established for a range of mental health and medical conditions, as

reflected in the high volume of systematic reviews; therefore, search results were limited to evidence-

based guidelines. We identified 22 evidence-based guidelines for this policy, and their recommendations

are summarized below (see References).

Guidelines support the use of standardized neuropsychological testing (Bolea-Alamanac, 2014; Minden,

2014; Volkmar, 2014; McClellan, 2013; American Academy of Child & Adolescent Psychiatry, 2012;

American Psychological Association, 2012; Echemendia, 2012; Wolraich, 2011; Heilbronner, 2009; Miller,

2009; American Psychiatric Association, 2006):

With established psychometric properties based published national normative data, with

scoring resulting in standardized or scaled scores.

In patients:

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- With an illness or injury known to be associated with impairments in cognitive or brain

development (e.g., degenerative dementias or traumatic brain injuries).

- With reported impairments in cognitive functioning.

- In whom evaluations of cognitive function are part of the standard of care for

treatment selection and treatment outcome evaluations.

- In whom documentation of cognitive impairment is a requirement of the diagnosis

(e.g., post-concussion syndrome, Alzheimer’s disease, or intellectual disability).

To help distinguish between cognitive disorders and malingering or factitious disorders.

Complex neuropsychiatric conditions with the potential to induce changes in mood or

motivational states can result in secondary impacts on cognitive functioning; these cognitive

changes require a neuropsychological assessment that incorporates other factors potentially

contributing to impaired cognitive functioning.

For a range of mental health and medical conditions with typical patterns of cognitive deficits

including Alzheimer’s disease, schizophrenia, bipolar disorder, major depressive disorder, and

autism.

Other clinical conditions for which neuropsychological testing may be medically necessary include, but are

not limited to:

Cerebrovascular disease (in the recovery/rehabilitation phase following significant clinical

recovery when there is still evidence of cognitive impairment or as a guide to rehabilitation and

treatment planning).

Other forms of dementia.

Parkinson's disease.

Human immunodeficiency virus encephalopathy.

Multiple sclerosis.

Epilepsy (as part of pre-surgical treatment planning).

Neurotoxic exposure.

Hypoxic brain injury.

Traumatic brain injury.

Chronic pain (when used to assess personality and mood or to perform a cognitive assessment

if symptoms indicate intellectual disturbances after discontinuation of pain-relieving or

psychotropic medications).

Neurologic disease (when used as an adjunctive personality assessment for identified or

suspected brain disorders, such as brain tumors and hypoxic brain injury).

Guidelines do not support the use of neuropsychological testing for:

Diagnosing uncomplicated attention deficit disorder/attention deficit hyperactivity disorder.

Heterogeneous neuropsychological profiles of attention deficit hyperactivity disorder and lack

of meaningful associations between its symptoms and neuropsychological deficits limit the

predictive value and diagnostic utility of neuropsychological testing. However,

neuropsychological testing may be medically necessary for persons with emotional or

behavioral (e.g., anxiety, depressive, oppositional defiant, and conduct disorders),

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developmental (e.g., learning and language disorders or other neurodevelopmental disorders)

and physical (e.g., tics and sleep apnea) conditions that may coexist with attention deficit

hyperactivity disorder.

Screening for cognitive deficits in asymptomatic populations.

Assessing the functional importance of changes on advanced neuroimaging (e.g., detection of

“silent” ischemic changes or degenerative changes) in the absence of neurocognitive

dysfunction, as there is insufficient evidence to correlate any functional importance to these

clinical changes.

Who may perform neuropsychological testing?

The widespread use of neuropsychological testing has led to questions about who should administer the

tests and who should interpret the results. A licensed psychologist, who has explicit training in

neuroscience and neurological bases of behavior in accordance with American Psychological Association

standards of practice, typically conducts or supervises neuropsychological testing (American Academy of

Clinical Neuropsychology, 2007). Clinical psychologists who perform neuropsychological testing must

demonstrate their competence through board certification (e.g., the American Board of Clinical

Neuropsychology).

Alternatively, a neuro-behavioral psychiatrist with certification in neurology through the American Board of

Psychiatry and Neurology, or accreditation in behavioral neurology and neuropsychiatry through the

American Neuropsychiatric Association may provide neuropsychological testing when both of the following

criteria are met (American Academy of Clinical Neuropsychology, 2007):

The provider has professional training and expertise in the types of tests/assessment being

requested.

The provider can conduct test administration, scoring, and interpretation in accordance with

currently prevailing national professional and ethical standards regarding provision of

neuropsychological testing services.

The licensed psychologist or other qualified care provider must have face-to-face contact with the patient

being tested, at a minimum at both an initial intake interview visit and at the testing feedback visit, and

they must interpret the test and write (and sign) the report (Puente, 2006; American Academy of Clinical

Neuropsychology, 1999). However, an appropriately trained psychometrist or psychometrician may

administer and score testing under their supervision.

Policy updates:

We identified one new guideline from the Canadian Task Force on Preventive Health Care (Pottie, 2016).

Building on previous U.S. Preventive Services Task Force recommendations for screening older adults for

cognitive impairment (Moyer, 2014), Pottie (2016) found insufficient evidence to support screening for

cognitive impairment in older asymptomatic adults. Screening for cognitive impairment is associated with a

potentially high false-positive rate, and treatment of mild cognitive impairment that may be detected on

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screening has not shown to produce a clinically meaningful benefit. These results do not change previous

findings, and no changes to the policy are warranted.

In 2017, we identified one new joint guideline from the Department of Veterans Affairs and Department of

Defense Evidence-Based Practice Working Group (2016) on the management of concussion-mild traumatic

brain injury. In this population, they recommend a limited role for neuropsychological testing in the

immediate post-concussive period, instead favoring symptom-based clinical guidance and best practices in

most cases. The diagnosis of mild traumatic brain injury is a clinical diagnosis, which, in many cases, relies

on history alone, and most symptoms of concussion will develop immediately after the concussion. Well-

controlled, long-term natural history studies after concussion injuries are lacking, and the diagnostic utility

of information on cognitive functioning in the post-acute period is not clear.

For persons with refractory symptoms persisting 30 to 90 days after mild traumatic brain injury, they made

a weak recommendation for referral, as appropriate, for a structured cognitive assessment or

neuropsychological assessment to determine functional limitations and guide treatment. For patients who

present to care with symptoms or complaints potentially related to brain injury, they recommended

strongly against using comprehensive and focused neuropsychological testing, including Automated

Neuropsychological Assessment Metrics, Neuro-Cognitive Assessment Tool, or Immediate Post-Concussion

Assessment and Cognition Testing, routinely in diagnosis and care. They acknowledged a need for

diagnostic accuracy studies of cognitive and neuropsychological testing in persons with concussion-mild

traumatic brain injury. These results are consistent with the current policy. No policy changes are

warranted.

In 2018, we updated the American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation

of Adults (Silverman, 2015 replaces American Psychiatric Association, 2006). No policy changes are

warranted.

Summary of clinical evidence:

Citation Content, Methods, Recommendations

Pottie (2016) for the

Canadian Task Force on

Preventive Health Care

Screening asymptomatic

older adults for cognitive

impairment

Key points:

Updated literature search based on Moyer (2014) published from December. 8, 2012 to

November 7, 2014 for randomized controlled trials (RCTs). No RCTs found.

Recommend against screening asymptomatic adults ≥ 65 years for cognitive

impairment based on lack of high-quality evidence of the benefits/harms of screening,

evidence of treatment ineffectiveness for mild cognitive impairment, and on the

potentially high rate of false-positive screens.

Practitioners should consider cognitive assessment for patients with signs and

symptoms of impairment or when family members or patients express concerns about

potential cognitive decline.

VA/DoD (2016)

Key points:

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Citation Content, Methods, Recommendations

Management of concussion-

mild traumatic brain injury

(mTBI)

Strong recommendation against performing comprehensive

neuropsychological/cognitive testing during the first 30 days following mTBI.

For patients with symptoms persisting 30 to 90 days and have been refractory to

treatment for associated symptoms (e.g., sleep disturbance or headache), weak

recommendation for being referred, as appropriate, for a structured cognitive

assessment or neuropsychological assessment to determine functional limitations and

guide treatment.

For patients with new symptoms that develop more than 30 days after mTBI, weak

recommendation for a focused diagnostic work-up specific to those symptoms only.

For patients identified by post-deployment screening or who present to care with

symptoms or complaints potentially related to brain injury, strong recommendation

against using the following tests in routine diagnosis and care of patients with symptoms

attributed to mTBI: comprehensive and focused neuropsychological testing, including

Automated Neuropsychological Assessment Metrics, Neuro-Cognitive Assessment

Tool, or Immediate Post-Concussion Assessment and Cognition Testing.

References

Professional society guidelines/other:

American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and

treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc

Psychiatry. Jan 2012; 51(1): 98 – 113. DOI: 10.1016/j.jaac.2011.09.019.

American Academy of Clinical Neuropsychology Practice Guidelines for Neuropsychological Assessment and

Consultation. The Clinical Neuropsychologist. 2007; 21(2): 209 – 231. DOI: 10.1080/13825580601025932.

American Academy of Clinical Neuropsychology Policy on the Use of Non-Doctoral-Level Personnel in

Conducting Clinical Neuropsychological Evaluations. The Clinical Neuropsychologist. 1999/11/01 1999;

13(4): 385 – 385. DOI: 10.1076/1385-4046(199911)13:04;1-Y;FT385.

American Psychological Association. Guidelines for the evaluation of dementia and age-related cognitive

change. Am Psychol. Jan 2012; 67(1): 1 – 9. DOI: 10.1037/a0024643.

Bolea-Alamanac B, Nutt DJ, Adamou M, et al. Evidence-based guidelines for the pharmacological

management of attention deficit hyperactivity disorder: update on recommendations from the British

Association for Psychopharmacology. J Psychopharmacol. Mar 2014; 28(3): 179 – 203. DOI:

10.1177/0269881113519509.

Echemendia RJ, Iverson GL, McCrea M, et al. Role of neuropsychologists in the evaluation and management

of sport-related concussion: an inter-organization position statement. Arch Clin Neuropsychol. Jan 2012;

27(1): 119 – 122. DOI: 10.1093/arclin/acr077.

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Heilbronner RL, Sweet JJ, Morgan JE, et al. American Academy of Clinical Neuropsychology Consensus

Conference Statement on the Neuropsychological Assessment of Effort, Response Bias, and Malingering.

The Clinical Neuropsychologist. 2009; 23(7): 1093 – 1129. DOI: 10.1080/13854040903155063.

McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with

schizophrenia. J Am Acad Child Adolesc Psychiatry. Sep 2013; 52(9): 976 – 990. DOI:

10.1016/j.jaac.2013.02.008.

Michels TC, Tiu AY, Graver CJ. Neuropsychological evaluation in primary care. American family physician.

Sep 1 2010; 82(5): 495 – 502. Available at: https://www.aafp.org/afp/2010/0901/p495.html. Accessed May

15, 2018.

Miller RG, Jackson CE, Kasarskis EJ, et al. Practice parameter update: the care of the patient with

amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral

impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American

Academy of Neurology. Neurology. Oct 13 2009; 73(15): 1227 – 1233. DOI:

10.1212/WNL.0b013e3181bc01a4.

Minden SL, Feinstein A, Kalb RC, et al. Evidence-based guideline: assessment and management of

psychiatric disorders in individuals with MS: report of the Guideline Development Subcommittee of the

American Academy of Neurology. Neurology. Jan 14 2014; 82(2): 174 – 181. DOI:

10.1212/wnl.0000000000000013.

Moyer VA. Screening for cognitive impairment in older adults: U.S. Preventive Services Task Force

recommendation statement. Ann Intern Med. Jun 3 2014; 160(11): 791 – 797. DOI: 10.7326/m14-0496.

Pottie K, Rahal R, Jaramillo A, et al. Recommendations on screening for cognitive impairment in older

adults. CMAJ. 2016; 188(1): 37 – 46. DOI: 10.1503/cmaj.141165.

Puente AE, Adams R, Barr WB, et al. The use, education, training and supervision of neuropsychological test

technicians (psychometrists) in clinical practice. Official statement of the National Academy of

Neuropsychology. Arch Clin Neuropsychol. Dec 2006; 21(8): 837 – 839. DOI: 10.1016/j.acn.2006.08.011.

Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services

Task Force Recommendation Statement. Pediatrics. Apr 2009; 123(4): 1223 – 1228. DOI:

10.1542/peds.2008-2381.

Silverman JJ, Galanter M, Jackson-Triche M, et al. The American Psychiatric Association Practice Guidelines

for the Psychiatric Evaluation of Adults. American Journal of Psychiatry. 2015; 172(8): 798 – 802. DOI:

10.1176/appi.ajp.2015.1720501.

VA/DoD clinical practice guideline for the management of concussion-mild traumatic brain injury. Version

2.0. February, 2016. Department of Veterans Affairs website.

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https://www.healthquality.va.gov/guidelines/Rehab/mtbi/mTBICPGFullCPG50821816.pdf. Accessed May

15, 2018.

Volkmar F, Siegel M, Woodbury-Smith M, et al. Practice parameter for the assessment and treatment of

children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. Feb 2014;

53(2): 237 – 257. DOI: 10.1016/j.jaac.2013.10.013.

Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and

treatment of attention-deficit/hyperactivit y disorder in children and adolescents. Pediatrics. Nov 2011;

128(5): 1007 – 1022. DOI: 10.1542/peds.2011-2654.

Peer-reviewed references:

American Board of Professional Psychology. Specialty Definition. Definition of a Clinical Neuropsychologist.

American Board of Professional Psychology website.

http://www.abpp.org/i4a/pages/index.cfm?pageid=3400. Accessed May 15, 2018.

Harvey PD. Clinical applications of neuropsychological assessment. Dialogues in clinical neuroscience. Mar

2012; 14(1): 91 – 99. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341654/. Accessed

May 15, 2018.

Schwarz L RP, Grossberg GT. Evidence-Based Reviews. Answers to 7 questions about using

neuropsychological testing in your practice. Current Psychiatry. 2014 March; 13(3): 33 – 39. Available at:

https://www.mdedge.com/psychiatry/article/80614/practice-management/answers-7-questions-about-

using-neuropsychological/page/0/1. Accessed May 15, 2018.

CMS National Coverage Determination (NCDs):

No NCDs identified as of the writing of this policy.

Local Coverage Determinations (LCDs):

A55771 Psychological and neuropsychological tests revision to the Part A and B LCD. CMS website.

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=55771&ver=3.

Accessed May 15, 2018.

L34646 Psychological and Neuropsychological Testing. CMS website. https://www.cms.gov/medicare-

coverage-database/details/lcd-details.aspx?LCDId=34646&ver=12. Accessed May 15, 2018.

L34520 Psychological and Neuropsychological Tests. CMS website. https://www.cms.gov/medicare-

coverage-database/details/lcd-details.aspx?LCDId=34520&ver=11. Accessed May 15, 2018.

Commonly submitted codes

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Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not

an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill

accordingly.

CPT Code Description Comment

96116

Neurobehavioral status exam (clinical assessment of thinking, reasoning and

judgment, e.g., acquired knowledge, attention, language, memory, planning

and problem solving, and visual spatial abilities), per hour of the psychologist's

or physician's time, both face-to-face time with the patient and time interpreting

test results and preparing the report

96118

Neuropsychological testing (e.g., Halstead-Reitman Neuropsychological

Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour

of the psychologist's or physician's time, both face-to-face time administering

tests to the patient and time interpreting test results

96119

Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery,

Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified

health care professional interpretation and report, administered by technician,

per hour of technician time, face-to-face

96120 Neuropsychological testing (e.g., Wisconsin Card Sorting Test), administered

by a computer, with qualified health care professional interpretation and report

96125

Standardized cognitive performance testing (e.g., Ross Information Processing

Assessment) per hour of a qualified health care professional's time, both face-

to-face time administering tests to the patient and time interpreting these test

results and preparing the report

ICD-10 Code Description Comment

N/A

HCPCS

Level II Code Description Comment

N/A