Insurance Codes and Questions: In-network patients


Insurance plans are extremely complicated.

These codes are provided as a courtesy without guarantee of coverage or cost.

1) Call your insurance company and ask about your mental health benefits for psychological testing.

2) Be prepared to request the following codes (the codes vary by evaluation type and medical history) when calling your insurance company. Let them know this is being conducted as out-patient at an office.

3) Make sure that Autism and ADHD are covered diagnosis, or the claims will be denied and the cost of the evaluation will increase.

4) Ask about your remaining out of pocket max, deductible, co-insurance, and copay for these codes:

* For Neuropsychological Evaluations (significant medical history, such as seizures, genetic conditions, head injury, hydrocephalus, fetal exposure to drugs or toxins, lead exposure, extremely low birth weight, extreme premature birth, concussions, sleep apnea, brain surgery, brain tumors, or cancer treatment, etc...)

Diagnosis Code: G93.40

CPT Codes: 96116, 96132, 96136

*For Psychological Evaluations (no medical history: ADHD, Autism, Anxiety, etc)

Diagnosis Code: Depends on the diagnosis we are primarily exploring, usually the primary concern has something to do with ADHD (F90.2) or Autism spectrum (F48.0).

CPT Codes: 90791, 96130, 96136