Fees

Insurance may cover part or all of the evaluation depending on the referral question, the child’s medical history, and the child’s medical insurance. The only insurer with whom we participate is Capital District Physicians Health Plan (CDPHP). Other insurers may cover part or all of the evaluation out of network, but that is not guaranteed. If you do not have CDPHP insurance and you are interested in seeking insurance reimbursement, we encourage you to contact your insurer and ask about out-of-network reimbursement for the following procedure codes:

96116 Neurobehavioral status exam
96136 Neuropsychological testing – first 30 min
96137 Neuropsychological testing – additional 30 min
96132 Neuropsychological testing evaluation services – first hour
96133 Neuropsychological testing evaluation services – additional hour

We will provide you with documentation, at your request, that you may use to support an insurance claim.

Note that insurance companies typically will not cover services for academic evaluations, school observations, school meetings, or fees for missed appointments.

We also accept out-of-pocket payments for those who do not wish to use their insurance policy or when insurance will not pay for the evaluation. The cost of the evaluations varies depending on the referral question and the age of the child. The range is approximately $2500 to $4000.