Insurance may cover part or all of the evaluation depending on the referral question, the child’s medical history, and insurance coverage. 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:
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Neuropsychological Evaluations (for acquired or active neurological conditions such as brain injury, epilepsy, stroke, tumors, cancer treatment)
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96116 Neurobehavioral status exam
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96136 Neuropsychological testing by psychologist – first 30 min
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96137 Neuropsychological testing by psychologist – additional 30 min
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96138 Neuropsychological testing by technician – first 30 min
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96139 Neuropsychological testing by technician – additional 30 min
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96132 Neuropsychological evaluation services – first hour
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96133 Neuropsychological evaluation services – additional hour
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Psychological Evaluations (for neurodevelopmental conditions such as ADHD, autism spectrum disorder, learning disabilities, and psychiatric conditions such as anxiety, mood disorders, and behavioral issues):​
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90791 Psychiatric diagnostic evaluation
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96136 Psychological testing by psychologist – first 30 min
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96137 Psychological testing by psychologist – additional 30 min
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96138 Psychological testing by technician – first 30 min
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96139 Psychological testing by technician – additional 30 min
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96130 Psychological evaluation services – first hour
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96131 Psychological evaluation services – additional hour
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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 testing (reading, writing and math), 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. Evaluations costs vary based on the referral question and the child's age. The range is approximately $2500 to $4000.