Specialized Service Procedures |
Published: October, 2001
|
Psychological Testing Policy
Pre-authorization for Psychological Testing
Biofeedback
Psychological Testing Policy
Requests for psychological and/or neuro-psychological testing for patients, at any level of care, must meet PBH Medical Necessity criteria. PBH requires that testing be pre-authorized and provided by a licensed, doctoral-level clinical psychologist.
Psychological testing may be appropriate when:
- a specific clinical question cannot be answered through a comprehensive biopsychosocial evaluation, by a board-certified psychiatrist or through a specific medical work-up by a physician. It is appropriate that neuro-psychological testing take place as part of a comprehensive examination by a board-certified Neurologist. When neuro-psychological testing is ordered by a Neurologist, coverage would fall under the medical insurance plan.
- validated testing instruments exist that can be used to answer the clinical question; and
- the clinical question and the testing results will clearly affect the treatment plan; and
- the clinical question is not purely educational in nature. Testing of this sort is provided as part of a child's education under the Federal Education of Handicapped Children Act (PL 94-142).
Special note: Testing for ADD (with or without hyperactivity) would be appropriate if the proper use of observational checklists and a trial of medication have been inconclusive. Even then, only limited assessment of attention would typically be authorized. Neuropsychological test batteries are unnecessary unless there is a reason to believe that a genuine neurological disorder is present after a neurological evaluation has been performed.
Back to Top
Pre-authorization for Psychological Testing
Behavioral health assessment data is gathered through a variety of methods including observation, mental status examination and history taking. The provider's interpretation of that data can be supported by review of clinical literature and professional consultation. When these techniques do not resolve important clinical issues, psychological tests also can play a useful role.
To obtain referral for psychological testing, providers may call PBH to request that the member be referred to a licensed psychologist in the PBH provider network. A preliminary assessment interview can then be authorized. Before testing is initiated, the psychologist must complete the PBH Psychological Testing Authorization Request Form (see Index of Forms). To determine which testing measures will be requested, the psychologist may either consult with the referring therapist, or wait until completing the assessment interview with the member. Upon receiving the Testing Authorization Request, PBH will review the testing request according to the PBH Psychological Testing Protocol.
PBH authorizes psychological and neuropsychological testing in 15-minute increments. When testing is approved, an authorization letter will be sent informing the practitioner of the number of 15-minute units that have been authorized. Practitioners should bill using CPT codes 96100 (psychological testing) and 96117 (neuropsychological testing). Claims should include the specific names of all tests administered and the total number of units of service being billed. For example if testing took one hour, you should bill for 4 units.
Back to Top
Biofeedback
There is a scarcity of data regarding the usefulness and effectiveness of biofeedback with purely psychological conditions. PBH will not approve biofeedback as a treatment for ADHD/ADD. However, there is some data supporting its use with certain anxiety disorders. Biofeedback may also be appropriate for some conditions covered under the diagnosis of "Psychological Factors Affecting Physical Condition." Authorizations for biofeedback under these conditions will be based on PBH Medical Necessity criteria and are dependent on the presence of biofeedback as an included benefit in the member's benefit plan.
Back to Top
  | 
