Evaluation Fees depend upon location and the type of services. All evaluations investigate your diagnosis even if the referral question is not well understood by you or by your doctor. For example, an adult stating, “I think I have ADHD” may have anxiety, autism, or another disorder altogether such as depression etc. causing their issues with attention. Our evaluations look for the cause of your symptoms, which, in some cases, may not be what you expect.
When evaluations or a referral questions have a medical component or a potential medical component it is always classified as a neuropsychological evaluation which is more in depth, more time consuming, and thus more expensive. Examples include seizures, traumatic brain injuries (TBI), multiple sclerosis, memory problems, cognitive problems etc.
Anytime your evaluation has a legal component such as the CA Bar Exam Accommodations, MCAT Accommodations, GRE Accommodations, SAT Accommodations, LSAT Accommodations etc., family law, criminal law, probate law, or if it is “court ordered” etc. it is considered a forensic case for fee purposes, and it is much more time consuming, litigious, and thus more expensive. IEE’s also fall under this category in some cases. The more time consuming, the greater the evaluation fees.
Evaluation fees & pricing model:
Evaluation Fees Forensic:
Forensic Evaluations can be psychological or neuropsychological. Anytime a case that involves any form of accommodations [lower end is for broad psychological issues, not cognitive], family law, criminal law, court ordered evaluations, and any form of disability, workplace exemptions etc. it is priced as forensic. Almost any family law or legal case is $5000.00.
Typical Costs: $5,000.00-$6,000.00.
Additional Forensic Work: Court Testimony for Forensic & Court Based Neuropsych Testing: $400 per hour, Portal to Portal/ Wait Time. Deposition charges are ($400 hourly, no minimum). Court testimony is $400.00 per hour with a 4-hour or half-day minimum. Out of area related travel is billed $400.00 hourly. Record review in excess of 100 pages is $400.00 per clinical hour.
**Expedited report fees ($600.00-$1,100).
Evaluation Fees Neuropsychological:
Any evaluation where there are complicated medical and/or psychological, and/or cognitive issues. Examples include: learning disorders/disabilities (LD) [e.g., dyslexia, dyscalculia, agraphia], traumatic brain injury (TBI) and/or post concussion syndrome, autism spectrum disorders for children, “school problems,” medical issues, cysts, seizures, strokes, memory problems, executive dysfunction, prodromal schizophrenia etc.
Typical Costs: $5,000.00.
Evaluation Fees Child & Adult Autism :
Children usually require in depth cognitive testing while adults usually do not.
Typical Costs: $4,500.00-$5000.00
Evaluation Fees ADHD/ADD:
College or high school level ADHD evals, and differential diagnosis for most affective, anxiety, and/or bipolar spectrum disorders usually fall under this category. Childhood ADHD evaluations are more comprehensive and fall under general neuropsychology.
Typical Costs: $5,000.00
Evaluation Fees Learning Disorders:
Learning disorders/disabilities (LD) [e.g., dyslexia [reading disorder], dyscalculia mathematics disorder], agraphia [disorder of written expression]. These evaluations are for diagnostics.
Typical Costs: $5,000.00
Evaluation Fees Psychological / Mental Health:
No confirmed or potential medical and/or confirmed or potential neurological issues. Minimal to no cognitive testing. Targeted and abbreviated testing for non-accommodation or non-legal related issues. Price can increase if your university or school requires more in-depth testing. College or high school level ADHD evals, adult autism w/o medical complications, and differential diagnosis for most affective, anxiety, and/or bipolar spectrum disorders usually fall under this category.
Typical Costs: $4,500.00-$5,000.00
Insurance Reimbursement: Your insurance, if it is a PPO plan, may give you some reimbursement for a neuropsych evaluation. Typically, with standard out of network benefits, you will receive 65% of the contracted rate which is around $500.00-$600.00 total.
Best Case Scenario: Sometimes you can obtain an out of network exemption, and receive approximately $900.00-$1,300.00. We will bill the insurance company for you if requested through our clearing house. However, our fees are due up front on the first visit. The check from the insurance company will be sent to you. If it is sent to us, we will cut you a check for that amount. Some insurances have paid up to $4,000.00 such as those in like Apple, Google, and other tech-related firms in Silicon Valley, or when an insurance plan has specialized autism services provisions.
Worst Case Scenario: HMO’s, Kaiser, or insurances that require “pre-authorization” will not reimburse you. You can fight them after the fact, especially if they do not have providers.
Below are the codes you can use to inquire about your insurance coverage and out of network coverage. Please use both the probable diagnostic code, and the procedure codes as well.
Diagnostic Codes (Updated ICD-10):
- Learning Disabilities are NEVER covered by insurance, neither are court-related, court-ordered, or accommodation evaluations
- 314.00 (F90.0) ADHD
- 299.00 (F84.0) Autism
- 294.9 (F09) Cognitive Problems (e.g., Brain Injury, Complicated Medical Concerns)
- 312.81 (F91.1) Behavior Problems
- 311 (F32.9) Depression
- 300.00 (F41.9) Anxiety
- 296.80 (F31.9) Bipolar Disorder
- 295.90 (F20.9) Schizophrenia
*Additional diagnostic codes can be found by searching the disorder you are inquiring about + “ICD-10 code” on Google.
Neuropsych Evaluation Current Procedural Terminology Codes: (CPT)
***CPT Codes have changed as of 2019. Here is the new list of codes! We do not release EIN or SS Numbers to patients.
90791 -Diagnostic Interview
96116 – Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face- to-face time with the patient and time interpreting test results and preparing the report; first hour.
96136 –Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes
96137 –Each additional 30 minutes (List separately in addition to code for primary procedure)
96132 -Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96133 – Each additional hour (List separately in addition to code for primary procedure)
This is not an exhaustive list of codes.
More here: https://www.apaservices.org/practice/reimbursement/health-codes/testing/codes-descriptions.pdf