Navigating the insurance world can be daunting, especially when you're seeking reimbursement for important assessments for your child. This step-by-step guide aims to simplify the process. Checking whether your insurance will reimburse assessments is crucial for several reasons:

• Assessments, depending on their nature and scope, can be expensive.

• Understanding your insurance coverage lets you make informed decisions about your healthcare or other necessary services.

• Dr. Greenfield is out-of-network for all insurance plans. Out-of-network Coverage rates vary, and will depend on your individual policy. ​

​

SUGGESTED STEPS TO NAVIGATING INSURANCE REIMBURSEMENT:

1. Start by Talking to your Pediatrician/Primary Care Provider

•  When relevant to your concerns, having a script in hand from your pediatrician for a psychological or neuropsychological assessment for medical treatment purposes can help support a potential insurance policy reimbursement. 

  • Note: Applicable concerns will typically relate to your child's development, such as cognitive/behavioral symptoms related to neurodevelopmental disorder that potentially require medical treatment (e.g., ADHD, Anxiety, Autism, Tics/OCD, etc).  Insurance will NOT cover targeted assessments related to specific academic functioning or learning disorder alone (e.g., Dyslexia assessment). 

​

2. Contact Your Insurance Company

•  Before beginning the assessment, we recommend contacting your insurance company to understand what your policy covered under "out-of-network" psychological or neuropsychological testing. If you one, mention any scripts provided to you by your child's doctor (see above).  Coverage information (typically given as a percentage) will dictate how much of your assessment fee may reimbursed.

• During the call, your insurance representative may ask you for the  Current Procedural Terminology "CPT" codes associated with the assessment services. Providing your representative with the CPT code listed below are essential identifiers that your insurance company uses to determine the reimbursable amount for each service. ​

  • CPT Code: 90791 for the intake appointment (1-2 hours)

  • CPT Code: 96136     for testing (first unit only)

  • CPT Code: +96137  for additional testing hours (up to 10 hours)

  • CPT Code: 96132     for the parent feedback session (1 hour)

  • CPT Code: +96133  for the child feedback session (1 hour)

  • CPT Code: +96133  for scoring and report writing hours 

• Some insurance policies may require pre-authorization for assessments. Make sure you ask about any necessary permissions you must have in place prior to scheduling your assessment.

​

3.  Seeking Reimbursement After Your Assessment

• While Dr. Greenfield does not bill insurance companies directly, we understand the significance of easing the reimbursement process for our families.  Once all of your assessment and feedback appointments are completed,  we provide a comprehensive superbill. This itemized form details the services you've received and confirms that you have paid for the assessment in full; it is designed specifically to be submitted to insurance companies for reimbursement.

​