[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-501732-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-501732-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","neuropsychological-and-psychological-testing-policy-30124","Neuropsychological and Psychological Testing - Policy 3.01.24","","Defines when neuropsychological testing (NPT) is medically appropriate and when it is not medically necessary, including detailed clinical indications and conditions. Requires supervision and interpretation by qualified health professionals and use of results to guide treatment or rehabilitation planning. States exclusions such as use as a screening tool for asymptomatic individuals, repeat testing within two years, and testing while under substance influence or shortly after detoxification. Also specifies investigational uses and contract coverage review criteria.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/neuropsychological-and-psychological-testing-policy-30124/501732/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/neuropsychological-and-psychological-testing-policy-30124/501732.png","ImageObject",300,407,{"name":42,"@type":43},"Logic","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-09","2026-10-03",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What requirements must be met for neuropsychological testing (NPT) to be medically appropriate?","Question",{"text":63,"@type":64},"NPT must be supervised and interpreted by qualified health professionals, used after a comprehensive evaluation is insufficient for diagnosis, and provide information to guide treatment or rehabilitation planning. Testing must also be tied to specified clinical indications and evidence or suspicion.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"When is NPT considered not medically necessary?",{"text":68,"@type":64},"NPT is not medically necessary if a comprehensive clinical evaluation has not yet been performed, if used as a screening tool for asymptomatic individuals, or for repeat testing within two years. It is also excluded when test administration and scoring exceed publisher-established time plus interpretation time, or when the person is under the influence of substances or within 14 days post-detoxification without ruled-out substance effects.",{"name":70,"@type":61,"acceptedAnswer":71},"Which uses are considered investigational for neuropsychological testing?",{"text":72,"@type":64},"Computerized NPT is investigational when it does not require a physician, psychologist, or licensed mental health professional to provide interpretation and prepare a report. NPT is also investigational for diagnosing chronic traumatic encephalopathy (CTE).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},501732,1791046117,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146,"preview_page_count":4},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","MEDICAL POLICY  \n| Medical Policy Title | Neuropsychological and Psychological Testing |\n| --- | --- |\n| Policy Number | 3.01.24 |\n| Current Effective Date | April 29, 2026 |\n| Next Review Date | April 2027 |\n\nOur medical policies are guides to evaluate technologies or services for medical necessity. Criteria are established through the assessment of evidence based, peer-reviewed scientific literature, and national professional guidelines. Federal and state law(s), regulatory mandates and the member's subscriber contract language are considered first in the determination of a covered service.  \n( Link to Product Disclaimer)  \nPOLICY STATEMENT(S)  \nNeuropsychological Testing  \nI. Neuropsychological testing (NPT) is considered medically appropriate for the assessment of cognitive impairment due to a suspected medical or psychiatric condition(s) when ALL of the following criteria are met:  \nA. Testing is supervised and interpreted by qualified health professional (e.g., licensed psychologist, board certified in neuropsychology, neurologist, or psychiatrist with specialized training and expertise in the types of tests/assessment being requested);  \nB. When a comprehensive evaluation has been insufficient to establish or inform a diagnosis and additional testing is necessary; (See Policy Guidelines)  \nC. When testing is needed for the assessment of one or more of the following:  \n1. There has been a significant mental status change, behavior change, cognitive function change, memory loss, or organic brain dysfunction, resulting from illness or injury;  \n2. To establish a baseline for either of the following:  \na. prior to brain surgery (e.g., epilepsy surgery, tumor resection, deep brain stimulation); or  \nb. for individuals under the age of 26 who have been diagnosed with a pediatric cancer or brain tumor that affects, or whose treatment may affect, brain development or function;  \n3. When a child presents with significant failure to progress cognitively or behaviorally atan expected neurodevelopmental pace; or  \n4. When there is a lack of response to ongoing treatment and a licensed behavioral health provider has determined that NPT is needed for a definitive diagnosis;  \nD. Testing results are expected to provide information that will be used to effectively guide treatment or rehabilitation planning;  \nE. When there is clinical evidence or suspicion of any of the following clinical indications:  \n1. Acquired immunodeficiency syndrome (AIDS) encephalopathy;  \n2. Brain tumor;  \n3. Central nervous system (CNS) infection (e.g., herpes encephalitis, human immunodeficiency virus (HIV) infection);  \n4. Cerebral anoxic or hypoxic episode;  \n5. Cerebrovascular accident (stroke);  \n6. Concussion: when the functional impairment has not improved after 3-6 months of standard care;  \n7. Cyanotic congenital heart disease;  \n8. Dementia;  \n9. Demyelinating disorders (e.g., multiple sclerosis);  \n10. Epilepsy or seizure disorder;  \n11. Extrapyramidal disease (e.g., Parkinson’s, Huntington’s disease);  \n12. Metabolic encephalopathy;  \n13. Metabolic insult to the brain;  \n14. Mild cognitive impairment (MCI), when the functional impairment has not improved after 3-6 months of standard care;  \n15. Neurodevelopmental condition (e.g., attention deficit/hyperactivity disorder, autism spectrum disorder, dyslexia, fetal alcohol syndrome, intellectual disability, Tourette syndrome);  \n16. Neurotoxin exposure (e.g., lead poisoning, cranial irradiation, chemotherapeutic agents);  \n17. Post concussion syndrome: when the functional impairment has not improved after 3-6 months of standard care;  \n18. Post-operative assessment of cognitive functioning following an appropriate internal (3-6 months) to allow for healing and ruling out acute delirium;  \n19. Psychiatric disorder with overlapping neurological features where an accurate diagnosis is essential for treatment planning;  \n20. Traumatic brain injury, mild, when functional impairment has not improved after","cbCaiu0O0YSO2Dig","https://ap.wps.com/l/cbCaiu0O0YSO2Dig","pdf",337474,23,"English","# Policy Statement(s)\n## Neuropsychological Testing\n## Not Medically Necessary\n## Investigational Indications\n## Review for Medical Necessity When Primarily for Non-Treatment Requests","[{\"question\":\"What requirements must be met for neuropsychological testing (NPT) to be medically appropriate?\",\"answer\":\"NPT must be supervised and interpreted by qualified health professionals, used after a comprehensive evaluation is insufficient for diagnosis, and provide information to guide treatment or rehabilitation planning. Testing must also be tied to specified clinical indications and evidence or suspicion.\"},{\"question\":\"When is NPT considered not medically necessary?\",\"answer\":\"NPT is not medically necessary if a comprehensive clinical evaluation has not yet been performed, if used as a screening tool for asymptomatic individuals, or for repeat testing within two years. It is also excluded when test administration and scoring exceed publisher-established time plus interpretation time, or when the person is under the influence of substances or within 14 days post-detoxification without ruled-out substance effects.\"},{\"question\":\"Which uses are considered investigational for neuropsychological testing?\",\"answer\":\"Computerized NPT is investigational when it does not require a physician, psychologist, or licensed mental health professional to provide interpretation and prepare a report. NPT is also investigational for diagnosing chronic traumatic encephalopathy (CTE).\"}]","Neuropsychological and Psychological Testing - Policy 3.01.24 | PDF",1791024025,58]