Does Insurance Cover Psychological Testing?

The short answer is “sometimes — and the only way to know is to ask your insurance directly using the right CPT codes.”

The long answer involves a tangle of plan rules, medical necessity criteria, and a particular wrinkle around ADHD testing that catches most people off guard. Here’s how to actually find out what your plan covers — and what to do if it doesn’t.

Why “It Depends” Is the Honest Answer

Insurance coverage for psychological testing varies along three dimensions.

The carrier. Aetna, Anthem/BCBS, Cigna, United, Kaiser, and the various Medicaid plans all have different policies for testing. Some are testing-friendly; others are restrictive.

Your specific plan. Even within one carrier, individual plans differ. Your employer’s plan with Cigna may cover testing fully while a different Cigna plan excludes it. Self-funded employer plans are particularly variable.

What’s being tested. Most plans treat psychological testing for established mental health diagnoses (depression, anxiety, PTSD, personality disorders, diagnostic clarification) more favorably than testing for ADHD or learning disorders. The reasoning is that some plans classify ADHD and learning-disability testing as “educational” rather than “medical” and exclude it on that basis.

This is why a friend’s experience with the same insurance company isn’t predictive of yours. The only reliable answer comes from calling your insurer.

The CPT Codes You’ll Need

When you call your insurance, the question to ask is whether they cover the following codes:

Code	What it covers
96130	Psychological testing evaluation services, first hour
96131	Each additional hour of psychological testing evaluation
96132	Neuropsychological testing evaluation, first hour
96133	Each additional hour of neuropsychological testing
96136	Test administration and scoring by a psychologist, first 30 minutes
96137	Each additional 30 minutes of test administration and scoring

A comprehensive evaluation typically bills several of these codes. For an adult ADHD eval, you might see 96130 + 96131 + 96136 + 96137 on the same claim. Ask whether each is covered.

Other Questions to Ask Your Insurance

While you have them on the phone:

• Is psychological testing covered at all under my plan? Some plans simply exclude it.
• Is ADHD testing specifically covered? Ask this even if the answer to the first question was yes — some plans cover general psychological testing but carve out ADHD.
• Is there a deductible I need to meet first? And how much have I met so far this year?
• What’s the copay or coinsurance after the deductible?
• Is pre-authorization required? Many plans require the clinician to submit medical necessity documentation before testing.
• Is a referral required from primary care? Less common but not unheard of.
• Are there session limits? Some plans cap covered testing at a set number of hours.

Get the representative’s name and a reference number for the call. Insurance customer service tells different stories on different days.

In-Network vs. Out-of-Network vs. Cash-Only

In-network means the provider has a contract with your insurance. You pay your plan’s copay/coinsurance; the provider bills insurance directly. Lowest out-of-pocket cost, but the trade-off is that in-network providers typically have longer waitlists (insurance reimbursement rates are low, so the practices that accept it are oversubscribed) and may bill hourly rather than offering flat-rate batteries.

Out-of-network with superbills means the provider doesn’t contract with your insurance but will give you an itemized receipt — a superbill — that you submit to insurance for partial reimbursement. You pay the provider up front; reimbursement (if any) comes from insurance to you. Out-of-network reimbursement rates range from 0% (some PPO plans, all HMO plans) to 80% (generous PPO plans with low deductibles). The advantage: shorter waitlists, transparent flat-rate pricing, and provider choice. The disadvantage: you carry the cash flow risk.

Cash-only / private pay means the provider doesn’t engage with insurance at all. Common for boutique assessment practices and forensic work. You pay flat-rate; no superbill, no reimbursement path.

FRTC is out-of-network for commercial insurance — we provide itemized superbills with the CPT codes above for you to submit for out-of-network reimbursement.

Colorado-Specific Notes

A few things worth knowing if you’re testing in Colorado:

Colorado Access (Medicaid) generally covers the clinical interview component of psychological evaluations. Coverage for the testing batteries themselves under Medicaid is variable and depends on the specific covered population, the CPT codes being billed, and whether the provider is a Medicaid-credentialed psychologist or a different license type. Call Colorado Access member services to confirm before you book.

Kaiser Permanente members generally need to receive psychological testing through Kaiser’s internal clinicians — Kaiser typically does not reimburse out-of-network testing.

Self-funded employer plans (TPA-administered, often with names like Anthem or Cigna on the card but actually self-funded by your employer) follow your employer’s specific coverage rules, which can differ from the carrier’s standard plan.

If Insurance Won’t Cover It

If your plan excludes psychological testing — or excludes the specific testing you need — you have a few options:

Pay out of pocket. Many people do, particularly for ADHD evaluations where insurance coverage is unreliable. Denver private-pay pricing ranges from about $900 (training clinics) to $5,000+ (boutique practices). FRTC’s published price list sits in the middle of that range with flat rates.

HSA / FSA. Health savings accounts and flexible spending accounts can typically pay for psychological testing as a qualified medical expense, even when insurance won’t reimburse it. Confirm with your plan administrator.

Sliding scale. Some practices, including FRTC, hold a small number of reduced-fee slots each quarter for clients with documented financial hardship. Ask during your consultation.

Wait and stack. If you’re close to your deductible — for an unrelated medical event later in the year, for instance — you may be able to time testing to take advantage of after-deductible coverage. This requires planning and isn’t always possible.

Negotiate the report scope. Sometimes a focused diagnostic clarification interview ($750–$1,000) is enough to answer the specific question you have, even when a full battery isn’t financially feasible. Talk to the evaluator about what you actually need the report to accomplish.

The Bottom Line

Call your insurance with the CPT codes above before you book. Take the rep’s name and a reference number. Ask the specific testing question — psychological testing for a specific diagnostic concern is different from ADHD-specific testing in most plans’ eyes. And know that “no” from insurance doesn’t have to mean no testing — superbills, HSAs, sliding-scale, and tighter-scope evaluations all keep the door open.

If you’re considering testing at FRTC, our psychological testing service page has the full price list and what’s covered. We’re happy to walk through insurance questions on a free 15-minute consultation call.