Guidelines for:
Psychological Testing
Psychological testing for emotional and behavioral problems is appropriate for differential diagnosis, determining the presence of
personality disorders in addition to clinical syndromes, and/or for when treatment is not progressing after sufficient use of evidence-based
treatment. A thorough clinical interview and history are the necessary star ting points for diagnosis and treatment planning but they are
not of sufficient reliability to make a valid diagnosis in all cases. An accurate diagnosis is essential for appropriate treatment.
A referral for psychological testing should include:
1. Presenting problems.
2. Diagnostic questions to be answered.
3. A list of the tests that will be used to answer the diagnostic questions and the amount of time needed for each test. The
tests chosen should be appropriate, reliable and valid for answering the diagnostic questions. Standard test batteries are
not recommended.
4. How treatment planning will be affected by the results.
5. If previous testing has been completed, have those results been obtained, reviewed, and utilized to determine what additional
information is needed to answer the diagnostic questions?
6. The referral source and what other evaluations and inter ventions have been provided thus far.
The CPT codes for psychological testing evaluation services are 96130/96131 when ser vices performed by a physician or other qualified
health care professional. Test administration and scoring are represented with codes 96136/96137 or 96138/96139 depending on the
provider type performing the service.
Psychological testing is to be conducted by a doctoral level, licensed psychologist who has specific training and experience in
administering and interpreting standardized tests.
Technician test administration and scoring services must include a minimum of two psychological tests.
REQUIREMENTS FOR AUTHORIZATION
1. Tests must be reliable and valid for answering the diagnostic questions under consideration. The tests must be the most recent
editions, be age appropriate and meet the developmental and cultural requirements of the patient.
2. A mental health assessment must be completed by a behavioral healthcare provider prior to testing. For many disorders, this
type of interview along with self-repor t scales or behavior rating scales will be sufficient for diagnosis and treatment planning.
3. A clear and specific rationale for testing must be provided. Additionally, the rationale should address the specific impact on
treatment planning.
4. A Psychological Testing Prior Authorization Request Form must be completed. The psychologist must complete the section that
covers the tests to be given and the amount of time needed for each. The referring clinician can complete the sections that
cover clinical information and diagnostic questions to be answered.
MEDICAL NECESSITY
These three guidelines need to be met for testing to be authorized:
1. The tests must be appropriate for providing the answers to the diagnostic questions/diagnosis or guide in providing the answer/
diagnosis.
2. The referral questions cannot be answered by means of a diagnostic interview, behavioral obser vations and/or self-report scales.
3. The test results will have a meaningful impact on treatment.
REASONS FOR NON-AUTHORIZATION
1. Testing primarily for educational or vocational purposes.
2. Testing for legal purposes.
3. Testing primarily for cognitive rehabilitation purposes.
4. Testing that exceeds established standards for administration time.
5. Routine entrance into a treatment program.
Approved by the Medical Advisory Council on 10/22/2014 Revised 10/2014 APP0176 (7/20)
Disclaimer: Recommendation of treatment does not guarantee coverage of services.