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 Definition of Medical Necessity for Neuropsychological Testing

"Neuropsychological testing is considered medically necessary for one or more of the following indications, where initial assessment or assessment over time is needed in order to:

1.    Measure cognitive or behavioral deficits related to known or suspected CNS impairment, trauma, or neuropsychiatric disorders, including when the information will be useful in determining a diagnosis, prognosis, or informing treatment planning; or


2.  Establish a treatment plan by measuring functional abilities/ impairments in individuals with known or suspected CNS and neuropsychiatric disorders; or


3.  Determine the potential impact of substances that may cause cognitive impairment (e.g., radiation, chemotherapy, prescribed or illicit drugs, toxins) or result in measurable improvement in cognitive function, including when this information is utilized to determine treatment planning; or


4.  Conduct pre-surgical or treatment-related measurement of cognitive function to determine whether one might safely proceed with a medical or surgical procedure that may affect brain function (e.g., deep brain stimulation, resection of brain tumors or arteriovenous malformations, epilepsy surgery, stem cell or organ transplant) or significantly alter a patient’s functional status; or


5.  Determine through measurement of cognitive abilities whether a patient’s medical condition impairs his/her abil- ity to comprehend and participate effectively in treatment regimens (e.g., surgical procedures, determining functional capacity for health care decision-making) or to function independently after treatment (e.g., work, independent living, managing financial affairs); or


6.  Design, administer, and/or monitor outcomes of cognitive rehabilitation procedures, such as compensatory memory training for brain-injured patients; or


7.  Measure cognitive or functional deficits in children and adolescents based on an inability to develop expected knowledge, skills or abilities as required to adapt to cognitive, social, emotional, or physical demands; or


8.  Evaluate primary symptoms of impaired attention  and concentration that can occur in many neurological and psychiatric conditions."

Psychological and Neuropsychological Testing Billing and Coding Guide,

American Psychological Association, 2019

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