Payment for Services
NADC will help with the pre-authorization and reimbursement process but ultimately the client is responsible for payment of fees at the time of service. We will provide you with a statement that contains all the information you need to submit for reimbursement from your insurer.
About Managed Care and Insurance Panels
We realize that many clients will first try to find insurance benefits to cover services. We have found that most insurances do not pay for these types of services or they pay very poorly. This is why so few highly experienced providers of mental health services are willing to serve as providers for health insurers.
In order to increase the likelihood of obtaining insurance reimbursement, a letter of medical necessity from a physician stating why the treatment or evaluation is needed will be helpful Then, the client should submit the letter along with the appropriate CPT code to the insurance company for pre-authorization of benefits. Having a neurological reason for evaluation such as brain injury, hypoxia, damage, disease, suspected genetic disorder or learning disability, or change in functioning is the most likely reason for reimbursement.
Insurance companies will sometimes reimburse neuropsychological evaluations if they deem that it is medically necessary to clarify diagnosis or treatment regime. Chances of getting reimbursed for the fee are increased with a prescription from a medical doctor (for a "Neuropsychological Evaluation") to determine the extent and specific nature of cognitive problems that have been noticed in the doctor's exam.
The CPT code for a neuropsychological evaluation is 96118. If the client pursues a pre-authorization of benefits for a neuropsychological evaluation, use only the term “neuropsychological evaluation”. Medical necessity is usually very important in getting reimbursed, but the amount that is reimbursed is not assured.
The following codes are normally paid through the medical portion of an insurance plan: 96118, 96150, 96151, 96152, 96153, 96154, 96155, 97532. These codes apply when the primary diagnosis being addressed is a medical rather than psychiatric diagnosis. All other CPT codes are generally reimbursed under the mental health portion of your insurance; which means that if a service is covered by your insurance, it will typically be reimbursed at the rate of 50%.