Understanding Your Psychological Testing Benefits
Insurance benefits for psychological testing vary widely, even among members with the same insurance company. While Renewal Therapy will verify your eligibility and provide an estimate whenever possible, only your insurance company can explain how your specific plan will process these services.
To help you better understand your expected out-of-pocket costs, we recommend calling the Member Services number on the back of your insurance card before your evaluation. See below for step by step instructions on which questions to ask!
Please note: Any estimate provided by your insurance company is not a guarantee of payment. Final payment responsibility is determined after your insurance company processes your claims.
For Anthem Blue Cross Blue Shield or Sentara Members
Renewal Therapy is in network with Anthem Blue Cross Blue Shield and Sentara commercial insurance plans. If you have Medicare, Medicaid, or another insurance plan, please refer to the out-of-network section below. Even when services are considered in network, your out-of-pocket costs may vary depending on your specific insurance plan, including your deductible, copayment, coinsurance, and other benefit requirements.
When speaking with a representative, you may find it helpful to ask the following questions:
Coverage
Does my plan cover psychological testing performed by a licensed psychologist?
Does my plan require prior authorization or pre-certification for psychological testing?
Are there any diagnosis or medical necessity requirements for psychological testing to be covered?
Deductible & Cost Sharing
Do I need to meet my in-network deductible before cost sharing begins?
After my deductible is met, what will my patient responsibility be (copay, coinsurance, or other cost sharing)?
Procedure Codes (CPT Codes)
Please ask about coverage for the following estimated procedure codes:
90791 (1 unit)
96130 (1 unit)
96131 (typically 5–6 units)
96136 (1 unit)
96137 (typically 7–8 units)
You may also wish to ask:
Are all of these CPT codes covered under my plan?
Is there anything else I should know about my psychological testing benefits?
For Clients Paying Out of Pocket and Seeking Out-of-Network Reimbursement
If Renewal Therapy is not in network with your insurance plan, you will be responsible for payment at the time services are provided. After your evaluation is complete, we can provide you with a Superbill, which is an itemized receipt that you may submit to your insurance company for possible reimbursement if your plan includes out-of-network benefits.
When speaking with your insurance company, consider asking:
Coverage
Does my plan include out-of-network benefits for psychological testing performed by a licensed psychologist?
Does my plan require prior authorization or pre-certification for out-of-network psychological testing?
Are there any diagnosis or medical necessity requirements for coverage?
Deductible & Cost Sharing
Do I need to meet my out-of-network deductible before reimbursement begins?
After my deductible is met, what percentage of the allowed amount will be reimbursed?
How is the allowed amount determined for out-of-network psychological testing?
Procedure Codes (CPT Codes)
Please ask about coverage for the following estimated procedure codes:
90791 (1 unit)
96130 (1 unit)
96131 (typically 5–6 units)
96136 (1 unit)
96137 (typically 7–8 units)
You may also wish to ask:
Are all of these CPT codes eligible for out-of-network reimbursement?
Is there anything else I should know about my psychological testing benefits?
