Insurance Benefit Guide for Neuropsychological Evaluations

Neuropsychological evaluations are often covered by insurance; however, plans vary in how they process these services. Even when a provider is in-network, final patient responsibility depends on how the claim is adjudicated once submitted.

Helpful starting point: Ask whether neuropsychological testing is adjudicated under medical or behavioral health benefits and whether prior authorization is required.
Practice information you may need

Practice
Heimberg Neuropsychology – Psychological Testing Inc.

Rendering provider
Brandon F. Heimberg, PsyD

Individual NPI (most commonly requested)
1205364635

Organizational NPI (if requested)
1437841814

Calabasas
5000 Parkway Calabasas, Suite 218
Calabasas, CA 91302

New York
125 Park Avenue, 25th Floor
New York, NY 10017

Ask: medical vs behavioral adjudication Ask: prior authorization required? Record: rep + reference # + date/time
What to ask (quick checklist)
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Network statusConfirm in-network status for your exact plan (provider and/or practice).

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How testing is processedIs neuropsychological testing adjudicated under medical or behavioral health benefits?

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DeductibleWhat is your individual deductible, and how much has been met?

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After deductibleDo you have a copay or coinsurance? What percentage?

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Prior authorizationIs prior authorization required for neuropsychological testing?

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Plan limitationsAre there annual visit limits or policy limitations related to neuropsychological testing?

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Estimated responsibilityBased on your current benefits, what is the estimated out-of-pocket responsibility for a comprehensive neuropsychological evaluation?

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Document the callRep name, reference number, and date/time of call.

Note: benefit quotes and estimates are not guarantees of payment.

Optional: procedure codes (only if your insurer requests them)

Some insurers request procedure (CPT) codes to confirm authorization requirements or limitations. Codes used can vary by case.

Professional evaluation services
96132, 96133

Test administration & scoring
96136, 96137, 96138, 96139

Brief assessment (if applicable)
96116, 96121

Note
We do not recommend quoting “units” during benefit calls because requirements vary by plan and by case.

Suggested phrasing for your call

Use any of the wording below if helpful (no need to read verbatim).

Hi — I’m calling to verify my benefits for a comprehensive neuropsychological evaluation. Provider: Brandon F. Heimberg, PsyD (Individual NPI: 1205364635) Practice: Heimberg Neuropsychology – Psychological Testing Inc. (Org NPI: 1437841814, if requested) Could you confirm: • In-network status for my exact plan • Whether neuropsych testing is processed under medical or behavioral health benefits • My remaining deductible and what applies after deductible (copay/coinsurance) • Whether prior authorization is required • Any annual limits or policy limitations for neuropsych testing Based on my current benefits, what would you estimate my out-of-pocket responsibility to be? Before we end, may I have your name, a reference number, and today’s date/time?

Important note
Benefit quotes do not guarantee payment. Claims are processed according to the terms and conditions of your policy at the time of adjudication. Our office provides good-faith estimates based on information available prior to claim submission. Final patient responsibility is determined by your insurance carrier once the claim is processed.

If you receive conflicting information, please document the representative’s name and reference number.