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Evaluation Fees

EVALUATION FEES EXPLAINED

Evaluation Fees depend upon location and the type of services. All evaluations investigate your diagnosis even if the referral question is not well understood by you or by your doctor. For example, an adult stating, “I think I have ADHD” may have anxiety, autism, or another disorder altogether, causing their issues with attention. Our evaluations look for the cause of your symptoms, which, in some cases, may not be what you expect.

Evaluations with a Medical Component

When evaluations have a medical component or a potential medical component, it is always classified as a neuropsychological evaluation which is more in depth, more time consuming, and thus more expensive. Examples include seizures, traumatic brain injuries (TBI), multiple sclerosis, memory problems, cognitive problems, etc.

Evaluations with a Legal Component

Anytime your evaluation has a legal component such as Accommodations for the CA Bar Exam, MCAT, GRE, SAT, LSAT, secondary and collegiate testing, etc., family law, criminal law, probate law, or if it is “court ordered," it is considered a forensic case for fee purposes, and it is much more time consuming, litigious, and thus more expensive. IEE’s also fall under this category in some cases.

Forensic Psychological/IME Evaluation Fees

Forensic Evaluations can be psychological or neuropsychological. When a case involves any form of accommodations, family law, criminal law, court ordered evaluations, and any form of disability, workplace exemptions and accommodations, etc., it is priced as forensic. 

 

Typical Costs: $6,000.00-$10,500.00

Retainer for most family law or legal cases: $5,000.00

​**Expedited report fees: $1,500.00-$3,000.00

 

Neuropsychological/IME Evaluation Fees

Any evaluation where there are complicated medical and/or psychological, and/or cognitive issues (e.g. learning disorders/disabilities (LD), dyslexia, dyscalculia, dysgraphia, traumatic brain injury (TBI), post concussion syndrome, autism spectrum disorders for children, “school problems,” medical issues, cysts, seizures, strokes, memory problems, executive dysfunction, prodromal schizophrenia, etc.

Typical Costs: $7,500.00-$15,000.00

Retainer for most Neuropsychological Cases: $7,500.00

Child & Adult Autism Evaluation Fees

Children usually require in depth cognitive testing while adults usually do not.

 

Typical Costs: $4,500.00-$6,000.00 

Retainer: $3,000.00

 

ADHD/ADD Evaluation Fees

College or high school level ADHD evaluations, and differential diagnosis for most affective, anxiety, and/or bipolar spectrum disorders usually fall under this category. Childhood ADHD evaluations are more comprehensive and fall under general neuropsychology.

 

Typical Costs: $5,000.00-$7,500.00

Retainer: $3,500.00

Learning Disorders Evaluation Fees

Learning disorders/disabilities (e.g., dyslexia - reading disorder, dyscalculia - mathematics disorder, dysgraphia and agraphia - disorders of written expression. These evaluations are for diagnostics.

​Typical Costs: $5,000.00-$7,500.00

Retainer $3.500.00

Psychological/Mental Health Evaluation Fees

Targeted and abbreviated testing for non-accommodation or non-legal related issues when there are no confirmed or potential medical and/or confirmed or potential neurological issues. Minimal to no cognitive testing.  Price can increase if your university or school requires more in-depth testing. College or high school level ADHD evaluations, adult autism without medical complications, and differential diagnosis for most affective, anxiety, and/or bipolar spectrum disorders usually fall under this category.

Typical Costs: $4,500.00-$5,500.00

Retainer $3,000.00

Insurance Reimbursement: Your insurance, if it is a PPO plan, may give you some reimbursement for a neuropsychological evaluation. Sometimes you can obtain an out-of-network exemption. We will bill the insurance company for you if requested or provide you with a Superbill that you can submit directly to your insurance company. However, all fees are due up front on the first visit. The check from the insurance company will be sent directly to you. If it is sent to us, we will cut you a check for that amount. Some insurances have paid up to $4,000.00 such as those in like Apple, Google, and other tech-related firms in Silicon Valley, or when an insurance plan has specialized autism services provisions. Worst Case Scenario: HMO’s, Kaiser, or insurances that require “pre-authorization” will not reimburse you. You can fight them after the fact, especially if they do not have providers.

Below are the codes you can use to inquire about your insurance coverage and out of network coverage. Please use both the probable diagnostic code, and the procedure codes as well. Diagnostic Codes (Updated ICD-10):

  • Learning Disabilities are NEVER covered by insurance, neither are court-related, court-ordered, or accommodation evaluations

  • 314.00 (F90.0) ADHD

  • 299.00 (F84.0) Autism

  • 294.9 (F09) Cognitive Problems (e.g., Brain Injury, Complicated Medical Concerns)

  • 312.81 (F91.1) Behavior Problems

  • 311 (F32.9) Depression

  • 300.00 (F41.9) Anxiety

  • 296.80 (F31.9) Bipolar Disorder

  • 295.90 (F20.9) Schizophrenia

*Additional diagnostic codes can be found by searching the disorder you are inquiring about + “ICD-10 code” on Google.

Neuropsych Evaluation Current Procedural Terminology Codes (CPT)

***CPT Codes have changed as of 2019.  Here is the new list of codes! We do not release EIN or SS Numbers to patients.

  • 90791 -Diagnostic Interview

  • 96116 – Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face- to-face time with the patient and time interpreting test results and preparing the report; first hour. 

  • 96136 –Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes

  • 96137 –Each additional 30 minutes (List separately in addition to code for primary procedure)

  • 96132 -Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

  • 96133 – Each additional hour (List separately in addition to code for primary procedure)

**This is not an exhaustive list of codes. More information is available at: https://www.apaservices.org/practice/reimbursement/health-codes/testing/codes-descriptions.pdf

DR. HEAFEY IS AVAILABLE TO CONDUCT ASSESSMENTS AT YOUR HOME, OFFICE OR OFF-SITE LOCATIONS

 

CONVENIENT APPOINTMENT TIMES CAN BE SCHEDULED ON NIGHTS, WEEKENDS AND HOLIDAYS

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