EVALUATIONS FOR CHILDREN AND ADULTS
 

EVALUATION FEES DEPEND UPON LOCATION AND TYPE OF SERVICES
WE DO NOT ACCEPT INSURANCE FOR THESE SERVICES

Evaluations investigate your diagnosis and look for the cause of your symptoms, which, in some cases, may not be what you expect. When evaluations have a legal component such as being “court ordered,” it is much more time consuming, litigious, and thus more expensive. 

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EVALUATION FEES:

• Forensic Evaluation services that involve any form of accommodations, family law, criminal law, court ordered evaluations, and any form of disability, workplace exemptions, etc. are priced at $400-500 per hour. Total cost for family law or legal cases range from $3,500-$25,000.

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• ​Court Testimony for Forensic & Court Based Testing: $2,500 for 1/2 day minimum; $5,000 for 4-8 hours

• Travel Time, Out-of-Area Travel, and Wait Time: $400 per hour plus transportation, accommodations, and food costs

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• College or high school level ADHD evaluations: $3,500-5,000

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• Record review in excess of 100 pages: $400 per hour​

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​**Expedited report fees on case-by-case basis: $500-1,500

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Insurance Reimbursement: If your insurance plan is a PPO, you may receive some reimbursement for an evaluation. You should contact your insurance company and request and out-of-network exemption. We will bill the insurance company for you if requested through our insurance Clearinghouse. However, our fees are due up front 48 hours prior to your initial appointment. Reimbursement from your insurance company will be sent directly to you. HMO’s, Kaiser, or insurances that require “pre-authorization” will not reimburse you. Please contact your insurance company to confirm your benefits, coverage, deductibles, and authorization for services. 

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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. 

Diagnostic Codes (Updated ICD-10):

• 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.

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Evaluation Terminology Codes (CPT):

• 90791 - Diagnostic Interview

• 96112 - Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory, and/ or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour 

• 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 

• 96130 - Psychological 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 

• 93131 - Each additional hour (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) 

• 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)

• 96146 -Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only 

*This is not an exhaustive list of codes. CPT Codes may be updated.

For more information: https://www.apaservices.org/practice/reimbursement/health-codes/testing/codes-descriptions.pdf