Psychological and Neuropsychological Testing Authorization
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Authorization form and requirements for requesting psychological or neuropsychological testing for Blue Cross Blue Shield - Tennessee members; applies to providers requesting prior authorization for these testing services.
No material clinical or coverage changes in this revision.
Coverage Criteria for Psychological and Neuropsychological Testing
Medical Necessity Criteria
Covered when documentation demonstrates clinical necessity and the testing is not primarily educational.
See form fields for referral questions, referral source, and rationale (Clinical Information).
Include the CPT codes and units on the form (see Test Administration and Scoring and CPT sections).
Form requests current/prior treatment and whether medical explanations were considered (Clinical Information).
If testing is educational in purpose it may be denied; account-specific arrangements may apply (See Educational testing exclusion).
Testing that assesses basic intellectual, cognitive, academic, developmental, psychomotor, or visual-motor functioning is generally considered educational in nature. Such services are not considered a covered benefit under the usual terms unless there is a specific account-level agreement stating otherwise. When submitting authorization requests, ensure the clinical rationale demonstrates that the testing is being requested for medical/diagnostic purposes rather than primarily for educational evaluation.
Requests where the primary purpose of testing is educational — including evaluation of intellectual ability, academic achievement, developmental or visual-motor skills — are not medically necessary under the plan’s usual coverage terms and may be denied. If testing has any educational purpose, indicate any account-specific arrangements that might allow coverage; otherwise do not expect coverage for primarily educational assessments.
CPT Codes, Units, and Evaluation Definitions
| 96130 | Psychological Testing Evaluation (60 min = 1 unit) - listed on form |
| 96131 | Psychological Testing Evaluation (60 min = 1 unit) - listed on form |
| 96136 | Test Administration (30 min = 1 unit) - listed on form |
| 96137 | Test Administration (30 min = 1 unit) - listed on form |
| 96138 | Test Administration (30 min = 1 unit) - listed on form |
| 96139 | Test Administration (30 min = 1 unit) - listed on form |
| 1 unit | 30 minutes for test administration and scoring (form defines evaluation and administration unit durations) |
| 96132 | Neuropsychological Testing Evaluation (60 min = 1 unit) - listed on form |
| 96133 | Neuropsychological Testing Evaluation (60 min = 1 unit) - listed on form |
| 96136 | Test Administration (30 min = 1 unit) - listed on form |
| 96137 | Test Administration (30 min = 1 unit) - listed on form |
| 96138 | Test Administration (30 min = 1 unit) - listed on form |
| 96139 | Test Administration (30 min = 1 unit) - listed on form |
| 1 unit | 30 minutes for test administration and scoring (form defines evaluation and administration unit durations) |
Prior Authorization and Required Provider Documentation
Prior authorization required via the authorization form
Prior authorization is required via the provided Psychological/Neuropsychological Testing Authorization Request Form for psychological testing (CPT 96130, 96131, 96136–96139) and neuropsychological testing (CPT 96132, 96133, 96136–96139). Tennessee providers may submit requests through Availity; out-of-state providers use their provider portal or Cohere.
- Check the appropriate service on the authorization form (Psychological Testing or Neuropsychological Testing).
- Include requested start date on the form.
- Submit the completed form as the prior authorization request via Availity (TN) or the provider portal/Cohere (out-of-state).
Complete and submit the authorization form
Provider highlight: complete and submit the Psychological/Neuropsychological Testing Authorization Request Form with all required clinical details to initiate review.
- Ensure the referral questions and why testing is requested now are clearly documented.
- List specific tests, units, and CPT codes on the form.
Required documentation to accompany authorization
Submit the completed authorization form including member and provider contact information, DSM-5/ICD-10 diagnosis codes under evaluation, clear referral questions and rationale, list of specific tests with units (one unit = 30 minutes), and the indicated CPT codes.
- Member details: name, member ID, DOB, contact info, and guardian info if minor.
- Clinical information: who referred the member, referral questions, why testing is requested now, how results will impact behavioral treatment, current and prior behavioral health treatment, and any medical explanations for symptoms.
- Test details: full test names, units for each test (1 unit = 30 minutes), and corresponding CPT lines (e.g., 96130–96139, 96132–96133).
- Attach additional clinical information as needed and include provider signature and date.
Educational-purpose testing may be denied — not a covered benefit
Testing that is partially or primarily for educational purposes (e.g., basic intellectual, cognitive, academic, developmental, psychomotor, visual-motor functioning) is usually considered educational and is not a covered benefit; such requests may be denied.
- If testing is intended for educational placement, school planning, or primarily educational evaluation, do not expect coverage unless account-specific arrangements apply.
Background and Purpose
Psychological and neuropsychological testing evaluate cognitive, emotional, and behavioral functioning to clarify diagnoses and inform behavioral treatment planning. The authorization form requests referral questions and clinical rationale, a list of specific tests with units and corresponding CPT codes, and supporting clinical information so the reviewer can determine whether testing is medically necessary and not primarily for educational purposes. Tennessee providers may submit prior authorization requests via Availity; out-of-state providers use their provider portal or Cohere.
Definitions and Exclusions
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