CurrentBlue Cross Complete of MichiganPolicy N/A

Neuropsychological Testing

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This policy governs coverage and authorization of neuropsychological testing for Blue Cross Complete of Michigan members, including covered indications, limitations, and referral requirements.

Policy Summary

PayerBlue Cross Complete of Michigan

PolicyNeuropsychological Testing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2021

Next Review DateN/A

Key ActionFor conditions not listed as alternative covered services, refer the member to fee-for-service Medicaid and the appropriate PIHP for authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Listed limitations or excluded conditions

4Alternative covered indications

All otherOther conditions requiring referral

Neuropsychological Testing Coverage

Alternative covered services

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CurrentBlue Cross Complete of MichiganPolicy N/A

Neuropsychological Testing

Customize your policy alerts

Sign up for all blue_cross_complete_of_michigan policy alerts

Know when blue_cross_complete_of_michigan releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs coverage and authorization of neuropsychological testing for Blue Cross Complete of Michigan members, including covered indications, limitations, and referral requirements.

Policy Summary

PayerBlue Cross Complete of Michigan

PolicyNeuropsychological Testing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2021

Next Review DateN/A

Key ActionFor conditions not listed as alternative covered services, refer the member to fee-for-service Medicaid and the appropriate PIHP for authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Listed limitations or excluded conditions

4Alternative covered indications

All otherOther conditions requiring referral

Neuropsychological Testing Coverage

Alternative covered services

Neuropsychological testing is covered for the following alternative service indications. Any one indication is sufficient.

Covered alternative indications

Depression or other mental health condition not responding to standard treatment: The member is already diagnosed with a mental health condition, such as depression, and is not responding to standard treatment.
Autism spectrum disorder: The member has an autism spectrum disorder.
Possible long-term opioid therapy: The member may be placed on long-term opioid therapy.
Possible diagnosis of hysteria: The member has a possible diagnosis of hysteria.

Neuropsychological testing is not covered when it is part of the psychological evaluation for bariatric surgery.

Neuropsychological testing is not covered when it is part of the psychological evaluation for transgender surgery.

Neuropsychological testing is not covered when performed to rule out a diagnosis related to organic brain syndrome, including memory loss or dementia.

Neuropsychological testing is not covered when performed to rule out pseudo seizures.

Neuropsychological testing is not covered for residents within the city of Flint who have elevated lead serum levels.

Authorization and Claim Handling

Prior Authorization

Refer unlisted conditions for authorization

For conditions not listed as alternative covered services, refer the member to fee-for-service Medicaid and the appropriate PIHP for authorization.

Denial Risk

Avoid a final mental health diagnosis

A claim for neuropsychological testing will be rejected and denied when the final diagnosis is mental health.

Prior Authorization

Refer other conditions for authorization

Conditions other than the listed alternative covered services should be referred to fee-for-service Medicaid and the appropriate Pre-Paid Inpatient Health Plan for authorization.

Purpose of Neuropsychological Testing

Neuropsychological testing helps differentiate an organic condition from a behavioral condition. This policy addresses testing for Blue Cross Complete of Michigan members in specified behavioral health, developmental, medication-management, and diagnostic circumstances, including covered alternative indications and listed limitations.

Policy Summary

PayerBlue Cross Complete of Michigan

PolicyNeuropsychological Testing

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2021

Next Review DateN/A

Key ActionFor conditions not listed as alternative covered services, refer the member to fee-for-service Medicaid and the appropriate PIHP for authorization.

SourceLink

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