Request for Authorization - Neuropsychological Testing PDF
This form/policy governs prior authorization and clinical documentation requirements for neuropsychological testing for Highmark BCBS WNY members in Medicaid Managed Care (MMC), HARP, Child Health Plus, and Essential Plan programs. It outlines clinical scenarios where testing may be medically necessary, required supporting clinical information, excluded indications, and the CPT codes to request.
No material clinical or coverage changes
Coverage Summary
This form/policy governs prior authorization and clinical documentation requirements for neuropsychological testing for Highmark BCBS WNY members in Medicaid Managed Care (MMC), HARP, Child Health Plus, and Essential Plan programs. It outlines clinical scenarios where testing may be medically necessary, required supporting clinical information, excluded indications, and the CPT codes to request.