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    v1.0.28
    OpenPayerPolicy UpdatesPsychiatry/Behavioral HealthLucet psychological testing Prior Auth | OpenPayer
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    CurrentlucetPolicy 20.5.004

    Psychological and Neuropsychological Testing Criteria - 2024

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    Defines authorization parameters and medical necessity criteria for psychological and neuropsychological testing for Lucet members for plan year 2024, including requirements for test administration, provider qualifications, and documentation for initial authorization.

    Policy Summary
    Payerlucet
    PolicyPsychological and Neuropsychological Testing Criteria - 2024
    Policy CodePolicy 20.5.004
    Change TypeNo material change
    Effective DateJan 1, 2023
    Last ReviewSep 1, 2023
    Next Review Date
    Key ActionInitial authorization requires documentation that ALL Initial Authorization Request criteria are met, including a completed face-to-face diagnostic assessment and a comprehensive post-testing report.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes have been made to the policy.

    8Initial Authorization Criteria
    2Expectation of Care Delivery Items

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    Coverage Summary

    This policy defines authorization parameters and medical necessity criteria for Psychological and Neuropsychological Testing for Lucet members for plan year 2024. It requires documentation of initial assessment, appropriate test selection and administration, qualified provider oversight, and comprehensive reporting to support benefit approval. (Policy number: 20.5.004; Effective date: 2023-01-01; Last review: 2023-09-01.)

    Policy metadata
    Policy (subject)Psychological and Neuropsychological Testing
    Policy Code (policy_number)20.5.004
    Payer (lucet)Lucet
    Effective Date (dates.effective)2023-01-01
    Last Review (dates.last_review)2023-09-01
    Status (status)CURRENT

    Medical Necessity Criteria

    Initial Authorization Request

    Must meet all of the following:

    ALL of the following

    • An initial face-to-face complete diagnostic assessment has been completed.
    • The proposed battery of tests is individualized to meet the member's needs and to answer the specific diagnostic/clinical questions identified by the diagnostic assessment.
    • The proposed battery of tests is standardized and has nationally accepted validity and reliability.
    • Testing is administered and interpreted by a licensed psychologist or other qualified mental health provider (as defined by applicable State and Federal law and scope of practice). Technician-administered and/or computer-assisted testing may be allowed under the direct supervision of a licensed psychologist or other qualified mental health provider. Neuropsychological testing must be supervised and interpreted by a licensed psychologist with specialization in neuropsychology.

    Provider Actions

    Prior Authorization

    Authorization requirement

    Initial authorization requires documentation that ALL criteria in the Initial Authorization Request are met, including a completed face-to-face diagnostic assessment and a comprehensive post-testing report.

    Documentation Required

    Comprehensive report required

    At the completion of testing providers must supply a comprehensive report that includes the tests used, scores, and an in-depth summary of the findings to support benefit approval.

    Documentation Required

    Provider qualifications and supervision

    Testing must be administered and interpreted by a licensed psychologist or other qualified mental health provider per applicable law and scope of practice. Technician-administered and computer-assisted testing are allowed only under the direct supervision of a licensed psychologist or other qualified provider. Neuropsychological testing must be supervised and interpreted by a licensed psychologist with specialization in neuropsychology.

    Coding

    No specific code groups are listed in the brief. Providers should refer to the payer's coding resources or adhere to CPT code definitions as noted under Expectations of Care Delivery when developing test batteries and billing for services.

    Background

    Policy provides authorization parameters to ensure consistent benefit decisions for psychological and neuropsychological testing. Applies to Lucet members and providers for plan year 2024.

    Revision History

    2023-01-01Effective Date

    Policy became effective.

    2023-09-01Last ReviewLatest

    Policy was reviewed.

    Policy Summary
    Payerlucet
    PolicyPsychological and Neuropsychological Testing Criteria - 2024
    Policy CodePolicy 20.5.004
    Change TypeNo material change
    Effective DateJan 1, 2023
    Last ReviewSep 1, 2023
    Next Review Date
    Key ActionInitial authorization requires documentation that ALL Initial Authorization Request criteria are met, including a completed face-to-face diagnostic assessment and a comprehensive post-testing report.
    SourceLink
    On This Page
    Coverage SummaryMedical Necessity CriteriaProvider ActionsCodingBackgroundRevision History
  1. The requested tests must have normative data and suitability for use with the member's age group, culture, primary language, and developmental level.
  2. At the completion of the testing, a comprehensive report is generated that includes the tests used, scores, and an in-depth summary of the findings of the assessment.
  3. The member is capable of participating in the selected battery of tests.
  4. The results of the proposed testing can reasonably be expected to contribute to the development and implementation of an individualized treatment plan.

    5. Expectations of Care Delivery

    ALL of the following

    • The requested time for administration, scoring and interpretation of the proposed testing battery must be consistent with the time requirements indicated by the test publisher.
    • The qualified health professional responsible for the development of the test battery will adhere to CPT code definitions for screening tests, psychological tests, neuropsychological tests, use of technicians, and machine-administered tests.
    Denial Risk

    Denial risk for inappropriate tests or insufficient justification

    Requests may be denied when the proposed tests are not standardized or lack nationally accepted validity/reliability, are not appropriate for the member’s age, culture, primary language, or developmental level, when the member is not capable of participating in the selected battery, or when results are unlikely to contribute to an individualized treatment plan.