Making a Referral for a Clinical Neuropsychological Evaluation

 

Who May Be Referred:  To be referred, the patient must

 

1) be age 16 years or older

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2) be covered by a current health insurance policy with one of these insurers, or be willing to pay out-of-pocket.

 

3) have a suspected or established neurologic diagnosis expected to affect cognitive function (stroke, brain tumor, brain infection or brain surgery, epilepsy, moderate/severe TBI, movement disorder, multiple sclerosis, normal pressure hydrocephalus, post-encephalitic state, HIV, etc.),

 

4) have a suspected or established major psychiatric diagnosis where a better understanding of cognitive function is likely to affect treatment planning.

 

Who Should Not Be Referred:  I do not perform evaluations of cognitive complaints due to ADHD, concussion, learning disability, developmental delay, or intellectual disability.
 

How to Refer:  Send a secure fax with a recent note that describes the reason for referral. Include contact information for the patient and for your office staff.  Your staff will be notified within 5 business days whether the referral is appropriate and whether additional documentation is required. 

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Prior Authorization/Medical Necessity: - Some insurancne plans require prior authorization and documentation of medical necessity prior to conducting a neuropsychological evaluation. The referring provider MUST provide sufficient information in the referral documentation so that I can justify the medical necessity of the evaluation when I request prior authorization. Otherwise, the evaluation may not be approved. Click here for information about what kinds of information are required to document medical necessity.