Psychological testing (also referred to as a psychological assessment) is a service performed by a Psychologist at the request of a licensed clinician seeking diagnostic clarity for their patient. Psychological testing referrals are clinician-driven to clarify diagnostic uncertainty and aid in treatment planning. Rula does not coordinate psychoeducational testing for learning disabilities, as this is not typically covered by commercial insurance.
It can be difficult to prove medical necessity to insurance companies in order to cover this service. Payers often ask “How will this testing change the course of your treatment with the patient?” If you believe that testing is needed to alter the course of treatment, please include a detailed clinical rationale where prompted on the Provider Referral Form so that we can advocate for the request on behalf of your patient.
Please reference Documenting Clinical Rationale for Psychological Testing Requests.
ADHD
Rula’s Clinical Quality team does not recommend referring patients for the sole purpose of diagnosing ADHD. ADHD is fundamentally diagnosed through history and psychiatric evaluation, and often insurance will not cover neuropsych testing for ADHD diagnosis (especially in adults), as there is no research showing neuropsych testing to be necessary or accurate. This is due to many factors, including poor sensitivity of tests for higher-level executive function deficits, and the testing environment that removes the environmental factors that affect function in daily life for people with ADHD.
If the diagnostic picture is complicated and testing is being requested to rule out other learning or psychiatric disorders, please state this in referral to give the best chance for insurance coverage. Routine referral for uncomplicated ADHD diagnosis is not standard of practice, and will often place a financial barrier to people receiving care, as they will likely have to pay out of pocket for this expensive testing.
Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5), to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD and how this condition impacts public health.
Autism Spectrum Disorders
There are several barriers to getting diagnosed with ASD as an adult. Since Autism is classified as a “developmental disorder” and there is not an established diagnostic test for ASD in adults, not all psychological testing resources offer ASD testing. Therefore, finding a doctor (usually a psychologist or psychiatrist) in a patient’s area who is willing to diagnose adults can be challenging. Most doctors who do offer diagnostic testing do not take insurance, and the cost can be thousands of dollars.
As an alternative, a provider can complete standardized screeners to help assess the diagnosis.
- There is no established diagnostic test for ASD in adults (more info HERE)
The Adult Repetitive Behaviors Questionnaire-2 (RBQ-2A) has shown some promise as a self-report measure. It can be found HERE.
Updated