Insurance coverage for evaluations and therapy can be confusing. Every insurance plan is different, and coverage may depend on the type of service, the reason for the service, medical necessity, prior authorization requirements, deductibles, and out-of-network benefits.
This page answers common questions about insurance, reimbursement, superbills, and payment for services at Goldberg & LaRosa Psychology Associates, PLLC.
Do You Accept Insurance?
Goldberg & LaRosa Psychology Associates, PLLC may be considered an out-of-network provider for many insurance plans. This means clients typically pay the practice directly and may then choose to submit documentation to their insurance company for possible reimbursement.
Some clients are able to receive partial reimbursement through out-of-network benefits. Others may not have coverage for the specific service they are seeking. Your insurance company determines whether a service is covered and how much, if anything, may be reimbursed.
We cannot guarantee insurance reimbursement, but we can help you understand what information you may need to ask your insurance company before scheduling.
What Does Out-of-Network Mean?
Out-of-network means the provider does not have a direct contract with your insurance company. You pay the provider directly, then you may submit a superbill or other documentation to your insurance company for possible reimbursement.
If your plan includes out-of-network benefits, your insurance company may reimburse part of the fee after your deductible has been met. If your plan does not include out-of-network benefits, you may not receive reimbursement.
Because benefits vary widely, it is important to contact your insurance company directly before scheduling if reimbursement is important to you.
Can I Receive Reimbursement From My Insurance Company?
Possibly. Reimbursement depends on your specific insurance plan and the service being provided.
Your insurance company may consider factors such as:
- Whether you have out-of-network benefits
- Whether your deductible has been met
- Whether the service is considered medically necessary
- Whether prior authorization is required
- Whether the CPT codes are covered under your plan
- Whether the purpose of the service is medical, educational, legal, workplace-related, or administrative
- Whether the diagnosis supports coverage for the service
The best way to understand your benefits is to call the member services number on your insurance card and ask about your specific plan.
What Is a Superbill?
A superbill is an itemized document that you may submit to your insurance company for possible out-of-network reimbursement.
When appropriate, a superbill may include:
- Provider information
- Client information
- Dates of service
- Service descriptions
- CPT billing codes
- Diagnostic codes, when applicable
- Fees paid
A superbill does not guarantee reimbursement. Your insurance company decides whether the service is covered, whether additional documentation is needed, and how much may be reimbursed.
Do You Provide Superbills?
Yes, when appropriate, we can provide a superbill for services that may be submitted to insurance for possible out-of-network reimbursement.
Superbills are typically available for certain therapy services and some medically necessary psychological or neuropsychological evaluations. The availability of a superbill may depend on the service, diagnosis, purpose of the evaluation, and documentation requirements.
Services that are primarily educational, legal, forensic, workplace-related, or administrative may not be reimbursable by insurance, even if a superbill is provided.
Will Insurance Cover a Neuropsychological Evaluation?
Insurance may cover neuropsychological testing when the insurance company determines that the evaluation is medically necessary.
Examples of medically focused referral questions may include:
- Are memory problems related to dementia, depression, anxiety, medication effects, or another condition?
- Are cognitive changes related to concussion, traumatic brain injury, stroke, Long COVID, or another medical issue?
- Is the person’s functioning affected by ADHD, autism, intellectual disability, or another developmental condition?
- What diagnosis best explains the person’s cognitive, emotional, behavioral, or daily functioning concerns?
- How are neurological, developmental, psychiatric, or medical factors affecting daily functioning?
Insurance coverage is less likely when testing is requested only for school placement, gifted testing, academic accommodations, legal matters, forensic questions, employment documentation, or administrative purposes.
Will Insurance Cover Autism Testing?
Insurance may cover autism testing when the evaluation is considered medically necessary and the plan includes coverage for psychological or neuropsychological testing.
Coverage may depend on the client’s age, symptoms, diagnosis, medical necessity, provider credentials, prior authorization requirements, and the specific testing codes used.
An autism evaluation may include tools such as the ADOS-2, developmental history interview, adaptive behavior measures such as Vineland-3 or ABAS-3, rating scales, record review, and clinical observation. Insurance companies may cover some parts of the evaluation and deny others, depending on the plan.
If you are seeking insurance reimbursement for autism testing, ask your insurance company whether psychological or neuropsychological testing for autism spectrum disorder is covered under your plan.
Will Insurance Cover Psychoeducational Testing?
Insurance often does not cover evaluations that are primarily educational in purpose. This may include testing for school placement, learning disabilities, academic accommodations, IEP planning, 504 planning, gifted programming, or college testing accommodations.
Some evaluations include both medical and educational questions. In those cases, coverage depends on how the insurance company defines medical necessity and whether the testing codes are covered under your plan.
If the main reason for testing is school planning, academic performance, or documentation for educational accommodations, you should not assume insurance will cover the evaluation.
Will Insurance Cover Therapy?
Individual therapy may be eligible for out-of-network reimbursement if your insurance plan includes out-of-network mental health benefits.
Coverage may depend on:
- Your out-of-network benefits
- Your deductible
- Your reimbursement rate
- The diagnosis being treated
- Whether telehealth or in-person therapy is covered
- Whether prior authorization is required
If you plan to seek reimbursement for therapy, contact your insurance company before scheduling and ask about out-of-network mental health benefits.
Will Insurance Cover Senior Support Services?
Memory, behavioral, and daily living support for seniors is typically private pay. These services may include caregiver coaching, behavioral support, cognitive rehabilitation-informed strategies, routine planning, and daily living support.
Because these services are often practical, caregiver-focused, and home or daily-life focused, they may not be covered by insurance.
Families who are exploring reimbursement may want to check with their insurance company, long-term care policy, care manager, or other benefits provider.
What Questions Should I Ask My Insurance Company?
Before scheduling, it may be helpful to call your insurance company and ask detailed questions about your benefits.
For evaluations, you may want to ask:
- Do I have out-of-network benefits for psychological or neuropsychological testing?
- Is prior authorization required for testing?
- Is neuropsychological testing covered under my plan?
- Is autism testing covered under my plan?
- Are psychoeducational evaluations covered?
- Are evaluations covered when the purpose is IEP planning, 504 planning, or academic accommodations?
- What CPT codes are covered?
- What diagnosis codes are required for coverage?
- What documentation is required for reimbursement?
- Do I need a referral from a physician?
For therapy, you may want to ask:
- Do I have out-of-network mental health benefits?
- What is my out-of-network deductible?
- How much of my deductible has been met?
- What percentage is reimbursed after the deductible is met?
- Are telehealth sessions covered?
- Is prior authorization required?
- How do I submit a superbill?
What CPT Codes Should I Ask About?
Insurance companies often ask for CPT codes when you call about coverage. CPT codes describe the type of clinical service provided.
Common testing-related CPT codes may include:
- 96130
- 96131
- 96132
- 96133
- 96136
- 96137
- 96138
- 96139
Common therapy-related CPT codes may include:
- 90791
- 90832
- 90834
- 90837
Not every service uses every code. Codes are selected based on the actual service provided, provider role, time spent, testing activities, interpretation, feedback, and report writing.
If your insurance company asks for codes before scheduling, please contact us so we can discuss which codes may be relevant to the service you are considering.
Do I Need Prior Authorization?
Some insurance plans require prior authorization before testing or therapy services. Prior authorization means the insurance company must review and approve the service before it begins.
Prior authorization does not guarantee payment. It only means the insurance company has reviewed the request based on the information available at that time.
If your plan requires prior authorization, you should ask your insurance company what documentation is needed, who must submit it, how long the process takes, and whether services are covered if authorization is denied.
Can You Guarantee That Insurance Will Pay?
No. We cannot guarantee that your insurance company will reimburse you or cover any specific service.
Insurance companies make their own coverage decisions based on your plan, benefits, deductible, diagnosis, CPT codes, medical necessity criteria, documentation requirements, and internal policies.
Even when a service appears to be covered, reimbursement may still be denied or paid at a lower rate than expected.
Why Are Some Evaluations Private Pay?
Many specialized evaluations are private pay because insurance may limit what can be evaluated, how much time is approved, which referral questions are covered, or whether educational, legal, workplace, or accommodation-related needs can be included.
A comprehensive evaluation often involves much more than the testing appointment. It may include clinical interviews, record review, test selection, test administration, scoring, interpretation, diagnostic formulation, report writing, recommendations, and feedback.
Private pay allows the evaluation to be designed around the full referral question and the person’s needs, rather than only what an insurance company may approve.
This can be especially important for:
- Complex autism evaluations
- Neuropsychological evaluations
- Psychoeducational evaluations
- Independent Educational Evaluations
- Bilingual or Spanish-language evaluations
- Testing accommodation evaluations
- Workplace accommodation evaluations
- Forensic or legal evaluations
- Evaluations involving multiple diagnoses or complex profiles
Can School Districts Pay for Evaluations?
In some cases, a school district may fund an Independent Educational Evaluation, also known as an IEE. This usually occurs when a family disagrees with the school district’s evaluation and requests an independent evaluation.
IEE rules and procedures can vary. Families may want to speak with their school district, educational advocate, or attorney about the process.
Our practice provides IEEs when appropriate and can discuss whether we may be a good fit for the evaluation being requested.
Can Employers or Other Programs Pay for Evaluations?
In some cases, reimbursement or funding may be available through an employer, professional organization, union, disability insurance carrier, legal matter, or other benefit program.
This may apply to evaluations for workplace accommodations, testing accommodations, return-to-work planning, disability-related documentation, cognitive concerns, or functional capacity questions.
Coverage and reimbursement vary. If you are hoping to use employer or outside funding, contact the appropriate benefits administrator before scheduling.
Why Choose Goldberg & LaRosa Psychology Associates?
Insurance questions are important, but choosing the right provider is just as important. A lower-cost or insurance-covered evaluation is not always the most useful option if it does not answer the right questions or provide recommendations that can be used in real life.
Goldberg & LaRosa Psychology Associates, PLLC provides thoughtful, detailed, and individualized services for children, adolescents, adults, older adults, families, schools, attorneys, physicians, agencies, and care teams.
- We take time to understand the full referral question.
- We choose evaluation tools based on the individual, not a generic template.
- We are experienced with complex autism, ADHD, learning, cognitive, behavioral, developmental, neurological, and emotional profiles.
- We offer bilingual and Spanish-language evaluations when appropriate.
- We provide clear reports with practical recommendations.
- We help clients understand what documentation may be useful for insurance, school, treatment, workplace, legal, or care-planning needs.
Our goal is to provide services that are clinically meaningful, clearly explained, and useful for the decisions you need to make.
How to Prepare Before Contacting Us
Before reaching out, it may be helpful to gather basic information about your insurance plan and the service you are seeking.
If possible, have the following information ready:
- The reason you are seeking services
- The type of service you are considering, such as evaluation, therapy, IEE, senior support, or consultation
- Your insurance company name
- Whether you have out-of-network benefits
- Whether prior authorization is required
- Any CPT codes your insurance company asks about
- Any documentation needed for school, work, legal, medical, or reimbursement purposes
You do not need to have all of this figured out before contacting us. We can help you understand what questions may be relevant based on the service you need.
Still Have Questions About Insurance?
Insurance coverage can be difficult to understand, especially when you are seeking an evaluation or support service for an important concern. We are happy to discuss the service you are considering and what documentation may be available for possible reimbursement.
If you are unsure whether your service may be private pay, eligible for out-of-network reimbursement, district-funded, or covered through another source, contact us to discuss the next step.