We understand that the cost of an evaluation or therapy service is an important part of choosing the right provider. Many families and individuals contact us with questions about fees, insurance reimbursement, superbills, Independent Educational Evaluations, and whether a service may be covered by insurance or another funding source.
This page explains common payment and reimbursement options in clear language. Coverage varies by insurance plan, school district, employer, and type of service, so we encourage you to contact us with questions before scheduling.
Private Pay Services
Goldberg & LaRosa Psychology Associates, PLLC provides private-pay services for many evaluations, therapy services, forensic matters, workplace evaluations, consultation services, and senior support services.
Private pay allows the evaluation or service to be based on clinical need, referral questions, and the individual’s full profile, rather than limits set by an insurance company.
Private pay may be appropriate when the service is needed for:
- Autism diagnostic clarification
- Neuropsychological evaluation
- Psychoeducational evaluation
- Independent Educational Evaluation, also known as an IEE
- IEP or 504 planning
- Testing accommodations
- Workplace accommodations
- Forensic or legal questions
- Senior support, caregiver coaching, or daily living support
- Individual therapy
We will explain the expected scope of service and fee information before you begin, so you can make an informed decision.
Do You Accept Insurance?
Our practice may be considered out-of-network for many insurance plans. This means payment is typically made directly to the practice, and some clients may choose to submit documentation to their insurance company for possible reimbursement.
Insurance coverage depends on your specific plan, your out-of-network benefits, the type of service, whether the service is considered medically necessary, and whether your insurance company authorizes or reimburses the service.
We cannot guarantee insurance reimbursement. However, when appropriate, we can provide documentation such as a superbill that you may submit to your insurance company.
Out-of-Network Reimbursement
If your insurance plan includes out-of-network benefits, you may be able to receive partial reimbursement for certain services. Reimbursement is determined by your insurance company, not by our practice.
Before scheduling, you may want to call your insurance company and ask about your out-of-network benefits for psychological, neuropsychological, or therapy services.
Helpful questions to ask your insurance company include:
- Do I have out-of-network mental health or neuropsychological testing benefits?
- Do I have an out-of-network deductible?
- How much of my deductible has been met?
- What percentage is reimbursed after the deductible is met?
- Is prior authorization required?
- Are neuropsychological testing codes covered?
- Are services covered if they are for educational planning, IEP planning, or testing accommodations?
- What documentation is required for reimbursement?
If your insurance company requests CPT codes, diagnostic codes, or documentation of medical necessity, please let us know. We can discuss what documentation may be appropriate for the service being provided.
Superbills
A superbill is an itemized document that may be submitted to an insurance company for possible out-of-network reimbursement.
When appropriate, a superbill may include:
- Provider information
- Dates of service
- Service descriptions
- CPT billing codes
- Diagnostic codes, when applicable
- Fees paid
Submitting a superbill does not guarantee reimbursement. Your insurance company decides whether a service is covered, how much may be reimbursed, and whether additional documentation is required.
Insurance and Neuropsychological Testing
Insurance companies often cover neuropsychological testing only when they determine that the evaluation is medically necessary. This may include evaluations related to cognitive decline, memory loss, traumatic brain injury, concussion, neurological conditions, developmental concerns, ADHD, autism, or diagnostic clarification.
Insurance may be less likely to cover testing when the purpose is primarily educational, academic, legal, or administrative.
Examples of medically focused referral questions may include:
- Is memory loss 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, behavioral, emotional, or daily functioning concerns?
Examples of services insurance may not cover include:
- Testing only for school placement
- Testing only for gifted programming
- Testing only for IEP or 504 documentation
- Testing only for academic accommodations
- Testing requested only for legal, forensic, or workplace purposes
Each insurance plan is different. The best way to understand your benefits is to contact your insurance company directly before scheduling.
Common Testing Codes
Some insurance companies ask for CPT codes when families inquire about coverage for neuropsychological or psychological testing. The codes used depend on the service, provider role, testing time, scoring, interpretation, feedback, and report writing.
Common testing-related CPT codes may include:
- 96130
- 96131
- 96132
- 96133
- 96136
- 96137
- 96138
- 96139
Not every evaluation uses every code. Codes are selected based on the services actually provided. If your insurance company requests codes before scheduling, please contact us so we can discuss the type of evaluation being considered.
Independent Educational Evaluations
An Independent Educational Evaluation, also known as an IEE, may be requested when a family disagrees with a school district’s evaluation. In some situations, the school district may fund the IEE.
IEEs are often used to better understand a student’s educational, developmental, cognitive, emotional, behavioral, or functional needs.
An IEE may address questions related to:
- Autism
- ADHD and executive functioning
- Learning disabilities
- Intellectual functioning
- Speech, language, or developmental concerns
- Behavioral and emotional functioning
- Adaptive functioning
- IEP services, accommodations, placement, and supports
If you are considering requesting an IEE, you may want to speak with your school district, educational advocate, or attorney about the process. We can also discuss whether our practice may be an appropriate fit for the evaluation being requested.
Workplace and Accommodation Evaluations
Some adults seek evaluations for workplace accommodations, testing accommodations, disability-related documentation, return-to-work planning, or functional concerns that affect job performance.
These evaluations may involve questions related to ADHD, learning disorders, autism, cognitive changes, traumatic brain injury, concussion, neurological conditions, psychiatric concerns, or executive functioning difficulties.
Possible funding or reimbursement sources may include:
- Private pay
- Out-of-network insurance reimbursement, when applicable
- Employer reimbursement, when available
- Union or professional association benefits, when available
- Disability insurance benefits, when applicable
Coverage and reimbursement vary. We recommend checking directly with your employer, benefits administrator, disability carrier, or insurance company before scheduling if reimbursement is a concern.
Why Many Specialized Evaluations Are Private Pay
Comprehensive evaluations require much more than the time spent in the testing session. A full evaluation may include clinical interviews, record review, test selection, test administration, scoring, interpretation, report writing, diagnostic formulation, recommendations, and feedback.
Insurance companies may limit the number of approved hours, restrict the purpose of testing, deny educationally focused evaluations, or require extensive authorization and documentation. These limits can make it difficult to complete a thorough evaluation that answers the full referral question.
Private pay allows us to:
- Choose tests based on the person’s needs, not insurance restrictions
- Address complex diagnostic questions thoroughly
- Include educational, developmental, behavioral, emotional, adaptive, and functional concerns when appropriate
- Write reports that are useful for families, schools, physicians, attorneys, employers, agencies, and care teams
- Provide recommendations that connect test findings to real-life next steps
Our goal is to provide a complete, thoughtful, and useful evaluation that helps you understand the diagnosis, the person’s strengths and challenges, and what to do next.
Payment for Therapy Services
Individual therapy may be private pay or may be eligible for out-of-network reimbursement depending on your insurance plan and benefits.
If you plan to seek reimbursement for therapy, you may want to ask your insurance company about:
- Out-of-network mental health benefits
- Deductible and reimbursement rate
- Whether telehealth or in-person therapy is covered
- Whether prior authorization is required
- What documentation is needed for reimbursement
When appropriate, we can provide a superbill for therapy services.
Payment for Senior Support Services
Memory, behavioral, and daily living support for seniors is typically a private-pay service. These services may include caregiver coaching, behavioral support, cognitive rehabilitation-informed strategies, daily living support, and collaboration with care teams.
Because these services are often practical, caregiver-focused, and daily-life focused, they may not be covered by insurance. Families should check with their insurance plan, long-term care policy, or care manager if they are exploring possible reimbursement.
Questions to Ask Before Scheduling
Before beginning services, it may be helpful to clarify your goals, payment options, and reimbursement possibilities.
Questions to consider include:
- What is the main reason I am seeking this evaluation or service?
- Is the purpose medical, educational, workplace-related, legal, therapeutic, or care-planning related?
- Do I need a diagnosis, recommendations, documentation, treatment, or support with daily functioning?
- Will I be using private pay, insurance reimbursement, district funding, employer reimbursement, or another source?
- Does my insurance plan require prior authorization?
- Do I need documentation for an IEP, 504 Plan, testing accommodations, workplace accommodations, legal matter, or medical provider?
If you are unsure, we can help you think through which type of service may best match your needs.
Our Approach to Payment Questions
Payment and insurance questions can feel confusing, especially when you are already trying to make decisions about care. We aim to make the process as clear and transparent as possible.
When you contact us, we can discuss:
- What type of service may be appropriate
- Whether the service is typically private pay
- Whether a superbill may be available
- What questions you may want to ask your insurance company
- Whether school district funding, employer reimbursement, or other payment options may be relevant
We want you to understand the likely payment process before beginning services.
Not Sure Where to Start?
You do not need to know exactly which payment option applies before contacting us. Tell us what service you are seeking, what questions you need answered, and whether insurance, reimbursement, or outside funding is a concern.
We can help you understand the next step and whether our practice may be the right fit.