ADHD Testing at Monarch Counseling: Insurance Considerations

We have discussed in the past how Current Procedural Terminology codes, also known as CPT codes are used for billing behavioral health services and medical services by providers. 

In addition to having possible limits on which providers can conduct ADHD testing and provide diagnostic reports, insurance policies may also have limits associated with using CPT codes.

Billing for CPT Codes

There may be limits on the number of units billed for CPT codes. Some policies also limit the number of individuals covered for ADHD testing in a calendar year. 

This means that, even though a provider may be in network with your insurance company, ADHD test testing, may, or may not be covered, depending on your insurance policy. Prior to scheduling ADHD testing, it is important to ask questions associated with your policy, especially any limits associated with ADHD testing.

Some insurance companies choose not to reimburse for certain CPT codes, so be sure to get clarification on all questions with your insurance company regarding ADHD testing. Coverage for ADHD testing not only depends on the insurance carrier, but the individual policy for an individual/family as well.

Self-Pay for ADHD Testing

Self-pay is also an option for ADHD testing. Here are some practical tips to optimize costs:

• If your insurance plan is up for renewal, ask about higher benefit levels for ADHD testing and confirm which CPT codes are covered.
• Consider the trade-offs between deductible levels and regular payroll deductions. A plan with higher deductible may reduce monthly take-home pay but can lower out-of-pocket costs at the time of testing.
• Ask your employer if they offer pre-tax funds or additional health benefits that could support ADHD testing.

Working with the Provider

If you choose self-pay, we will discuss pricing upfront and provide a clear, written agreement for the services rendered. We emphasize comprehensive reporting with recommendations and accommodations tailored to the child or adult being evaluated.

Ready to explore payment options?

Reach out to Monarch Counseling to review your insurance details, discuss self-pay options, and determine the best path for ADHD testing.