CPT Codes & Superbills: Insurance Coverage for Neuropsychology in Florida

What Are CPT Codes and the Neuropsychology Superbill?

CPT codes (Current Procedural Terminology) are the standard billing identifiers used by healthcare providers, including neuropsychologists, to describe services rendered. A Superbill is a detailed, itemized receipt that includes the CPT codes and ICD-10 diagnostic codes, allowing patients to submit a claim for out-of-network reimbursement from their insurance company.

Essential Neuropsychology CPT Codes and Billing Units

Understanding these time-based codes is crucial for predicting coverage. The total number of units billed reflects the hours of work involved in a comprehensive evaluation.

• 90791: Initial Psychiatric Diagnostic Interview. The first step covering comprehensive history and diagnostic interviewing. Typically covered, including via telehealth (-95 modifier) in Florida.
• 96116: Neurobehavioral Status Exam. A brief assessment of cognitive and behavioral functioning, often used for follow-up or screening. Coverage varies by insurer.
• 96132 (First Hour) / 96133 (Each Additional Hour): Neuropsychological Testing Evaluation Services. Billed by the psychologist for professional time spent on test selection, integration, interpretation, clinical decision-making, and report writing.
• 96136 (First 30 Min) / 96137 (Each Additional 30 Min): Neuropsychological Test Administration & Scoring. Time spent by the qualified health care professional personally administering and scoring standardized tests. A full battery often requires 12–20+ units.

Insurance Coverage: Medical Necessity and Out-of-Pocket Costs

Insurance coverage for neuropsychology hinges on medical necessity. This determines which codes are covered and which conditions qualify for reimbursement.

What Insurance Often Covers (Even Out-of-Network)

• Initial diagnostic interviews like 90791 are the most reliably covered service.
• Telehealth for interviews (90791, 96116) is commonly reimbursed by most commercial plans; Medicare is generally more restrictive.

Diagnoses Typically NOT Covered (No Medical Necessity)

Insurance companies only reimburse neuropsychological evaluations when deemed medically necessary (e.g., post-TBI, stroke, or moderate cognitive decline). The following are routinely denied:

• ADHD (without a neurological or psychiatric comorbidity)
• Learning Disorders (dyslexia, dyscalculia, etc.)
• Academic or school performance issues
• Gifted testing or twice-exceptional evaluations
• Testing for career, employment, or legal accommodations only
• Baseline cognitive testing (if PCP deems complaint subjective or screener shows no deficit)
• Family history of dementia or psychiatric illness without current cognitive symptoms

The Reality of Full Testing Coverage

Full neuropsychological batteries (96132, 96133, 96136, 96137) are frequently considered out-of-pocket expenses or reimbursed at a partial rate, whether remote or in-person. Medicare is generally more restrictive than commercial insurance.

Virtual Neuropsychology: Validity and the Concierge Model

The concierge model addresses traditional concerns about remote testing:

• Clinician Oversight: Licensed neuropsychologists personally administer and score each test, making real-time adjustments for remote validity rather than relying on a technician.
• Validated Digital Tools: Adaptive platforms ensure randomized stimuli and reliable measurement of cognitive domains, mirroring in-office accuracy. Learn more about remote testing validity.
• Security and Controlled Environment: HIPAA-compliant platforms, minimal distraction, and secure sessions.

Traditional resistance to remote testing stems from industry inertia, professional conservatism, and financial interests. Large-scale in-person testing dominates the market; effective remote testing threatens revenue streams, similar to how dominant pharmaceutical products resist competition.

Maximizing Your Superbill Reimbursement

• Request Detail: Ensure your Superbill includes CPT codes, ICD-10 codes, date of service, total time, and provider tax ID.
• Understand Your Plan: Reimbursement is subject to your out-of-network deductible and coinsurance.
• Use Tools: Services like Thrizer help automate claim submission.

Bottom Line: What is Likely Reimbursable

• ✅ 90791 Initial Diagnostic Interview – virtual or in-person
• ✅ 96116 Neurobehavioral Status Exam – often reimbursable, especially for clinical follow-up
• ❌ 96132/96133 Neuropsychological Evaluation – rarely reimbursed remotely; partial coverage in-person if medically necessary
• ❌ 96136/96137 Test Administration & Scoring – frequently out-of-pocket, even in-person unless pre-authorized
• ❌ Diagnoses without medical necessity (ADHD alone, learning disorders, school performance issues, baseline testing, family risk) – not covered

Your Next Steps: Planning the Evaluation

Begin with a virtual screening or 90791 diagnostic interview to establish medical necessity. This guides whether full testing is justified and informs insurance authorization and potential out-of-pocket costs.

View My Neuropsychology Fee Schedule