This document addresses the use of neuropsychological testing, also known as psychometric testing, which refers to a quantitative, comprehensive evaluation of cognitive, motor and behavioral functional abilities related to developmental, degenerative, and acquired brain disorders. Specifically, this testing is an objective evaluation of mental cognitive, motor and behavioral function and is not a mental health evaluation. This testing may be used to augment a comprehensive medical history and physical examination, as well as a neurological investigation of certain conditions.

Note:  Please see the following document for information related to testing for behavioral health-related conditions:
CG-BEH-01 Screening and Assessment Tools for Pervasive Developmental Disorders.

Medically Necessary:

Neuropsychological testing is considered medically necessary for any of the following indications:

• When there are only mild or questionable deficits on standard mental status testing, and more precise evaluation is needed to establish the presence of abnormalities or distinguish them from changes that may occur with normal aging or the expected progression of other disease processes; or
• When there is a need to quantify the deficits, particularly when the information will be useful in determining a prognosis; or
• When there is a need to characterize the strengths and weaknesses of an individual, as a guide to treatment or rehabilitation planning; or
• When neuropsychological data can provide a more comprehensive profile of function that, when combined with clinical, laboratory, and imaging data, may assist in determining a diagnosis; or
• When the individual is being considered for epilepsy surgery.

Note: Repeat testing to track the status of an illness or recovery progress is generally not warranted. 

Clinical conditions which may require the use of neuropsychological testing may include, but are not limited to:

• Traumatic brain injury;
• Cerebrovascular disease (in the recovery/rehabilitation phase following significant clinical recovery when there is still evidence of cognitive impairment or as a guide to rehab and treatment planning);
• Dementia;
• Parkinson's disease;
• Human immunodeficiency virus encephalopathy;
• Multiple sclerosis;
• Epilepsy (as part of presurgical treatment planning);
• Neurotoxic exposure;
• Hypoxic brain injury;
• Chronic pain (when used to assess personality and mood or to perform a cognitive assessment if symptoms indicate intellectual disturbances after discontinuation of pain-relieving or psychotropic medications);
• Neurologic disease (when used as an adjunctive personality assessment for identified or suspected brain disorders, such as brain tumors, hypoxic brain injury).

Note: Testing requests for medical indications not listed above and for retesting are reviewed on an individual case-by-case basis to determine medical necessity.

Not Medically Necessary:
Neuropsychological testing is considered not medically necessary when the criteria outlined above are not met, including, but not limited to:

• When similar neuropsychological testing has been performed in the last 12 months (subject to individual case consideration for medical necessity);
• When there is no clinical diagnosis or symptoms/behaviors suggestive of the need for this testing;
• When test results will not directly contribute to or impact the treatment plan;
• For other non-medical uses of this testing, (e.g., educational/vocational purposes; as a routine screening test of cognitive function, forensic applications, to evaluate malingering).

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

The selection of specific tests and the timing of administration should be determined by the provider.  These decisions would consider multiple factors including, but not limited to:

• Severity of the individual's deficits;
• Nature of the brain disorder, (e.g., stroke, degenerative, trauma);
• Characteristics of the clinical syndrome, (e.g., whether aphasia is present);
• Age of the individual;
• Associated physical limitations;
• Neuropsychiatric disorders, (e.g., depression, anxiety);
• Effects of medications;
• Distractibility;
• Motivation;
• History of developmental disabilities;
• History of substance abuse.

The value of neuropsychological testing is dependent upon the cooperation and effort of the individual being tested. Testing should be considered only after appropriate assessment and optimal treatment of any factor that would affect cooperation and effort. Examples of these include: medication effects, alcohol or other substance abuse, and mood disorders.

Neuropsychological assessments by themselves are insufficient, as a basis for decisions regarding medical therapy and are not intended to provide recommendations for specific diagnostic and pharmacologic interventions.  Neuropsychological test results reflect functional capacity and are not diagnostic of a specific etiology or indicative of a precise localization of a neurologic disease.

Neuropsychological testing is to be performed by clinicians, (e.g., physicians, psychologists) appropriately trained to perform and interpret test results, when this type of testing evaluation falls within their scope of professional practice.

Neuropsychological testing is typically a comprehensive battery of tests to assess multiple cognitive domains, such as intelligence, learning ability, motor function, memory, reasoning, receptive and expressive language skills, etc.

Peer Reviewed Publications:

1. Banks ME. The role of neuropsychological testing and evaluation: when to refer. Adolesc Med. 2002; 13(3):643-662.
2. Binder LM, Campbell KA. Medically unexplained symptoms and neuropsychological assessment. J Clin Exp Neuropsychol. 2004; 26(3):369-392.
3. Boake C, Millis SR, High WM, et al. Using early neuropsychologic testing to predict long-term productivity outcome from traumatic brain injury.  Arch Phys Med Rehabil. 2001; 82(6):761-768.
4. Claypoole KH, Noonan C, Mahurin RK, et al. A twin study of cognitive function in chronic fatigue syndrome: The effects of sudden illness onset. Neuropsychology. 2007; 21(4):507-513.
5. Goldberg E, Bougakov D. Neuropsychologic assessment of frontal lobe dysfunction.  Psychiatr Clin N Am. 2005; 28(3):567-580.
6. Goldstein MA, Silverman ME. Neuropsychiatric assessment.  Psychiatr Clin North Am. 2005; 28(3):507-547.
7. Palumbo D, Lynch PA.  Psychological testing in adolescent medicine.  Adolesc Med Clin. 2006; 17(1):147-164.
8. Sachdev PS, Brodaty H, Valenzuela MJ, et al. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology. 2004; 62(6):912-919.
9. Trollor JN. Attention deficit hyperactivity disorder in adults: conceptual and clinical issues. Med J Aust. 1999; 171(8):421-425.
10. Wild K, Howieson D, Webbe F, et al.  Status of computerized cognitive testing in aging: A systematic review. Alzheimers Dement. 2008; 4(6):428-437.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Psychiatric Association.  Position statement: Recognition and management of HIV-related neuropsychiatric findings and associated impairments.  October 2003. Available at: http://www.psych.org/Departments/EDU/Library/APAOfficialDocumentsandRelated/PositionStatements
   /200305.aspx. Accessed on June 9, 2011.
2. American Psychological Association. Guidelines for psychological practice with older adults.  August, 2003.  http://www.apa.org/practice/guidelines/older-adults.pdf.  Accessed on June 9, 2011.
3. American Psychological Association. Presidential Task Force on the Assessment of Age-Consistent Memory Decline and Dementia.  Guidelines for the evaluation of dementia and age-related cognitive decline.  Washington, DC: American Psychological Association.  February 1998. Available at: http://www.apa.org/practice/guidelines/dementia-age.pdf. Accessed on June 9, 2011.
4. Children's Oncology Group, National Cancer Institute (NCI).  Neuropsychological and Behavioral Testing in Young Patients with Medulloblastoma or Supratentorial Primitive Neuroectodermal Tumor (PNET).  Cochrane Database Syst Rev. October 14, 2008; NCT00772200.  Last updated June 8, 2011.  Available at:  http://www.clinicaltrials.gov/ct2/show/NCT00772200?term=neuropsychological&rank=5.  Accessed on June 9, 2011.
5. Cushman JG, Agarwal N, Fabian TC, et al. Eastern Association for the Surgery of Trauma (EAST) Practice Management Guidelines Work Group.  Practice management guidelines for the management of mild traumatic brain injury.  Winston-Salem, NC. 2000.  Available at: http://www.east.org/Content/documents/practicemanagementguidelines/brain-mild-traumatic-injury-management.pdf. Accessed on September 20, 2011.
6. Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH Jr, Dawson G, et al. Practice parameter: Screening and Diagnosis of Autism: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000; 55(4):468-479.
7. Knopman DS, DeKosky ST, Cummings JL, et al.  American Academy of Neurology (AAN).  Practice parameter:  Diagnosis of Dementia (An Evidence-based Review).  Report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2001; 56:1143-1153.  Available at:  http://www.neurology.org/content/56/9/1143.full.pdf.  Accessed on June 9, 2011.
8. Petersen RC, Stevens JC, Ganguli M, et al.  Practice parameter:  early detection of dementia; mild cognitive impairment (an evidence-based review).  Report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2001; 56(9):1133-1142.
9. Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007; 46(7):894-921.
10. Randolph C, Hilsabeck R, Kato A, et al. International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN).  Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009; 29(5):629-635.
11. Volkmar F, Cook EH Jr, Pomeroy J, et al. Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues. J Am Acad Child Adolesc Psychiatry. 1999; 38(12 Suppl):32S-54S.

Neuropsychological Testing (NPT)
Psychometric testing