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Fillable Online mass Psychological and neuropsychological

Fillable Online mass Psychological and neuropsychological 2025

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The document is a supplemental form for psychological and neuropsychological assessments, designed to collect specific patient information and diagnostic data necessary for health plan evaluations. It includes sections for identifying information, relevant diagnostic data, requested CPT codes for testing, reasons for assessment necessity, mental health history, and clinician details. The form aims to ensure compliance with medical necessity criteria set by health plans.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Identifying Information' section. Enter the dates of service requested, your first name, last name, date of birth, gender, and other personal details as required.
In the 'Relevant Diagnostic Data' section, specify the primary possible diagnosis and any comorbid conditions. If there are no additional diagnoses, check the box indicating 'None'.
Complete the 'CPT Codes Requested' section by entering relevant codes for psychological and neuropsychological testing evaluations based on your needs.
Provide detailed information in the 'Relevant Mental Health/SA History' section regarding any mental health history or substance use concerns.
Finally, review all entries for accuracy before submitting. Ensure that all required fields are completed to avoid delays.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does MassHealth cover neuropsych testing?

This is one of the infuriating aspects of having ADHD. Typically, neuropsych testing is not covered by insurance because its not medically necessary to diagnose ADHD, the diagnostic interview that a psychiatrist can do themselves is sufficiently accurate.

Does MassHealth cover neuropsychological evaluation?

Live consultations and assessments conducted through HIPAA compliant Zoom and performed by a highly trained neuropsychology team can help. We Offer: In office assessments replicated in your home and at your convenience. A comprehensive assessment of memory and other thinking skills by an expert.