Cigna and Evernorth psychological testing coverage: codes and prior authorization
The short answerCigna's policy covers neuropsychological testing (96132, 96133, 96136 to 96139) only when information will guide decisions, there are symptoms of significant decline, and one of a listed set of conditions is reasonably suspected. Educational, vocational, baseline and screening uses are not covered. The member's plan document overrides the policy.
By Javier Alvarez · Updated · 1 min read
1 row: Cigna (Evernorth). Public policy, not the member's benefits.
Cigna and Evernorth
Evernorth Coverage Policy EN0258 Neuropsychological Testing (effective 9/15/2026) · All states
| 96116 | Listed (medically necessary when the policy criteria are met) [1] |
|---|---|
| 96121 | Listed (medically necessary when the policy criteria are met) [1] |
| 96130 | Not named (the policy addresses neuropsychological testing only) [1] |
| 96131 | Not named (the policy addresses neuropsychological testing only) [1] |
| 96132 | Listed (medically necessary when the policy criteria are met) [1] |
| 96133 | Listed (medically necessary when the policy criteria are met) [1] |
| 96136 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| 96137 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| 96138 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| 96139 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| Where it applies | All of the following: the information will be used for clinical decision making, there are symptoms indicative of a significant decline in cognitive or behavioral functioning, and there is a reasonable suspicion of a listed condition. [1] |
| Diagnoses | Listed suspicions include autism spectrum disorder, brain tumor, anoxic or hypoxic episode, CNS infection with neurocognitive problems, dementia, demyelinating disease, epilepsy, toxic exposure, Parkinson's or Huntington's disease, postconcussion syndrome, stroke and traumatic brain injury. Concussion and mild cognitive impairment qualify only with a change in mental status, suspicion of an underlying CNS condition and failed standard treatment. [1] |
| Prior authorization | Evernorth's Massachusetts supplemental form for behavioral providers (01/2024) says authorization for psychological testing is not routinely required and to contact Evernorth Behavioral Health for account-specific information. We found no national prior authorization rule for Cigna. [2] |
| Also | Not covered for any indication not listed, including educational or vocational assessment, improving academic performance, baseline assessment of function, monitoring chronic conditions with no significant new change, and screening. Computerized neuropsychological testing that needs no clinician interpretation and report is experimental. A number of states mandate autism coverage, so check the plan. [1] |
- Evernorth (Cigna): Coverage Policy EN0258 Neuropsychological Testing (effective 9/15/2026), checked October 30, 2026
- Evernorth Behavioral Health: Massachusetts Psychological and Neuropsychological Assessment Supplemental Form (01/2024), checked October 30, 2026
What Cigna and Evernorth's documents say
The table above has every field we found for Cigna and Evernorth, with numbered sources. In short:
- Prior authorization. Evernorth's Massachusetts supplemental form for behavioral providers (01/2024) says authorization for psychological testing is not routinely required and to contact Evernorth Behavioral Health for account-specific information. We found no national prior authorization rule for Cigna.
- Where it applies. All of the following: the information will be used for clinical decision making, there are symptoms indicative of a significant decline in cognitive or behavioral functioning, and there is a reasonable suspicion of a listed condition.
- Codes. 96116, 96121, 96132 and 96133 are listed. 96130 and 96131 are not named in this policy. 96136, 96137, 96138 and 96139 are limited.
Psychological testing coverage at other national payers
Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral and Carelon Behavioral Health.
Check Cigna and Evernorth's claim against the row
Before the claim goes out, compare it with the row above: the evaluation and administration codes pair the way the policy says, the hours fit any cap, the referral question is documented, and prior authorization covers the units. The psychological testing table compares Cigna (Evernorth) with every other payer we checked.