Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX) psychological testing coverage: limits, who can bill and referrals
By Javier Alvarez · Updated · 1 min read
1 row: Medicare (Novitas). Public policy, not the member's benefits.
Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX)
Novitas LCD L35101 Psychiatric Codes, Section II Psychological and Neuropsychological Testing · AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX
| Where it applies | Testing is for suspected mental illness where clarification is needed for the diagnosis and treatment plan. When a psychiatric condition or dementia is already diagnosed, testing adds value only if results would significantly change understanding or treatment, for example a change in condition or a capacity question. [1] |
|---|---|
| Visit limits | Each test must be medically necessary; standardized batteries are acceptable only if each component test is. Depending on the issues, a typical battery may require 7 to 10 hours including administration, scoring and interpretation. [1] |
| Referral | A physician order is needed when an independent psychologist (not a clinical psychologist) performs the tests. [1] |
| Who can bill | Independently practicing psychologists may provide the tests when a physician orders them. PTs, OTs and SLPs may do aphasia assessment under general supervision of a physician or clinical psychologist. NPs, CNSs and PAs follow Benefit Policy Manual chapter 15, section 80.2. [1] |
| Also | Documentation must show the reason for referral, tests administered with scoring, interpretation and time, the present evaluation, the diagnosis or suspected diagnosis, recommendations, and who performed the service. Brief screens such as the Folstein Mini-Mental Status Exam are not separately classified as testing. [1] |
- CMS Medicare Coverage Database: LCD L35101 Psychiatric Codes, Novitas (revision effective 01/01/2024), checked October 30, 2026
What Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX)'s documents say
The table above has every field we found for Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX), with numbered sources. In short:
- Visit limits. Each test must be medically necessary; standardized batteries are acceptable only if each component test is. Depending on the issues, a typical battery may require 7 to 10 hours including administration, scoring and interpretation.
- Who can bill. Independently practicing psychologists may provide the tests when a physician orders them. PTs, OTs and SLPs may do aphasia assessment under general supervision of a physician or clinical psychologist. NPs, CNSs and PAs follow Benefit Policy Manual chapter 15, section 80.2.
- Where it applies. Testing is for suspected mental illness where clarification is needed for the diagnosis and treatment plan. When a psychiatric condition or dementia is already diagnosed, testing adds value only if results would significantly change understanding or treatment, for example a change in condition or a capacity question.
Psychological testing coverage at other national payers
Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral, Cigna and Evernorth and Carelon Behavioral Health.
Check Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX)'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 Medicare (Novitas) with every other payer we checked.