What is a psychoeducational assessment?

A psychoeducational assessment is a type of formal psychological evaluation. Its goals are to analyze and understand mental processes underlying an individual’s academic performance. These types of assessments are often recommended for students who are experiencing difficulty in school. Testing can help shed light on why a student is struggling, and can provide specific recommendations for the school, the parents, and the student for addressing these concerns. A psychoeducational assessment can also provide the basis for an Individualized Educational Plan (IEP or 504 Plan) to be put in place with the school.

Do schools provide psychoeducational assessments?

Sometimes schools provide psychoeducational testing in house and free of charge, but usually there must be a significant demonstrated need in place to do so. For example, the child might have to be more than a year or two behind peers on standardized tests before the school will provide an evaluation. Also, schools tend to limit the testing to a narrow scope, which may leave out important explanations for why the student is struggling. And because the school psychologists work for the school and not the parents, they may not be motivated to assess the family’s specific concerns. Usually private testing is a better option. However, you might consider speaking to your school’s Psychologist or Special Education Director to see if they would be willing to pay for, or contribute to, outside testing.

What are the steps in a psychoeducational assessment?

  1. Intake session. Typically, an assessment psychologist will have an initial meeting to identify the presenting problems and testing goals. This will help them to correctly select a battery of tests.
  2. Test administration and scoring. Then they will administer testing face-to-face. The testing administration is usually a time-intensive process, and often spans several days. This is necessary for a comprehensive evaluation. The tests are then scored.
  3. Evaluation. After testing and scoring is completed, the psychologist will review the results, integrate the data, and generate a written report. This step often takes several weeks.
  4. Feedback session. Lastly, the psychologist will share the results of the testing with the patient and/or their family, and provide specific recommendations — usually in a final meeting.

How is a psychoeducational assessment billed?

The first 30 minutes of test administration and scoring is billed with CPT Code 96136. Each additional 30 minutes of test administration and scoring is billed with CPT Code 96137. All other time is billed by the hour, with CPT Code 96130 being used for the first hour, and CPT Code 96131 being used for each additional hour. Costs often range from $2000 to $5000.

Your health insurance plan may cover none, some, or all of the evaluation. It usually depends on many factors. Most health insurance policies will cover testing if they deem it to be “medically necessary” (i.e., the result of a medical condition or a psychiatric disorder). Many insurance companies will not cover testing if it is solely for educational purposes. However, sometimes plans do provide coverage. Here are some recommendations for checking:

  • Call your insurance company (see the Benefits Hotline number on the back of your insurance card) and ask about the estimated reimbursement rate for the CPT Codes mentioned above. When you call, be sure to specify the reason for the testing (e.g., ADHD, learning disability).
  • Ask if they can send you a list of local providers that are “in-network” with the insurance company.
  • Also ask if there is “out-of-network” coverage for this type of testing.
  • If you are told that testing is covered, ask if you will need “pre-certification” or “pre-authorization” (i.e., advance approval) prior to beginning testing.

You may be able to find local providers who are in-network with your insurance company. An in-network provider will typically be less expensive. However, be aware that in-network assessors may be limited in the battery they can administer, which may reduce the comprehensiveness of the testing. Out-of-network providers have the freedom to perform more thorough testing, which can help to fully elucidate the problems.

Out-of-network Referrals

If you can afford to pay for the assessment, then I would recommend using an out-of-network provider. These following local psychologists are excellent:

Tiffany Garner, Psy.D.
1104 Kenilworth Drive, Suite 301
Baltimore, MD 21204
410-499-1101
drtiffanygarner@gmail.com
Website

Mary Jo Coiro, Ph.D.
5911 York Road, Suite 100
Baltimore, MD 21212
410-330-0120

In-network Referrals

Testing at Mt. Washington Pediatric Hospital or the Kennedy Krieger Institute may be in-network options, depending on your insurance plan. Call your insurance company to check before scheduling an intake.

Mt. Washington Pediatric Hospital
Learning Assessment Center
1501 Sulgrave Avenue, Suite 102
Baltimore, MD 21209
410-578-5037
Website

Kennedy Krieger Institute
Department of Neuropsychology
1750 E. Fairmount Avenue, 3rd Floor
Baltimore, MD 21231
888-554-2080
Website

What if I can’t afford the assessment?

Loyola University Maryland offers sliding scale testing as part of their student training clinic. Unfortunately, they have usually a long waitlist.

Loyola Clinical Centers
5911 York Road, Suite 100
Baltimore, MD 21212
410-617-1200
theclinics@loyola.edu
Website

Your child’s school or your employer may be willing to pay, in whole or part, so it may be helpful to look into these options as well. A payment schedule (i.e., stretching out payments) can often be arranged with many providers. And in some cases, providers may be willing to offer a sliding scale if you can demonstrate financial need. It never hurts to ask.

Alternatives

If you have a strong suspicion that your child has ADHD and nothing more, and your goal is simply to treat their ADHD with medication, therapy, or coaching, then a comprehensive evaluation may not be necessary. However, I would recommend speaking to your pediatrician or therapist for advice on the matter.