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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that psychological testing includes the administration, interpretation, and scoring of the tests and 
other medically accepted tests for evaluation of intellectual strengths, psychopathology, psychodynamics, 
mental health risks, insight, motivation, and other factors influencing treatment and prognosis. 
 
Comments: These tests do not represent psychotherapeutic modalities but are diagnostic aids. Use of such tests 
when mental illness is not suspected would be a screening procedure not covered by Medicare. Each test 
performed must be medically necessary. Therefore, standardized batteries of tests are not acceptable unless 
each test in the battery is medically necessary. 
 
Changes in mental illness may require psychological testing to determine new diagnoses or the need for 
changes in therapeutic measures. Repeat testing not required for diagnosis or continued treatment would be 
considered medically unnecessary. Nonspecific behaviors that do not indicate the presence of, or change in, a 
mental illness would not be an acceptable indication for testing. Psychological or psychiatric evaluations that 
can be accomplished through the clinical interview alone (e.g., response to medication) would not require 
psychological testing, and such testing might be considered as medically unnecessary. Adjustment reactions or 
dysphoria associated with moving to a nursing facility do not constitute medical necessity for psychological 
testing. 
 
B. Description: Neuro-Cognitive, Mental Status, Speech Testing.  
 
Testing which is intended to diagnose and characterize the neurocognitive effects of medical disorders that 
impinge directly or indirectly on the brain. Examples of problems that might lead to neuropsychological testing 
are: 
1. Detection of neurologic diseases based on quantitative assessment of neurocognitive abilities (e.g., mild 
head injury, anoxic injuries, AIDS dementia) 
2. Differential diagnosis between psychogenic and neurogenic syndromes 
3. Delineation of the neurocognitive effects of central nervous system disorders 
4. Neurocognitive monitoring of recovery or progression of central nervous system disorders; or 
5. Assessment of neurocognitive functions for the formulation of rehabilitation and/or management 
strategies among individuals with neuropsychiatric disorders.  
Comments: The content of neuropsychological testing procedures differs from that of psychological testing in 
that neuropsychological testing consists primarily of individually administered ability tests that 
comprehensively sample cognitive and performance domains that are known to be sensitive to the functional 
integrity of the brain (e.g., abstraction, memory and learning, attention, language, problem solving, 
sensorimotor functions, constructional praxis, etc.). These procedures are objective and quantitative in nature 
and require the patient to directly demonstrate his/her level of competence in a particular cognitive domain. 
Neuropsychological testing does not rely on self-report questionnaires such as the Minnesota Multiphasic 
Personality Inventory 2 (MMPI-2), rating scales such as the Hamilton Depression Rating Scale, or projective 
techniques such as the Rorschach or Thematic Apperception Test (TAT) when questions of how brain damage 
or degenerative disease processes (e.g. right hemisphere CVA) may be affecting emotional expression or how 
significant emotional distress or mood impairment might be affecting cognitive function (e.g. question of 
presence of "pseudodementia") arise. 
 
Typically, psychological testing will require from four (4) to six (6) hours to perform, including administration, 
scoring and interpretation. Supporting documentation in the medical record must be present to justify greater 
than 8 hours per patient per evaluation. If the testing is done over several days, the testing time should be 
combined and reported all on the last date of service. If the testing time exceeds eight (8) hours, medical 
necessity for extended time should be documented. Medical records may be requested. 
You can find this rule in the Medicare Local Coverage Determination (LCD)- L33632, Psychiatry and 
Psychology Services. 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.