Psychological Testing and Assessment

Psychological testing and assessment is a technique performed by licensed psychologists in order to measure and evaluate behavior, cognition, mood, affect, and/or personality in order to improve understanding of capabilities and symptoms. It typically entails a combination of activities, measures, and tools including the use of norm-referenced psychometric instruments. Psychological testing and assessment are covered when performed as part of a medical or behavioral health evaluation, intended to address a specific clinical question that impacts clinical management of the member and criteria is met.

Clinical Guideline Coverage Criteria

The Plan requires the use of the following InterQual Subsets or SmartSheets to obtain prior authorization for psychological testing:

1. Psychological testing, Minnesota Multiphasic Personality Inventory-Adolescent-Restructured Form^® (MMPI-A-RF^®)
2. Psychological testing, Minnesota Multiphasic Personality Inventory-2^®(MMPI-2^®)
3. Psychological testing, Minnesota Multiphasic Personality Inventory-3^® (MMPI-3^®)
4. Psychological testing, Millon^® Adolescent Clinical Inventory (MACI^®)
5. Psychological testing, Personality Assessment Inventory^™ (PAI^®)
6. Psychological testing, unspecified symptom validity test (SVT)
7. Psychological testing, unspecified test

Tufts Health Plan Modification to InterQual Criteria:

For each of the above SmartSheets, Question two, 'reason for testing' choices E and F, are not medically necessary based on limited evidence designation:

• E) Behavioral prediction for judicial or correctional purposes
• F) Detection of malingering for disability adjudication or forensic purposes

Limitations

The Plan considers psychological testing and assessment as not reasonable or medically necessary under the following circumstances:

1. The testing is being conducted primarily for educational (including learning disabilities), vocational or legal purposes;or
2. The testing is being conducted primarily to make or confirm a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) that can reasonably be made or confirmed via conventional interviewing, history, and collateral contact/data collection;
3. The request is solely for the use of instruments or processes that do not require licensed psychologists to administeror interpret;
4. The testing is requested primarily to guide titration of medication;
5. The testing is primarily for the purpose of qualifying for services that are covered under applicable state or federalspecial education laws;
6. The testing is a request to repeat previous or similar testing, and there has not been a significant change in functioning or there isn’t a clear reason to expect that the testing would yield new information or further impact the clinical management of the Member;
7. The testing is being used as a screening tool or as the primary or initial approach to evaluation;
8. Medication side effects, impaired mental status such as active psychosis or other confounds including substance use are present that suggest that test results would potentially be invalid or inaccurate. Current abstinence from substances is required;
9. The time requested for the testing significantly exceeds the time that has been indicated by the publisher or in the scientific literature, and the clinical information submitted does not support a need for the amount of time² Psychological Testing and Assessmentrequested (including ancillary time allowed under the procedure code, if any). In such circumstances the Plan may approve less time than requested.

Codes