Prior authorization for psychological testing: forms, fax, clocks

Psychological and neuropsychological testing needs prior authorization at some plans and not others: Carelon Health of Pennsylvania and TRICARE West require it, Aetna's flyer dropped precertification for testing on January 1, 2019, and Evernorth's Massachusetts form calls it not routinely required; where it applies, the plan's form goes by portal or the fax number the form prints.

The request comes from the psychologist or neuropsychologist who will test and goes to the member's plan or its behavioral health manager before testing starts. Two plans' pages put the diagnostic interview first. Optum's Provider Express page on psychological and neuropsychological testing says a diagnostic interview should be completed before prior authorization requests are submitted, and Anthem HealthKeepers' Virginia Medicaid testing form (February 2026) asks for a diagnostic interview and relevant screening measures by the psychologist first, other than in exceptional cases.

Does psychological testing need prior authorization?

Psychological testing needs prior authorization only where the member's plan requires it: Optum says not all plans do, Aetna's 2024 precertification list leaves testing off, and Carelon Health of Pennsylvania, TRICARE West and the Oklahoma Medicaid plans require it. The table sets out each plan's rule from its own page or form, with "Not stated" where the page is silent.

Aetna's behavioral health precertification flyer (form 83.03.885.1, dated 7/20) says testing stopped requiring precertification or authorization on January 1, 2019, and that precertification requirements apply unless state law expressly dictates otherwise. Aetna's participating provider precertification list, effective August 1, 2024, names the behavioral health services that require precertification, among them inpatient confinements, partial hospitalization, applied behavioral analysis and transcranial magnetic stimulation, and psychological and neuropsychological testing is not on it. The list applies to Aetna, Aetna Medicare and Innovation Health plans among others, and not to Traditional Choice, indemnity, Foreign Service Benefit, Mail Handlers Benefit or Rural Carrier Benefit plans.

Evernorth's Massachusetts assessment form (924879 01/2024) states that authorization for psychological testing is not routinely required and sends clinicians to Evernorth Behavioral Health for account-specific information. Its Behavioral Health Resource Guide (03/26) says authorization is dependent upon the benefit plan and marks CPT 96130 and 96132, the first hour of psychological and neuropsychological testing evaluation, as services that may be handled by medical based on plan type.

TriWest's Mental Health Specific Referral Checklist for TRICARE West lists Psychological/Neuropsychological Testing (BH_PSYTEST) as pre-authorization required, while office-based outpatient psychotherapy and medication management need no referral or pre-authorization except for active-duty service members. A joint FAQ from Oklahoma Complete Health, Aetna Better Health of Oklahoma and Humana Healthy Horizons in Oklahoma (733807OK0525) dates the start of testing prior authorization to April 1, 2025 for the first two plans and May 1, 2025 for Humana Healthy Horizons.

What does a testing authorization request carry?

A testing authorization request carries the provider's and the member's identifying data, the clinical case for testing, each test with its time, and the CPT codes, in the set each plan's own form asks for. The table shows which forms ask for each item.

BlueCross BlueShield of Tennessee's commercial Psychological/Neuropsychological Testing Authorization Request Form (26PED4051305, 03/26) asks for each test by full name with its units: "One unit equals 30 minutes." Carelon Health of Pennsylvania authorizes psychological tests in the same 30-minute units. The Massachusetts Collaborative assessment supplemental form that Aetna hosts (GR-69756, dated 12-25) lists 96130 and 96131 for psychological testing evaluation and 96132 and 96133 for neuropsychological testing evaluation, each per 60 minutes, 96136 to 96139 for test administration per 30 minutes, and 96116 and 96121 for neurobehavioral status evaluation. CMS's Medicare mental health coverage booklet lists the same evaluation and administration codes.

The Massachusetts form asks for specific information in the context of each health plan's own medical necessity criteria and invites any additional data relevant to them. Aetna Better Health of Oklahoma's Behavioral Health Standard Form (OK-23-08-01) asks in section 5 for the clinical question testing will answer, how testing will affect treatment, and a 6-month clinical summary from the treating psychiatric provider. TriWest's BH_PSYTEST checklist asks whether the chart holds a documented mental status exam and tells the clinician to save the page as a PDF and submit it with supporting documents, such as a recent psychological evaluation and progress notes.

Which plans take a testing request by fax, and which want the portal?

Fax is a printed channel for testing requests on Evernorth's Massachusetts form, both Anthem forms, the Humana Healthy Horizons and Aetna Better Health forms in Oklahoma and Carelon Health of Pennsylvania's PER form, while Optum, Aetna and Carelon Behavioral Health steer requests to their portals. Each number is the one the plan's own form prints, for that plan and state:

• Evernorth's Massachusetts form says to file by facsimile at 860.687.7329, and Massachusetts providers who file electronically register for the online prior authorization tool first.
• Anthem HealthKeepers' Virginia Medicaid form takes fax at 844-445-6642, and Anthem's Missouri Medicare Advantage neuropsychological testing form (May 2026) takes fax at 844-430-1703, each before services are rendered, beside Availity, which the Missouri form calls the preferred method.
• Humana Healthy Horizons in Oklahoma has providers download the PA request form from its SoonerSelect prior authorization page and fax it to 833-558-9712.
• Aetna Better Health of Oklahoma's form is headed with the fax number 833-923-0829 and also points to Availity for requests and clinical uploads; Oklahoma Complete Health prefers Availity Essentials and takes fax when Availity Essentials is not available.
• Carelon Health of Pennsylvania's provider manual says the Psychological Evaluation Request (PER) form can be faxed or uploaded via ProviderConnect.

Optum tells clinicians to manage all psych and neuropsych services, prior authorization requests included, in the Provider Express secure portal, which needs a One Healthcare ID (OHID). Its October 2025 Top of Mind notice starts the enhanced digital request process with Optum/UnitedHealthcare Commercial, Medicare Advantage and coordination of benefit plans, for in-network and out-of-network providers alike, and Optum's Texas authorization forms page lists the Optum Psych Testing Request as a new electronic submission. Aetna takes most precertification requests through its Availity provider portal or from the office's own EMR system.

Carelon Behavioral Health's testing update strongly encourages its portal instead of faxing and keeps a paper version on its Clinical Forms page under Psychological Evaluation Forms, and its Forms and Guides page lists the Psych Neuropsych Evaluation Request Form. BlueCross BlueShield of Tennessee sits between the two: its form goes as an attachment in Availity for Tennessee providers or through the provider's portal or Cohere from out of state, while the same form says to attach additional clinical to fax.

A faxed request and the appeal that can follow it are covered in how to fax a prior authorization or appeal and prove delivery, and sending the finished evaluation is covered in what fax service psychologists use to send evaluation reports.

How long does the plan have to decide?

Under CMS-0057-F, Medicare Advantage organizations, Medicaid and CHIP fee-for-service programs, Medicaid managed care plans and CHIP managed care entities must send a prior authorization decision within 72 hours for an expedited request and seven calendar days for a standard one, from January 1, 2026. CMS's fact sheet on CMS-0057-F also names Qualified Health Plan issuers on the Federally Facilitated Exchanges as impacted payers and excludes them from those clocks, and no policy in the rule applies to prior authorization decisions for drugs.

Beginning in 2026, impacted payers must give a specific reason for a denied prior authorization, whatever method carried the request, and CMS says the decision may come by portal, fax, email, mail or phone. CMS set March 31, 2026 for the first metrics report and January 1, 2027 for the Prior Authorization API. The urgent path is covered in how to request an expedited prior authorization.

Carelon Health of Pennsylvania sets its own clock for psychological tests: a decision within two business days of receipt of all clinical information. The Medicare Advantage and Medicaid plans in the table fall under CMS-0057-F's clocks, and the other plans' pages print no clock of their own.

What gets psychological testing denied or left uncovered?

Psychological testing gets denied or left uncovered when no authorization is on file, when the plan's form excludes the purpose, such as educational, placement, custody, disability or forensic testing, or when the request skips the diagnostic interview the forms ask for first. Carelon Behavioral Health names a lack of prior authorization on file as the first of five common denial trends for testing claims.

BlueCross BlueShield of Tennessee's form says testing of basic intellectual, cognitive, academic, developmental, psycho-motor and visual-motor functioning is usually considered educational, and testing partially or primarily for educational purposes is not a covered benefit, a disqualifier that may be subject to account-specific arrangements. TriWest's checklist says testing will not be conducted for academic placement, to determine the presence or nature of a learning disorder, to influence custody determinations or job placements, for general screening, or because teachers or parents asked for it. Anthem's Virginia Medicaid form calls placement purposes, disability evaluations and forensic purposes not covered benefits.

A denial from a payer under CMS-0057-F carries a specific reason, and the options after one are in what to do after a prior authorization denial: peer-to-peer, resubmission or appeal.

How does Medicare pay a psychologist for testing?

Traditional Medicare lets an independently practicing psychologist who is not a clinical psychologist bill directly only for diagnostic psychological and neuropsychological tests ordered by a physician, a clinical psychologist or a non-physician practitioner authorized to order diagnostic tests, under CMS's Program Integrity Manual, chapter 10. A psychologist practices independently when rendering services on the psychologist's own responsibility, free of the administrative and professional control of an employer such as a physician, institution or agency.

The Medicare Benefit Policy Manual, chapter 15, covers tests by a psychologist who is not a clinical psychologist and practices independently when a physician orders them. When a psychologist on the staff of an institution, agency or clinic performs diagnostic psychological tests, that entity bills for them. The CMS-855I keeps the two roles apart: section 2H has one box for Psychologist, Clinical (section 2I) and another for Psychologist Billing Independently (section 2I2).

How do you send testing requests from a HIPAA fax account?

A testing request leaves from the practice's own number on a paid Fax Pigeon plan, and a decision the plan faxes back lands in the same shared inbox. The completed form and the evaluations behind it upload as PDF or Word files, and a cover sheet is optional. Every delivered fax gets delivery proof. Everyone who handles authorizations works from that inbox, and adding people costs nothing.

* Official sources (CMS, Optum Provider Express, Aetna, Evernorth, Carelon Behavioral Health, BlueCross BlueShield of Tennessee, TriWest (TRICARE West), Anthem, the Oklahoma Medicaid plans) were read on October 20, 2026. Fax Pigeon prices and plan terms as of October 21, 2026.