Fees & Insurance
Fees & Insurance
Clear information about fees and insurance helps families plan with confidence. Before an evaluation begins, ClearStep will explain the anticipated scope of services, estimated fee, payment schedule, and available billing documentation.
ClearStep is currently private pay. A superbill is provided that you can submit to your insurer for possible out-of-network reimbursement. Reimbursement varies by health plan and by the type of evaluation. Before scheduling, ClearStep will explain whether the proposed service will be handled as out-of-network or self-pay. Families should also verify their individual benefits directly with their insurer.
Why is your wait shorter than other practices?
Out-of-Network Reimbursement
For services handled as out-of-network or self-pay, families pay ClearStep according to the payment schedule explained before the evaluation. After services are completed and payment requirements are met, ClearStep can provide a superbill that the family may submit to its insurance company for possible out-of-network reimbursement.
A superbill does not guarantee reimbursement. The amount reimbursed, if any, depends entirely on the family’s health plan, deductible, coverage rules, prior-authorization requirements, and the insurer’s allowed amount.
What Is a Superbill?
A superbill is a detailed receipt that contains information an insurance company may need to review an out-of-network claim, including:
- The patient’s name and date of birth
- The provider’s name, credentials, NPI, and tax identification information
- Dates of service
- Procedure codes
- Diagnosis codes, when clinically appropriate
- The amount charged and amount paid
How to Check Out-of-Network Benefits
- Call the Member Services number on the back of your insurance card.
- Tell the representative: “I am calling to check my out-of-network benefits for a neuropsychological evaluation for my child.”
- Ask whether your plan includes out-of-network benefits and whether a referral or prior authorization is required.
- Ask for your out-of-network deductible, how much has been met, the reimbursement percentage after the deductible, and whether reimbursement is based on the provider’s fee or the plan’s allowed amount.
- Ask whether the plan reimburses the procedure codes that may be used for the evaluation. Common examples are listed below, but final codes and units depend on the services actually provided.
- Ask where and how to submit a superbill and supporting receipts.
- Write down the representative’s name, the date of the call, and the call reference number.
Common Procedure Codes
The following codes are commonly associated with neuropsychological evaluation services. They are examples only. ClearStep will use the codes and units that accurately describe the services provided.
- 90791 — Initial diagnostic interview
- 96116 — Neurobehavioral status examination
- 96132 & 96133 — Professional neuropsychological evaluation services, including integration and report work
- 96136 & 96137 — Test administration and scoring by the psychologist
Scheduling, Deposits & Cancellations
A $300 deposit is collected when your evaluation is scheduled and is credited toward the cost of the evaluation. For private-pay families, the $300 deposit is due when you schedule and is credited toward your evaluation fee. The balance is due on the day of testing.
Because each appointment reserves dedicated time for your child, I ask for two business days’ notice to change or cancel any appointment. If I don’t receive that notice, the following fees apply:
- $100 — late-canceled or missed intake or feedback session
- $300 — late-canceled or missed testing day
No-shows are charged the same as late cancellations.
Insurance Call Script
A one-page guide with the questions above, ready to bring to your call with your insurance company.
Download the Insurance Call ScriptFrequently Asked Questions
Do you submit claims to insurance?
The claim process depends on whether the service is out-of-network or self-pay. ClearStep will explain the process before scheduling. For services handled as out-of-network, families generally submit the superbill to their insurance company.
Will insurance reimburse me?
Reimbursement cannot be guaranteed. It depends on the terms of your specific health plan, deductible, prior-authorization rules, and allowed amounts.
Can I use HSA or FSA funds?
Evaluation charges may be eligible when they meet the plan’s definition of a qualified medical expense. Please confirm eligibility and documentation requirements with your HSA or FSA administrator.
Can the report be shared with my child’s school or healthcare providers?
Yes. With appropriate authorization, families may share the report with schools, physicians, therapists, and other providers.
Can you tell me the final cost upfront?
ClearStep will provide an anticipated scope and fee before the evaluation begins. The fee may vary if the clinical question or required testing changes, and any material change will be discussed with the family.
Good Faith Estimate
People who do not have health insurance, or who choose not to use insurance for a service, are generally entitled under federal law to receive a written Good Faith Estimate of expected charges when care is scheduled sufficiently in advance or upon request. The estimate is not a bill.
Have questions about a specific evaluation? Contact ClearStep — you don’t need to know which evaluation is right before reaching out.