Are ADHD Assessments Covered By Insurance?

An ADHD assessment typically involves a comprehensive evaluation, but whether that assessment is covered by insurance depends upon several factors.

Kahina Beasley (Louis), Psy.D.
Are ADHD Assessments Covered By Insurance?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. In order to help manage symptoms and improve quality of life, it is imperative to receive diagnosis and treatment.‍

Insurance will sometimes cover diagnosis and/or treatment, but – as is the case with most things insurance related – it’s complicated.‍

An ADHD assessment typically involves a comprehensive evaluation conducted by a qualified healthcare professional. This individual may be a psychiatrist, a psychologist, or a pediatrician. An evaluation may include interviews with the individual, as well as family members, behavioral observations, and psychological testing.

Whether an assessment is covered by insurance, however, depends upon several factors. These factors include your type of insurance plan, regional regulations, and the specific policies of your insurance provider.

If deemed medically necessary, an ADHD assessment is typically covered by a good insurance plan. ADHD is recognized as a legitimate medical condition that significantly impacts one’s functioning and overall well-being. Most insurance plans provide some coverage for mental health evaluations, including those related to ADHD.

However, the extent of coverage and the specific criteria for reimbursement can vary widely. Some insurance plans require pre-authorization and / or a referral from a primary care physician. Additionally, certain insurance plans have limitations on the types of professionals who can conduct assessments.

Individuals with ADHD may require ongoing treatment. This could include medication management, therapy, or education-based interventions. Coverage for these treatments will also vary depending on the insurance plan and the specific services provided.