What an ADHD evaluation costs in California — compare two real quotes

Name the decision before asking the price

Check the one answer you need first. If two matter, ask whether one service truly covers both.

• I need a clinical evaluation to decide whether ADHD fits.
• I need a prescriber to discuss medication with me.
• I need broader testing for learning, memory, thinking or another diagnosis.
• I need a report for a college, employer, examination board or disability decision.
• I need my child’s public school to evaluate educational support.

Who must use the answer or report?

What has that person or office said it will accept?

Before paying for documentation: ask the school, college, employer or examination board who may write it, what it must contain and how current it must be. A diagnosis does not guarantee that a report meets somebody else’s rule.

Get the whole scope in writing

Write Not included or Not answered instead of guessing. Billing codes and units do not tell you whether the report will answer your question, but they give your plan something exact to check.

Copy this:

“I am comparing two evaluation options. Please send me the decision this evaluation is designed to answer, everything included in the total, the expected billing codes and units, the document I will receive, and the full expected charge. Please mark anything that is not included.”

Confirm the payment route

Check one route for each option. A practice saying that it “takes” a plan is not the same as your plan confirming the provider, service and codes.

• Self-pay or not using insurance. Ask for a written good faith estimate. CMS says an uninsured or self-pay person can request one, and usually must receive one when care is scheduled at least three business days ahead. A bill from one provider that is at least $400 above that provider’s estimate may qualify for the federal dispute process.²
• Commercial insurance. Give the plan the evaluator’s name, location, billing codes and expected units. Ask about network status, prior authorization, deductible, copay or coinsurance, and any exclusion that applies to the exact service.
• Medi-Cal. California’s current provider manual lists psychological and neuropsychological testing as covered non-specialty mental health services when clinically indicated. It also sets provider, code and frequency rules. That is a coverage category, not a promise that a particular office is available or that every requested battery qualifies.³ Ask the managed-care plan or county route who owns the referral.
• Public K–12 school. If a disability is suspected and the question concerns school functioning, a parent can make a written referral for assessment. If the district decides an assessment is to be conducted, the plan and assessment are provided without charge. The district can refuse; ask for prior written notice stating what it refused and why.⁴ ⁵ Do not buy a private report until the school says what decision remains unanswered.
• College, employer or examination board. Confirm the documentation rule with that gatekeeper first. Payment coverage and document acceptance are two separate questions.

Test whether the quote will solve the problem

The cheaper quote can be expensive if the report is rejected. The larger quote can also be expensive if nobody can name the extra question it answers.

One unanswered question that could change my choice:

Option A:

Option B:

Compare only what is confirmed

Do this: leave a number Unknown until the practice or plan confirms it. Do not turn an advertised starting price, an hourly fee or another person’s bill into your total.