3.704.

3 List of Psychological Tests
Material was prepared for use as an aid in handling requests for psychological testing. The minutes allocated for each test include administration, scoring and write up. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. INSTRUMENT 16 Personality Factor (16-PF) ABEL Screen Achenbach Child Behavior Checklist (CBCL) ACTeERS-ADD-H Comprehensive, Teachers Rating Scale Adaptive Behavior Assessment System (ABAS II) ADHD Rating Scale Adolescent Apperception Cards Adolescent Psychopathology Scale Alcohol Use Inventory Delete Aphasia Screening Test (Reitan Indiana) Asperger/austism Rating Scale Asperger’s Syndrome Diagnostic Scales (ASDS) ADDES Attention Deficit Disorder Eval. Scales (ADDES) Attention-Deficit Scales for Adults (ADSA) Auditory Continuous Performance Test Australian Scale for Asperger’s Syndrome Autism Diagnostic Observation Scale (ADOS) Bayley Scales of Infant Development Beck Anxiety Inventory Beck Depression Inventory Beck Depression Inventory-II (BDI-II) Beck Hopelessness Scale (BHS) Beck Scale for Suicidal Ideation Beck Youth Inventory Beery VMI (Test of Visual-Motor Integration) Behavior Assessment System for Children (BASC) Bender Visual Motor Gestalt Test Benton Facial Recognition Test Pers: Single Scale Pers: Single Scale Pers: Single Scale Pers Rating Scale Pers Rating Scale Symptom Rating Scale Neuro/LD: Visual Behav Rating Scale Neuro Neuro: Visual TYPE Personality Inventory Sexual Interest Behav Rating Scale Behav Rating Scale Behav Rating Scale Behav Rating Scale Proj-Thematic Objective personality test Drinking Styles Neuro: Language Rating scale Rating scale Behav Rating Scale ADHD Attention; ADHD Rating scale Rating scale 1-42 17-80 17-80 13 – 80 17 – 80 17 – 80 7-14 3+ 4 - 18 4+ 5 – 18 17+ 6 – 11 AGE 16+ Adol + 4-16 5 – 13 0-89 4 – 18 12 – 19 Childadult 16+ 5+ MINUTES 30 120 15 15 15 15 60 60 30 30 15 15 15 15 30 15 60 60 15 15 15 15 15 15 30 30 30 30 Neuro; not for personality assessment Allow 1 hr for set of checklists Allow 1 hr for set of checklists Allow 1 hr for set of checklists Primarily forensic in nature: may not be covered COMMENTS

3.704.3 Revised 12/08/05, 12/14/06; 12/13/07; 11/01/09, 11/18/09 1 of 11

11/18/09 2 of 11 . Solving Behav Rating Scale Rating Scales Personality Scale Behav Rating Scale Neuro Pers: Screening Pers Rating Scale Neuro-Language 12+ 5 – 13 5 – 16 7-17 6 – 12 15 15 15 45 Allow 1 hr for set of checklists 8+ 15+ Adults Adults Child/adol escent 13+ 13+ 12+ Preschool 6-16 3-10 6.3 Revised 12/08/05. 11/01/09.704. 12/14/06. 12/13/07.5-18 15+ 4-16 AGE 7+ 6-69 6-69 6-69 6-69 MINUTES 20 90 15 15 15 20 15 30 30 45 60 30 45 30 5 15 15 15 60 45 45 15 15 15 Allow 1 hr for set of checklists Short form of SLR-90-R Allow 1 hr for set of checklists Versions for preschool and child/adolescent COMMENTS 3.3. Solving Neuro: Language Neuro: Language Neuro.704. scoring and write up. Revised Clinical Evaluation of Language Fundamentals (CELF) TYPE Neuro: Visual Neuro: Visual Neuro: Language Neuro: Language Neuro: Language Neuro: Language Neuro: Memory/Learning Neuro: Visual Neuro: Visual Neuro: Prob. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. INSTRUMENT Benton Judgement of Line Orientation Test Benton Multilingual Aphasia Exam (BMAE) Benton MAE Sentence Repetition Benton MAE Token Test Benton MAE: Visual Naming Test Benton Right-Left Orientation Test Benton Serial Digit Learning Test Benton Visual Form Discrimination Test Benton Visual Retention Test Booklet Categories Test Boston Diagnostic Aphasia Examination-3 Boston Naming Test BRIEF (Behavior Rating Inventory of Executive Functioning) Brief Neuropsychological Cognitive Exam Brief Symptom Inventory Brown Attention-Deficit Disorder Scales Burk’s Behavior Rating Scale Child Attention Problems (CAP) Children’s Apperception Test (CAT) Children’s Auditory Verbal Learning Test (CAVLT) Categories Test Child Behavior Checklist (CBCL see Achenbach) Childhood Autism Rating Scales Childhood Trauma Questionnaire Children’s Attention & Adjustment Survey (CAAS) Children’s Category Test (CCT) Children’s Depression Inventory (CDI) Children’s Depression Rating Scale. The minutes allocated for each test include administration. Neuro Symptom Checklist Behav Rating Scale Behav Rating Scale Behav Rating Scale Proj: Thematic Neuro-Memory/Learning Neuro-Prob.

11/18/09 3 of 11 . may not be covered Structured interview Norms only on normal pop Allow 1 hr for set of Cklists . Expected to be free part of 90801 Allow 1 hr for set of checklists COMMENTS Allow 1 hr for set of checklists 3. 12/14/06. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions.3 Revised 12/08/05. The minutes allocated for each test include administration.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. scoring and write up.704.1 17+ 18+ 4+ 3.704.17 3 – 17 6 – 14 6-19 18+ 5-18 AGE 6 – 19 5 – 16 8-12 8 – 14 Adult MINUTES 15 60 45 15 15 15 30 60 15 15 60 45 15 60 15 15 15 30 30 45 45 120 60 80 80 30 90 60 30 Primarily educational. INSTRUMENT Revised Children’s Manifest Anxiety Scale Children’s Memory Scale (CMS) Children’s Personality Questionnaire Children’s State-Trait Anxiety Inventory Chronic Pain Battery Clock Drawing Cognistat Cognitive Assessment System (CAS) Color Form Test Comprehensive Behavior Rating Scale for Children (CBRSC) Comprehensive Test of Nonverbal Intelligence (CTONI) Computer Category Test Conner’s Adult ADHD Rating Scale (CAARS) Conner’s Continuous Performance Test II Conners’ Rating Scale-Teacher or Parent Conner’s Rating Scales-Revised Controlled Oral Word Association Test (COWAT) California Psychological Inventory (CPI) Children’s Personality Questionnaire (CPQ) California Verbal Learning Test for Children (CVLT) California Verbal Learning Test (CVLT) Delis-Kaplan Executive Functional Scale (D-KEFS) Dementia Rating Scales (Mattis) Denman Memory Battery Detroit Test of Learning Aptitude Devereau Scales of Mental Disorders Diagnostic Achievement Battery – 2 Diagnostic Achievement Battery –2 (DAB2) Diagnostic Interview for Children and Adolescents Computer TYPE Pers Rating Scale Neuro-Memory Pers Inventory Beh Rating scale Pain adaptation Neuro Neuro Neuro/educational Neuro: Child Behav Rating Scale Nonverbal test of IQ Neuro: Prob Solving Behav Rating Scale Neuro: Attention Behav Rating Scale Behav Rating Scale Neuro: language Pers Inventory Pers Inventory Neuro: Memory/Learning Neuro: Memory/Learning Neuro: Exec Neuro: Screen Neuro: Memory Battery IQ Personality Academic Skills Academic achievement Behav Rating Scale 6-17 5-18 6-14 6-14 6 – 17 65-81 13+ 8-12 5 – 16. 11/01/09.3. 12/13/07.

11/18/09 4 of 11 .3 Revised 12/08/05.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. The minutes allocated for each test include administration. INSTRUMENT Program (DICA-IV) Differential Ability Sale (DAS) Dyadic Adjustment Scale Eating Inventory Eating Disorder Inventory 2 (EDI-2) Endler Multidimensional Anxiety Scales Cog/Neuro Relationship Satisfaction Personality Personality Pers Rating Scale 6-18 Adult 17+ 12+ 13+ 60 15 15 15 15 Allow 1 hr for set of checklists Allow 1 hr for set of checklists Allow 1 hr for set of checklists TYPE AGE MINUTES COMMENTS ERASOR Estimate of Risk of Adolescent Sexual Offense Recidivism Examining for Aphasia Expressive One Work Vocabulary Test – Revised Family Apperception Test Family Kinetic Drawing Finger Tapping Test (Electric or Manual) Folstein Mini Mental Status Fuld Object Memory Evaluation Sex offender assessment 12-18 Language Neuro: Language Proj-Thematic Proj-Thematic Neuro: Motor Neuro Neuro: Memory Adult 13 – adult 2-12 6 – 15 Child+ Child+ Adult 15 75 20 30 30 5 15 15 15 45 15 15 45 Forensic. Part of MSE only Allow 1 hr for set of checklists 3. 11/01/09. 12/14/06. Battery Gordon Diagnostic System Gray Oral Reading Test (GORT-R OR GORT-3) Grip Strength Grooved Pegboard Halstead Reitan Neuro Battery Hamilton Depression Inventory (HDI) Hamilton Rating Scale for Depression-Revised (Clinician Form) Hamilton Rating Scale for Depression-Revised (Self-Report) Hand Test Hare Psychopathy check list-R (PCL-R) IQ Rating scale Rating scale LD/Neuro Neuro/ADD. 28 items Fundamental Interpersonal Relations Orientation-Behavior FIRO-B Pers-Soc/Behav General Ability Measure for Adults (GAMA) Gilliam Autism Rating Scale (GARS-2) Gilliam Asperger’s Disorder Scale (GADS) Goldman-Fristoe-Woodcock Auditory Discrim. 12/13/07. self-report version of Hamilton Depression Rating Scale. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions.704.3. attn-CPT Academic Neuro: Motor Neuro: Motor Neuro Battery Symptom rating scale Pers Rating Scale Pers Rating Scale Projective Personality 4+ Child+ 60 45 5 10 Child+ 18+ 18+ 18+ Adult 18+ N/A 15 0 15 45 150 See times for individual tests from this battery Allow 1 hr for set of cklists. may not be covered. scoring and write up.704.

3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. The minutes allocated for each test include administration. Inventory AGE 13+ Child+ MINUTES 30 120 30 30 15 30 15 60 Personality for delinquent and conduct d/o. 11/01/09.5 11 – 85 6-18 5-14 Child+ 45 TYPE Pers. 12/13/07.3 Revised 12/08/05. may not be covered 30 30 90 90 30 60 80 30 25 30 15 150 30 150 30 60 60 15 15 Allow 1 hr for set of checklists Allow 1 hr for set of checklists COMMENTS 3.704. personality for delinquent and conduct d/o 8--adult 60 Forensic. 12/14/06. HSQ-R) Human Figure Drawings Incomplete Sentences Blank Intermediate Visual and Auditory CPT (IVA) Jesness Inventory J-Soap Juvenile Sex Offender Assessment Protocol Judgment of Line Orientation Kaufman Brief Intelligence Test (K-BIT) Kaufman Adolescent and Adult Intelligence Test Kaufman Assessment Battery for Children (KABC) Kaufman Short Neuropsychological Assess Procedure (K-SNAP) Kaufman Test of Education Achievement (K-TEA) Key-Math Diagnostic Arithmetic Test – Revised Kinetic Family Drawings Lateral Dominance Exam Learning Disabilities Diagnostic Inventory (LDDI) Louisville Behavioral Checklist Luria-Nebraska Neuropsych Battery Luria-Nebraska Neuropsych – Screen Version Luria-Nebraska Neuropsych Battery for Children Luria-Nebraska Neuropsych for Children – Screen Version Make a Picture Story Millon Adolescent Personality Inventory (MAPI) Marital Satisfaction Inventory-Revised (MSI-R) Maryland Addictions Questionnaire (MAQ) Proj-Inkblot Neurosych Proj-Thematic Beh Rating Scale Proj-Thematic Proj Attn – ADHD Antisocial personality Sex offender assessment Neuropsych IQ IQ IQ & Academic Skills Neuro screen Academic Skills Academic Skills Proj-Thematic Neuro: Motor Educational Beh Rating Scale Neuro Battery Neuro Screen Neuro Battery Neuro Screen Projective Pers Inventory Marital/Relationship Chemical Dep 8-18 4-17 13+ 13+ 8-12 8-12 Adolescent 13-18 18 – 90 16+ Child+ 4-18 Child+ Child+ 5 – 90 8-adult 9-20 Adult 4-90 11-85 2.3. INSTRUMENT High School Personality Inventory Holtzman Inkblot Test Hooper Visual Organization Test House Tree Person (H-T-P) Home Situations Questionnaire (HSQ. scoring and write up.704.5-12. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. 11/18/09 5 of 11 .

6-8. Inventory-Adolesc.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. 120 for school age children Allow 1 hr for set of checklists 60 Versions for adolescent and adult males Allow 1 hr for set of checklists Allow 1 hr for set of checklists Assumes 6th grade reading level Recommend most recent version. pain coping Neuro: Memory Neuro Pers Inventory Pers Inventory Medical Coping Style Pers Inventory Pers Inventory Pers Inventory Neuro. INSTRUMENT Matching V’s and Figures Test McCarthy Scales of Children’s Abilities McGill Pain Inventory Memory Assessment Scales MicroCog Assessment of Cognitive Functioning Millon Adolescent Clinical Inventory (MACI) Millon Adolescent Personality Inventory (MAPI) Millon Behavioral Health Inventory (MBH) Minnesota Multiphasic Personality Inventory (MMPI) Minnesota Multiphasic Pers.6 18+ 18-90 18 – 89 13-19 13-19 18+ 14+ 18+ 13-18 Adults 4-8 Adult 8 – 17 17+ 17+ 17+ 3-12 18 – 88 18-74 18-74 AGE MINUTES 15 90 15 60 60 60 60 60 60 60 60 90 25 15 15 30 30 60/120 15 60 60 30 15 15 10 15 15 45 90 75 Allow 1 hr for set of checklists Allow 1 hr for set of checklists 60 for pre-school. scoring and write up. COMMENTS 3. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. 11/18/09 6 of 11 . 11/01/09. 12/13/07. Inventory-2 (MMPI-2) Minnesota Multiphasic Pers. The minutes allocated for each test include administration. (MMPI-A) Minnesota Test for Differential Diagnosis of Aphasia Motor-Free Visual Perception Test Multiphasic Sex Inventory Multiscore Depression Inventory for Children Multiscore Depression Inventory for Adolescents and Adults NEO Personality-R (NEO PI-R) NESPY (Executive Function Test) NEPSY (Developmental Neuropsychological Assessment) Neuropsychological Impairment Scale Omni Personality Inventory Omni IV Personality Disorder Inventory Paced Auditory Serial Addition Test Pain Apperception Test Pain Patient Profile (P3) Pain Patient Profile Parent-Child relationship Inventory (PCRI) Parenting Stress Index (PSI) Paced Auditory Serial Addition Task (PASAT: C) Peabody Developmental Motor Scales and Activity Cards Peabody Individual Achievement Test – Revised (PIAT-R) TYPE Neuro – Attention IQ Personality. 12/14/06.3 Revised 12/08/05.704.3.704. MMPI-II. Language Neuro/LD: Perceptual Sex offender assessment Pers Rating Scale Pers Rating Scale Pers Inventory Neuro Neuro screen Neuro screen Pers Inventory Pers Inventory Neuro: Attention Pain disorders Pain Medical Coping Style Prenatal Style Parental Style Neuro: Attention Developmental Academic Skills Adult 17-76 17-76 3 – 12 3 – 12 16+ 0–7 5 – 18 2.

The minutes allocated for each test include administration.5-Adult MINUTES 30 15 15 30 60 60 60 Forensic. scoring and write up. may not be covered.5+ 7-89 Adult 12 – 18 19+ 18+ 11+ 8-29 30 Adult 5-18 3-16 7-18 3+ 13+ 13 – 19 15 75 30 15 30 15 15 15 45 15 30 60 45 15 15 30 15 30 15 15 15 Allow 1 hr for set of checklists Allow 1 hr for set of checklists Allow 1 hr for set of checklists May be primarily forensic Allow 1 hr for set of checklists Allow 1 hr for set of checklists AGE 2.704. 12/14/06. Problem Solving Neuro: Memory Neuro.3 Revised 12/08/05. Attention Interview Schedule Neuro/LD: Motor Neuro-Memory-Lang Proj. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. malingering Neuro Beh Rating Scale Neuro: Language Symptom rating scale Personality Personality. sexual attitudes Allow 1 hr for set of checklists Allow 1 hr for set of checklists Allow 1 hr for set of checklists COMMENTS 3.-Thematic IQ/Neuro. 11/18/09 7 of 11 . single scale 5 – 18 20-80 7 – 12 12-19 18+ Child + 12 to adults 6-15 6. 11/01/09. 12/13/07. Revised (PDI-R) Purdue Pegboard Quick Neurological Screening Test-2 (QNST-2) Roberts Apperception Test for Children (RATC) Raven’s Progressive Matrices (all versions) Rey Auditory Verbal Learning Test—move to alphabetic order Rey 15-Item Test—move to alphabetic order Repeatable Battery for Assessment of Neuropsychological Status (RBANS) Revised Behavior Problem Checklist (RBPC) Revised Token Test Reynolds Adolescent Depression Scale Reynolds Adolescent Adjustment Screening Inventory Reynolds Adolescent Depression Scale TYPE IQ-Brief/LD Personality Inventory Chemical Dep Chemical Dep Pers Inventory Pers Inventory Pers Inventory Sex offender assessment Neuro Academic Skills Pers Inventory Personality IQ-Single Task Pers Rating Scale Life Problems Neuro. INSTRUMENT Peabody Picture Vocabulary Test – Revised (PPVT-R) Perception of Ability Scale for Students Personal Experience Inventory for Adolescents (PEI) Personal Experience Inventory for Adults (PEI-A) Personality Assessment Inventory Personality Research Form (PRF) Personality Inventory for Youth PHASE Philadelphia Head Injury Questionnaire Peabody Individual Achievement Test (PIAT-R) Personality Inventory for Children. revised (PIC-R) Piers-Harris Children's Self Anapt Scale Porteus Mazes Problem Behavior Inventory Problem Experiences Checklist Progressive Figures Test Psychiatric Diagnostic Interview.704.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing.3.

40 items 30 35 20 30 30 45 30 15 30 15 120 15 15 20 45 Allow 1 hr for set of checklists Allow 1 hr for set of checklists Allow 1 hr for set of checklists Structured interview for DSM-IV-TR-Axis II AGE 7-12 MINUTES 15 30 120 60 Forensic. may not be covered. may not be covered Forensic.704.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. 11/18/09 8 of 11 .3 Revised 12/08/05. Booklet Format Single and Double Simultaneous Stimulation Test Sixteen Personality Factor Questionnaire (16pf) Slosson Full-Range Intelligence Test (S-FRIT) Slosson Full-Range Intelligence Test (S-FRIT) Slosson Intelligence Test – Revised Social Phobia and Anxiety Inventory Speech Sounds Perception Test School Situations Questionnaire (SSQ. 12/14/06. SSQ-R)/Survey Stanford Binet Intelligence Scale State-Trait Anger Expression Inventory State-Trait Anxiety Inventory Stroop Color Naming Structured Interview of Reported Symptoms TYPE Symptom rating scale Neuro: Visual-Motor Proj-Inkblot Proj. Sex offender assessment Sex offender assessment Beh Rating Scale Pain assessment Beh Rating Scale Symptom Checklist Neuro: Perceptual Neuro: Memory Neuro: Perceptual Neuro-Dementia Sex offender assessment Sex offender assessment IQ-BRIEF Neuro: Problem Solving Neuro: Perceptual Pers Inventory IQ IQ IQ-Brief Beh Rating Scale Neuro: Language Behavioral Rating Scale IQ-Multitask Symptom rating scale Symptom rating scale Neuro: Attention Malingering Screen 12 – 67 15+ 7+ 18+ 6-12 16+ 5t – 21 5 – 21 4+ 14+ Adult 14-18 Teen + 14+ 15+ Child+ Child+ 9-18 13+ 4 – 13 Adult 18+ 60 15 15 15 30 15 20 30 30 30 90 Forensic. scoring and write up.Revised (SOAPP-R) Structured Clinical Interview (SCID II Patient Questionnaire) Symptom Checklist 90 Revised (SCL-90-R) Seashore Rhythm Test Selective Reminding Test Sensory Perceptual exam (Klove) Severe Impairment Battery (SIB) Sexual Adjustment Inventory-Juvenile Sexual Attitude Questionnaire Shipley Institute of Living Scale Short Category Test. The minutes allocated for each test include administration. norms 14-18 15 Forensic. 11/01/09. INSTRUMENT Reynolds Child Depression Scale Rey-Osterrieth Complex figure Test Rorschach Rotter Incomplete Sentence Test RSTI Risk-Sophistication-Treatment Inventory SA-45 symptom Assessment 45 School Behavior Checklist Screener and Opioid Assessment for Patients with Pain.3.704. 12/13/07. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. may not be covered. may not be covered Allow 1 hr for set of checklists Includes scoring COMMENTS Allow 1 hr for set of checklists 3.

3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing.11 6 – 89 3+ 12 – 40 3 – 13 4 – 13 12 – 18 3+ 5-85+ 4-80 12+ 12 – 18 15 15 15 20 35 35 60 30 60 60 60 20 60 60 60 15 60 30 30 20 20 30 20 30 30 60 30 Minorities and non-minorities Allow 1 hr for set of checklists TYPE Beh Rating Scale AGE 18+ MINUTES 30 COMMENTS Structured interview for dissociative disorders 3. Revised Test of Visual-Perceptual Skills Revised (non-motor) TVPS-3 Test of Visual-Perceptual Skills Revised (non-motor) Upper Level TVPS-3 Token Test (Revised Token Test.3 Revised 12/08/05. Token Test for children) Test of Nonverbal Intelligence (TONI-2) Test of Variable Attention (TOVA) Tower of London Chemical Dep Symptom rating scale Personality. Upper Level Test of Visual-Motor Skills. 11/01/09. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions.3. 12/13/07. scoring and write up. The minutes allocated for each test include administration. 12/14/06. Single Scale Neuro: Attention Neuro: Perceptual Neuro: Perceptual Proj-Thematic Personality/Marital Proj-Thematic Proj-Thematic Neuro/Auditory Proc/educ Proj-Thematic Attention Neuro/language/educational Neuro/language/educational Malingering Neuro-Mem-LD IQ Neuro/LD: Visual Neuro-LD Neuro-LD Neuro-LD Neuro-LD Neuro-Language IQ – Nonverbal NEURO/ADD: Attention Neuro 6+ 5+ 5+ Adoles+ 13+ Approx 65 – 18 4-18 6+ 18 – 80 4-8 8-12 16+ 5-19. INSTRUMENT Structural Clinical Interview for DSM-Dissociative Disorders (SCID-D) Substance Abuse Subtle Screening Inventory (SASSI) Suicidal Ideation Questionnaire Suicide Probability Scale Symbol-Digit Modalities test Tactual Performance Task (TPT) Target Test Thematic Apperception Test (TAT) Taylor-Johnson Temperament Analysis Tasks of Emotional Development (TED) Tell-Me-A-Story (TEMAS) Test of Auditory Processing Skills (TAPS: 3) Test of Emotional Development (TED) Test of Everyday Attention (TEA) (TEA-CH for children) Test of Language Development – Primary (TOLD P:3) Test of Language Development – Intermediary (TOLD P:3) Test of Memory Malingering (TOMM) Test of Memory and Learning (TOMAL) Test of Nonverbal Intelligence-3 (TONI-3) Test of Visual-Motor Integration (see Beery VMI) Test of Visual –Motor Skills. 11/18/09 9 of 11 .704.704.

704. scoring and write up. 11/01/09. Memory Neuro-Attn Neuro: Visual Neuro: Visual IQ-Multitask IQ-Multitask IQ/Neuro IQ Neuro: Memory Neuro: Memory Neuro: Memory IQ-Multitask Beh Rating Scale Neuro/LD: Language Memory-LD Neuro: Language Chemical Dep Symptom Screen Academic Skills Academic Skills AGE MINUTES 15 COMMENTS 8 – 16 18+ 18-69 15 30 60 15 6 – 90 0-18. Rev (WPPSI-R) Wender Utah Rating Scale Wepman Auditory Discrimination Test Wepman’s Auditory Memory Battery Western Aphasia Battery Western Personality Inventory Whitaker Index of Schizophrenic Thinking (WIST) Wechsler Individual Achievement Test (WIAT) Wechsler Individual Achievement Test for Children (WIAT) rd TYPE Neuro.3 Revised 12/08/05.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing.3. 12/13/07. 11/18/09 10 of 11 . Attention Personality Personality Malingering Neuro: Language Neuro: ADHD. The minutes allocated for each test include administration. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. Screening version .5 hr. INSTRUMENT Trail Making Test Trauma Symptom Checklist for Children (TSC) Trauma Symptom Inventory (TSI) Validity Indicator Profile (VIP) Verbal Fluency Vigil Continuous Performance Test Vineland Adaptive Behavior Scales Vineland Social-Emotional Early Childhood Scales Visual-Aural Digit Span Test Visual Search and Attention Test (VSAT) Developmental Test of Visual – Motor Integration (VMI) Hooper Visual Organization Test (VOT) Wechsler Adult Intelligence Scale – III (WAIS-III) Wechsler Adult Intelligence Scale – Revised (WAIS-R) Wechsler Adult Intelligence Scale – Revised as a Neurological Instrument (WAIS-R NI) Wechsler Abbreviated Scale of Intelligence (WASI) Wechsler Memory Scale Wechsler Memory Scale Revised Wechsler memory Scale – 3 Ed. (WMS-III) Wechsler Preschool & Primary Scale of Intell.704. 12/14/06. 3. Attn Adapt/Developmental Emotional Developmental Neuro/LD.5 hr.11 5 – 11 12+ 18+ 3+ Child+ 16-74 16-74 16-74 16-74 16+ 16+ 16 – 89 3-7 60 75 30 20 15 20 20 135 135 180 60 75 75 75 120 15 May be appropriate for screening Recommend Revised Recommend Revised 4-8 5–8 Adol+ 18+ 20 15 75 15 15 Allow 1 hr for set of checklists 12+ 5-12 45 45 Screening version .

0 for Standard & Supp. 12/13/07. INSTRUMENT Wide Range Assess of Vis-Motor Abil (WRAVMA) Wide Range Achievement Test – 3rd Edition (WRAT-3) Wechsler Intell Scale for Children (WISC-IV) Wechsler Intell Scale for Children – Revised (WISC-R) Weschler Memory Scale (WMS) Weschler Memory Scale-Revised Wisconsin Card Sorting Test (WCST) Wonderlic Personnel Test Woodcock-Johnson Psychoeduca Battery (Achievement) Woodcock-Johnson Psychoeduca Battery (Cognitive) Woodcock Language Proficiency Battery-R Woodcock Reading Mastery Tests-R Word Fluency/Verbal Fluency Wechsler Preschool & Primary Scale of Intel (WPPSI-R) Wide Range Assessment of memory & Learning (WRAML) Wide Range Achievement Test – 3rd Edition (WRAT-3) Wide Range Achievement Test – Revised (WRAT-R) Zung Depression Index LD Academic Skills IQ-Multitask IQ-Multitask Neuro.3 Revised 12/08/05. The minutes allocated for each test include administration. 11/01/09.3.5 for R Standard Battery/2. Determination of the medical necessity of psychological tests always requires consideration of the clinical facts of the specific case to assure that tests given are a cost-effective means of determining the appropriate treatment for the individual patient and are related to the diagnosis and treatment of covered mental health conditions. scoring and write up.704.5 for Standard Battery/2.0 for Standard & Supp. 12/14/06. Needs IQ or HALTEAD AS REFERENCE Recommend Revised Recommend Revised COMMENTS 3. 11/18/09 11 of 11 .704. Memory Neuro: Problem Solving Job-IQ Potential Academic Skills Cognitive/IQ Language Academic Skills Neuro: Language IQ-Multitask Neuro/LD: Memory Academic Skills Academic Skills Pers Screen 3-7 5-17 5+ 5+ TYPE AGE 3 – 17 5+ 6-16 6-16 16+ 16+ 12+ Adult 2+ 2+ 2 – adult 5 – 75 MINUTES 45 30 135 120 30 75 45 15 90 90 60 60 15 120 60 30 30 15 10-15 minutes screening version available 1. 1.3 List of Psychological Tests Material was prepared for use as an aid in handling requests for psychological testing. Memory Neuro.

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