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 Questionnaire (16-PF)

TYPE Personality

ABEL Screen

Sexual Interest Achenbach System of Empirically Based Assessment (ASEBA) Behav Rating Scale

AGE

MINS.

16+

30

35-60 min per Tests in Print for admin time only

Adol +

120

Primarily forensic in nature: may not be covered

60

Preschool Module

Behav Rating Scale

1.5-5

10

Caregiver-Teacher Report Form

Behav Rating Scale

1.5-5

10

Child Behavior Checklist (CBCL)

Behav Rating Scale

1.5-5

15

Teacher Report Form

Behav Rating Scale

6-18

20

Youth Self-Report (YSR)

Behav Rating Scale

11-18

20

ACTeERS-ADD-H Comprehensive, Teachers Rating Scale

Behav Rating Scale

5 – 13

15

Adaptive Behavior Assessment System (ABAS II)

Behav Rating Scale

0-89

30

Adaptive Behavior Scale (ABS)

Developmental

3-18

30

ADHD Rating Scale

Behav Rating Scale

4 – 18

15

Adolescent Anger Rating Scale

Behav Rating Scale

11-19

15

Adolescent Apperception Cards

Projective Personality

Adolescent Psychopathology Scale

Personality

Adult Behavior Checklist (ABCL)

12 – 19

60

Child-adult

60

Behav Rating Scale

18-89

30

Alzheimer’s Quick Test (AQT)

Neuro

Adult

10

Amen System Checklist

Behav Rating Scale

Adult

15

Animal Naming

Neuro

Child-adult

10

Aphasia Screening Test (Reitan Indiana)

Neuro

5+

30

Asperger’s Syndrome Diagnostic Scales (ASDS)

Rating scale

5-18

20

Attention Deficit Disorder Eval. Scales (ADDES)

Behav Rating Scale

5 – 18

15

Attention-Deficit/Hyperactivity Disorder Test (ADHDT)

Behav Rating Scale

3-23

10

Attention-Deficit Scales for Adults (ADSA)

Behav Rating Scale

17+

15

Auditory Consonant Trigram Test (ACT)

Neuro, educational

16-69

15

Auditory Continuous Performance Test

Attention; ADHD

6 – 11

30

Australian Scale for Asperger’s Syndrome (ASAS)

Rating scale

Primary school

15

Reviewed: 12/08/05, 12/14/06; 12/13/07; 11/01/09, 11/18/09, 10/17/11, 07/16/12, 07/15/13 Revised: 07/15/13

COMMENTS

Admin. Time 20 min. + 10 min. for scoring, interpretation, write up.

On-line, self-scoring

Page 1 of 14

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

TYPE

Autism Behavior Checklist (ABC)

Rating scale

Autism Diagnostic Interview (ADI-R) Autism Diagnostic Observation Scale (ADOS)

AGE

MINS.

3-35

15

Autism diagnosis

Mental age >2

60

Rating scale

Toddler-Adult

60

Autism Spectrum Rating Scales (ASRS)

Rating scale

2-18

15

Barkley Adult ADHD Rating Scale (BAARS)

Rating scale

18-89

15

Basic Personality Inventory (BPI)

Personality Test

12+

35

Battell Developmental Inventory

Developmental Assessment

Battery for Health Improvement (BHI)

Personality Test

0-7

30

18-65

25-40

Bayley Scales of Infant Development

Development

Beck Anxiety Inventory

Personality Test

1-42 months

60

17-80

15

Beck Depression Inventory-II (BDI-II) Beck Hopelessness Scale (BHS)

Personality Test

13 – 80

15

Personality Test

17 – 80

15

Beck Scale for Suicidal Ideation (BSS)

Pers Rating Scale

17 – 80

15

Beck Youth Inventory (BYI)

Symptom Rating Scale

7-14

15

Beery VMI (Test of Visual-Motor Integration)

Neuro/LD: Visual

3+

30

Behavior Assessment System for Children (BASC)

Behav Rating Scale

4 - 21

30

Behavior Rating Inventory of Executive Functioning (BRIEF)

Neuro

2-90

90-150, should substitute for other measures

Relationships between psychopathology and pain

45

Versions for preschool, child/adolescent, and adult Neuro; not for personality assessment

Bender Visual Motor Gestalt Test

Neuro

4+

30

Benton Facial Recognition Test

Neuro

6-74

30

Benton Judgment of Line Orientation Test

Neuro

7+

20

Benton Multilingual Aphasia Exam (BMAE)

Neuro

6-69

90

Benton MAE Sentence Repetition

Neuro

6-69

15

Benton MAE Token Test

Neuro

6-69

15

Benton MAE: Visual Naming Test

Neuro

6-69

15

Benton Right-Left Orientation Test

Neuro

16-64

10

Benton Serial Digit Learning Test

Neuro

16-64

15

Benton Visual Form Discrimination Test

Neuro

Adult

15

Benton Visual Retention Test

Neuro

8+

30

Booklet Categories Test

Neuro

15+

45

Boston Diagnostic Aphasia Examination-3

Neuro

Adults

60

Boston Naming Test

Neuro

Adults

30

Reviewed: 12/08/05, 12/14/06; 12/13/07; 11/01/09, 11/18/09, 10/17/11, 07/16/12, 07/15/13 Revised: 07/15/13

COMMENTS

Page 2 of 14

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

TYPE

AGE

MINS.

Brief Neuropsychological Cognitive Exam

Neuro

13+

30

Brief Symptom Inventory (BSI)

Behav Rating Scale

13+

5

Brief Test of Attention (BTA)

Attention Measure

17-82

15

Brief Visuospatial Memory Test-Revised (BVMT-R)

Neuro

18-79

60

Brown Attention-Deficit Disorder Scales (BADDS)

Behav Rating Scale

12+

15

Burk’s Behavior Rating Scale

Behav Rating Scale

Preschool

15

Burt Word Reading

Educational

Child

5

Buschke Selective Reminding Test

Neuro

5-91

30

California Psychological Inventory (CPI)

Objective Personality Test

13+

30

California Verbal Learning Test (CVLT)

Neuro: Memory/Learning

17+

45

California Verbal Learning Test for Children (CVLT)

Neuro: Memory/Learning

5 – 16.1

45

Carroll Depression Scale

Rating Scale

18+

15

Category Test

Neuro

15+

45

Child Bipolar Questionnaire (CBQ)

Behav Rating Scale

Child Development Inventory-4

Development/Personality

5-18

15

15 mos.-6

60

Child Symptom Inventory (CSI) Childhood Autism Rating Scales (CARS)-2

Rating Scale

6-12

15

Rating Scales

2+

15

Childhood Trauma Questionnaire

Personality Scale

12+

15

Children’s Apperception Test (CAT)

Projective Personality Test

3-10

60

Children’s Attention & Adjustment Survey (CAAS)

Behav Rating Scale

5 – 13

15

Children’s Atypical Development Scale

Rating Scale

Child

15

Children’s Auditory Verbal Learning Test-2 (CAVLT)

Neuro-Memory/Learning

6.5-18

45

Children’s Category Test (CCT)

Neuro

5 – 16

15

Children’s Depression Inventory (CDI)

Personality

7-17

15

Children’s Depression Rating Scale, Revised

Personality

6 – 12

15

Children’s Manifest Anxiety Scale Revised

Personality

6 – 19

15

Children’s Memory Scale (CMS)

Neuro

5 – 16

60

Children’s Personality Questionnaire (CPQ)

Personality

8-12

30

Children’s Self Report Projective Inventory

Projective Personality Test

5-12

120

Reviewed: 12/08/05, 12/14/06; 12/13/07; 11/01/09, 11/18/09, 10/17/11, 07/16/12, 07/15/13 Revised: 07/15/13

COMMENTS

Short form of SLR-90-R.

Norms only on normal population

Juvenile onset bipolar rating scale- parent administered

Page 3 of 14

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

TYPE

AGE

MINS. 15

Children’s State-Trait Anxiety Inventory

Beh Rating scale

8 – 14

Chronic Pain Battery

Pain adaptation

Adult

15

Clinical Assessment of Behavior (CAB)

Behavior Rating Scales

2-18

15

Clinical Evaluation of Language Fundamentals (CELF)-4

Neuro

5-21

30

Clock Drawing

Neuro

Not stated

15

Cognistat

Neuro

18+

30

Cognitive Abilities Scale II (CAS)

Neuro/Educational

5-18

60

Cognitive Assessment System (CAS)

Neuro/educational

5-18

60

Cognitive Coping Strategies Inventory-R

Rating Scale

Adult

15

Color Trails Test

Neuro

Adult-Older Ad.

10

Comprehensive Assessment of Spoken Language (CASL)

Neuro; Educational

3-21

60

Comprehensive Behavior Rating Scale for Children (CBRSC)

Behav Rating Scale

6 – 14

15

Comprehensive Test of Nonverbal Intelligence (CTONI)

6-19

60

Comprehensive Test of Phonological Processing (CTOPP)

Nonverbal test of I lli Neuro/Educational

5-24

45

Comprehensive Trail Making Test (CTMT)

Neuro

8-74

15

Computer Category Test

Neuro

15-80

45

Computerized Assessment of Response Bias (CARB)

Neuro; Forensic

Adult

15

Connor’s 3

Behav Rating Scale

15

Conner’s Adult ADHD Rating Scale (CAARS)

Behav Rating Scale

18+

15

Conner’s Continuous Performance Test II (CCPT)

Neuro

4+

60

Conner’s Continuous Performance Test, Kiddie Version (KCPT) Neuro, Forensic

4-5

15

Behav Rating Scale

3- 17

15

Conner’s Rating Scales-Revised

Behav Rating Scale

3 – 17

15

Contextual Memory Test (CMT)

Neuro; educational

Adult

30

Controlled Oral Word Association Test (COWAT or COWA)

Neuro; educational

16+

15

Coping Responses Inventory (CRI)

Personality

12-90

20

D2 Test of Attention

Attention

Child-Adult

10

Delis-Kaplan Executive Functional Scale (D-KEFS)

Neuro: Exec

8-89

120

AGE

MINS.

TYPE

Reviewed: 12/08/05, 12/14/06; 12/13/07; 11/01/09, 11/18/09, 10/17/11, 07/16/12, 07/15/13 Revised: 07/15/13

60 for basic; 75 for standard

45 for children 3-5

Effort, malingering

8-18

Conner’s Rating Scale-Teacher or Parent

INSTRUMENT

COMMENTS

COMMENTS Page 4 of 14

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.

Dementia Rating Scales (Mattis)

Neuro: Screen

65-81

60

Depression and Anxiety in Youth Scale (DAYS)

Objective Personality

6-19

45

Detailed Assessment of Posttraumatic Stress (DAPS)

Personality

18-91

60

Detroit Test of Learning Aptitude (DTLA)-4

Intelligence

6-17

120

Developmental Indicators for the Assessment of Learning (DIAL) 3 Developmental Profile II

Educational; Neuro

3-7

40

Neuro; Educational

0-9.5

40

Developmental Test of Visual Perception (DTVP)-2

Development; Neuro

4-9

45

Devereau Scales of Mental Disorders

Personality

5-18

30

Diagnostic Achievement Battery –2 (DAB2)

Academic achievement

6-14

60

Diagnostic Assessment of Reading (DAR)

Neuro; Educational

5-Adult

30

Differential Ability Sale (DAS)

Educational; Neuro

6-18

60

Digit Vigilance Test

Neuro

20-80

20

Dot Counting Test (DCT)

Neuro; Forensic

17+

15

Draw-a-Person (DAP)

Projective Personality

Child-Adult

15

Dyadic Adjustment Scale

Personality

Adult

15

Dyslexia Screening Instrument

Educational

Early Childhood Attention Deficit Disorders Evaluation Scale (ECADDES) Eating Inventory

Beh Rating scale Personality

6-21

20

2-7 F; 2-6.5 M

20

17+

15

Eating Disorder Inventory 2 (EDI-2)

Personality

12+

15

Endler Multidimensional Anxiety Scales Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR) Examining for Aphasia

Pers Rating Scale Sex offender assessment

13+ 12-18

15 15

Neuro

13 – adult

75

Executive Control Battery (ECB)

Neuro

Not Specified

60

Expressive One Word Vocabulary Test – Revised

Neuro

2-12

20

Expressive Oral-Word Picture Vocabulary Test (EOPVT)

Neuro

2-80

15

Family Apperception Test

Projective Personality Test

6 – 15

30

AGE

MINS.

Not Specified

10