How Much does a Private Autism Assessment Cost in North Carolina?
In North Carolina, the cost of a private autism assessment varies based on the provider type, the complexity of the evaluation, and your insurance coverage.
Typical costs for private evaluations in North Carolina include:
- Private Insurance: Families usually responsible for a copay of $25 to $50 or 10% to 20% coinsurance after meeting their deductible.
- North Carolina Medicaid: Offers a $0 copay for qualifying families, as these services are covered under the EPSDT mandate.
- Self-pay/Private Fees: For those paying out-of-pocket, a comprehensive evaluation typically ranges from $1,500 to $3,000, though some private psychology practices may charge up to $5,000.
- Telehealth Evaluations: These are often more affordable, ranging from $800 to $2,000, and can reduce wait times significantly.
- University-Based Clinics: These may offer a sliding scale, with costs ranging from $500 to $1,500.
Factors that influence these fees include the provider’s credentials (e.g., a licensed psychologist vs. a master’s-level clinician), geographic location, and whether gold-standard tools like the ADOS-2 are administered.
Because coverage varies by plan, it is recommended to contact your insurer to verify if CPT codes 96130 and 96131 (diagnostic evaluation) are covered under your specific benefits.
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