Autism Evaluation Cost in Pennsylvania
In Pennsylvania, private-pay autism evaluations typically run $2,000–$5,000. Act 62 caps covered autism services at $36K/year (through age 21) on state-regulated plans. PA's PH-95 category of Medicaid — the "loophole" — lets families access coverage regardless of income.
Quick Answer
In Pennsylvania, private-pay autism evaluations typically run $2,000–$5,000. Act 62 caps covered autism services at $36K/year (through age 21) on state-regulated plans. PA's PH-95 category of Medicaid — the "loophole" — lets families access coverage regardless of income.
- Private-pay range: $2,000-$5,000 (typical about $3,200).
- Commercial insurance: $0–$1,500 depending on deductible.
- Medicaid: covered with a typical copay of $0.
Private-pay (no insurance)
For a comprehensive pediatric evaluation (history, ADOS-2, cognitive testing, written report). Updated 2026-04-21.
Commercial Insurance
$0–$1,500 depending on deductible
Typical out-of-pocket
Act 62 of 2008 requires state-regulated plans to cover evaluations and treatment through age 21, within the $36K annual cap (adjusted for inflation). Self-funded ERISA plans are exempt — confirm your plan type.
Medicaid
$0
Typical copay
PA Medical Assistance and HealthChoices MCOs cover evaluations under EPSDT. Families using the PH-95 ("loophole") category can access MA coverage regardless of income for children with disabilities.
Wait Times
3–6 months
Private psychologist
Major center: 9–18 months (CHOP, Pittsburgh Children's, Penn State Hershey)
Editorial Review
Cost ranges on this page are directional estimates compiled from published price lists, public fee schedules, and manual review.
Actual charges depend on the provider, testing scope, insurance contract, and your deductible or network status. Confirm fees and prior authorization requirements before scheduling.
Last reviewed 2026-04-21 by Autism Hearts Editorial Team
Wait Times by Provider Type
- Major medical center
- 9–18 months (CHOP, Pittsburgh Children's, Penn State Hershey)
- Private psychologist
- 3–6 months
- Telehealth
- 4–8 weeks at telehealth-first practices
Getting on multiple waitlists simultaneously is strongly recommended. Telehealth and private-practice waits are often significantly shorter than academic medical centers.
Low-Cost & Free Evaluation Options in Pennsylvania
A.J. Drexel Autism Institute — community clinic
Philadelphia
CHOP Center for Autism Research
Philadelphia
Research studies may offer free or discounted evaluations for qualifying participants.
Penn State Hershey Medical Center — Psychology Clinic
Hershey
Watson Institute
Pittsburgh area
Accepts Medicaid; evaluation coordination with school districts.
PH-95 Medical Assistance (Katie Beckett equivalent)
Use the PH-95 category of Medical Assistance to get Medicaid coverage for evaluation regardless of family income.
Related
Pennsylvania Medicaid coverage details
Full breakdown of HCBS waivers, ABA benefit rules, and the state insurance mandate.
Sources
These sources support the current pricing and coverage context for Pennsylvania. Always confirm the latest quote directly with the provider before booking.
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