HIMS AME vs. Neuropsychologist vs. Psychologist: Who Does What in Your FAA Evaluation?

Dr. Jordan 'Coach' Keller•
HIMS AME vs. Neuropsychologist vs. Psychologist: Who Does What in Your FAA Evaluation?

HIMS AME vs. neuropsychologist vs. psychologist: who does what in your FAA evaluation?

TL;DR: You will probably see three or four different professionals during a HIMS evaluation. Each has a specific job. Only the HIMS AME can actually recommend issuance to the FAA. The psychologist tests you but does not make that call. Here's who does what, what each costs, and how to avoid the document coordination failures that delay certificates by months.

Table of contents

Why this matters

Your AME just referred you for "a neuropsych evaluation with a HIMS psychologist." But wait: isn't your AME already a HIMS AME? Are they the same person? Different people? Who writes the report that goes to the FAA?

This confusion is common, and it's not your fault. The FAA's evaluation structure involves multiple credentialed professionals, each with a defined role. When pilots don't understand those roles, things go sideways: reports go to the wrong person, documents don't reach Oklahoma City, and what should be a six-week process turns into six months.

I see this play out in pilot forums regularly. Someone assumed their HIMS AME submitted to the FAA. They didn't. Three months later, the pilot discovers the packet is sitting in a fax queue somewhere. That's an avoidable mistake, and understanding the chain is the first line of defense against it.

Let me walk you through each professional, their credentials, their actual job, and what they cost.

The five professionals you might encounter

1. Your regular AME (Aviation Medical Examiner)

Your standard AME holds an MD or DO designation with FAA authorization. They conduct annual physicals for Class 1, 2, and 3 medicals.

What they can do: defer your certificate if they spot something that needs further review. What they cannot do: approve a Special Issuance for AASI (Authorization for Special Issuance) conditions. That requires a HIMS AME.

If your regular AME refers you out, it typically means they've identified a condition (cognitive concerns, mental health history, substance use) that falls outside their authorization level. The referral itself doesn't mean you're grounded for good; it means the review process has a specific lane, and your AME is directing you into it.

2. HIMS AME (Human Intervention Motivation Study AME)

This is the quarterback of your evaluation. HIMS AMEs are senior AMEs who've completed additional training in substance abuse, mental health, and neurocognitive conditions. They carry the FAA authority to recommend issuance for AASI conditions.

They don't administer CogScreen. Let me say that plainly, because it surprises a lot of pilots: the HIMS AME reviews and interprets your CogScreen results, but a HIMS psychologist administers the actual test.

What a HIMS AME consult typically costs: $1,500 to $3,500 for an initial evaluation. Follow-up monitoring runs $500 to $1,000 per year once you're certified.

They coordinate your entire evaluation, order the appropriate testing, and write the final recommendation to the FAA. If you're doing a HIMS evaluation, this person is your primary contact and the hub through which everything flows.

3. HIMS psychologist (the person who actually administers CogScreen)

A HIMS psychologist holds a PhD or PsyD with a specific HIMS designation. They administer the CogScreen-AE and other cognitive tests as directed by your HIMS AME, then write a neuropsychological report that goes back to the AME.

This is an important distinction: they test you. The HIMS AME interprets those results alongside your clinical history and makes the FAA recommendation. The psychologist does not make the issuance call.

Cost for CogScreen-AE alone: $1,500 to $2,500. A full neuropsychological battery runs $3,000 to $5,000.

If your evaluation requires only CogScreen (as in the ADHD Fast Track pathway), you might not need the full battery. Your HIMS AME specifies what testing is required.

4. General neuropsychologist (non-HIMS)

A general neuropsychologist has a PhD or PsyD specializing in cognitive assessment but does not hold HIMS designation. In some regions, HIMS-designated psychologists are scarce, and the FAA may accept evaluations from general neuropsychologists. Results vary by region and evaluating AME.

The risk: a general neuropsychologist's report may need additional interpretation by a HIMS AME, adding time and cost. If you have a choice, use a HIMS-designated psychologist. If you're in a region where none are available, confirm with your HIMS AME before booking.

5. Your treating psychologist or psychiatrist

This is the one pilots most commonly misunderstand. Your treating mental health provider (the therapist or psychiatrist who manages your depression, anxiety, or ADHD) does not conduct FAA evaluations.

The FAA separates treatment from evaluation deliberately. A treating provider has a therapeutic relationship with you that creates inherent bias. They can provide treatment records and stability letters. They cannot write the neuropsychological report that determines your fitness.

If a provider tells you they can write "the letter to the FAA" to approve your medical certificate, ask for clarification. Treatment summary letters are appropriate. FAA evaluation reports require the credentialing described above.

The evaluation chain: who talks to whom

For a typical ADHD or neurocognitive concern, the process looks like this:

Step 1: Your regular AME defers and refers you to a HIMS AME.

Step 2: The HIMS AME reviews your medical history, conducts a clinical interview, and determines what testing is needed. For ADHD Fast Track, this typically means CogScreen-AE. For a standard track or more complex presentation, it might mean a full neuropsychological battery.

Step 3: The HIMS AME refers you to a HIMS psychologist. This is their referral to make. Don't self-refer.

Step 4: The HIMS psychologist administers the testing and writes a report, typically sent directly to your HIMS AME (not to you first, and not directly to the FAA).

Step 5: The HIMS AME receives the report, integrates it with your clinical picture, and writes their recommendation to the FAA.

Step 6: The FAA reviews the packet and issues a decision: standard issuance, Special Issuance, request for additional records, or denial.

One thing pilots consistently underestimate: you are the coordinator. These professionals don't automatically loop each other in. If your psychologist's report gets sent somewhere wrong, or your HIMS AME didn't receive a particular document, the process stalls. Nobody will call you to tell you it stalled. Tracking your own packet, confirming receipt at each step, and following up proactively is not optional.

Credential verification: how to confirm you're seeing the right person

The FAA maintains a searchable database of HIMS AMEs. Before your first appointment, verify your AME's HIMS designation. For HIMS psychologists, ask your HIMS AME for a referral. They know who in your region holds the appropriate credentials and has experience with aviation evaluations.

Some specific questions worth asking before you book:

  • "Are you HIMS-designated?" (for psychologists. This is non-negotiable if you want the path of least resistance with the FAA)
  • "How many CogScreen-AE evaluations do you conduct each month?" (a provider who does one or two per year has a meaningfully different level of familiarity than one who does ten)
  • "Will your report go to my HIMS AME, or directly to the FAA?" (it should go to your HIMS AME)
  • "What does your fee include, and are there additional charges if supplemental testing is needed?"

Red flags worth knowing: a psychologist who says they'll "write the letter for the FAA" (the HIMS AME writes the recommendation, not the psychologist); a clinic that's never heard of CogScreen; anyone offering a guaranteed outcome.

Cost breakdown by professional

Here's a realistic picture of what different components cost, based on ranges pilots report in HIMS consultations:

Professional Service Typical range
HIMS AME Initial consult $1,500 to $2,500
HIMS AME Annual follow-up monitoring $500 to $1,000
HIMS psychologist CogScreen-AE only $1,500 to $2,500
HIMS psychologist Full neuropsych battery $3,000 to $5,000
Psychiatrist Medication evaluation and letter $800 to $1,500
General psychologist Treatment records summary $200 to $500

For an ADHD Fast Track evaluation (CogScreen + HIMS AME consult), budget $4,000 to $7,000. For a standard track with a full neuropsychological battery, $6,000 to $10,000 is realistic.

These figures don't include travel if you need to see a specialist in another city, time off work during the evaluation period, or costs for any preparation resources.

I want to be direct about something: this is expensive. For working pilots, the financial pressure to get this right the first time is real. That's one reason preparation matters, not just psychologically but economically.

Document flow: who sends what to whom

This is where most delays happen. Understand whose job it is to send what:

Your job: Get your medical records to your HIMS AME before the consult. If you receive any test results directly (some psychologists copy you), confirm they've also been sent to your HIMS AME. Track what's been submitted and when.

HIMS psychologist's job: Send test results directly to your HIMS AME, not to the FAA, and ideally not only to you.

HIMS AME's job: Compile everything (clinical history, test results, their own evaluation) into a consolidated recommendation to the FAA. They should send you a copy.

The most common failure points: the psychologist sends the report to the wrong AME (this happens when a pilot has seen multiple AMEs); the pilot assumes the AME submitted to the FAA when they're still waiting on a missing document; test results get omitted from the final packet.

Certified mail with return receipts, email confirmations, and a simple tracking spreadsheet are not overkill here. They're basic professional document management for a process that can cost you your certificate if something falls through a crack.

Common scenarios and who you need

ADHD Fast Track (four or more years off stimulant medication)

You need: a HIMS AME and a HIMS psychologist for CogScreen-AE. A full neuropsychological battery is typically not required unless the HIMS AME requests it based on your results or clinical presentation. Expected timeline: four to eight weeks if documentation is complete and the process moves cleanly.

ADHD standard track (recent diagnosis or currently on medication)

You need: a HIMS AME, a HIMS psychologist for a full battery, and possibly a psychiatrist for a medication management review. Expected timeline: eight to sixteen weeks.

Depression or anxiety Special Issuance renewal

You typically need: a HIMS AME and a letter from your treating psychiatrist documenting stability. A HIMS psychologist is usually not required unless cognitive concerns have been raised. Expected timeline: four to six weeks.

Substance abuse initial certification

You need: a HIMS AME as the primary coordinator (this is core HIMS territory), and a HIMS psychiatrist for the addiction assessment. CogScreen may or may not be required, depending on whether cognitive concerns exist. This pathway is more complex. Expect twelve to twenty-four weeks for an initial certification.

How CogScreen preparation fits in

If your evaluation includes CogScreen-AE, familiarity with the test format matters more than most pilots expect.

The CogScreen-AE is not a trivia test. You can't study facts for it. But you can reduce the cognitive overhead of unfamiliar interfaces, response formats, and timing pressures, and that reduced overhead means your actual cognitive abilities are what show up in the results, rather than confusion about the test mechanics.

PilotPrep (faacogscreen.com) offers preparation modules built around the mechanics of each CogScreen subtest: the same response patterns, the same adaptive difficulty structure, the same dual scoring of speed and accuracy. The platform uses pilot-normed benchmarks so your practice scores reflect where you stand relative to other aviators, not the general public.

To be clear: no preparation tool guarantees a particular outcome, and PilotPrep isn't a diagnostic instrument. What it does is reduce the unfamiliarity factor so that on test day, you're dealing with your actual cognitive profile, not the additional penalty of encountering an unfamiliar format under high-stakes conditions.

You can explore the modules before committing. The platform offers three practice questions per test in guest mode, which is enough to understand what you're working with.

Putting it together

The HIMS evaluation chain involves multiple professionals, each with a specific and non-overlapping role. The regular AME defers. The HIMS AME coordinates and recommends. The HIMS psychologist tests. The treating provider documents. Nobody else makes your case to the FAA.

Know who you're seeing, verify their credentials, and understand what each piece of paper is supposed to do and where it's supposed to go. The clinical side of this process is hard enough without administrative failures adding months to your timeline.

If you're approaching a CogScreen evaluation as part of this process, preparation is worth your time. The research on cognitive test familiarity is consistent: people perform closer to their actual ability when the format isn't novel. Use that to your advantage.

Dr. Jordan "Coach" Keller is an AI educator persona created by PilotPrep LLC. Content on faacogscreen.com is educational in nature and does not constitute medical or legal advice. For guidance specific to your medical certification situation, consult a qualified HIMS AME.

References

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