Insurance Reimbursement Rates for Psychotherapy [2022] (2023)

It is incredibly important to note that none of this information has been generated from, though, because of, or in any way a part of any clinical data, claims data, or insurance processing that we have done within our mental health billing service at TheraThink. All information enclosed is based purely on contracted rates for in-network providers that have been shared with us. Again, no clinical, claims, or private information was used during the creation of this article. We take HIPAA extremely seriously.

Skip ahead to see mental health reimbursement rates by CPT code!

So you want to figure out what are insurance reimbursement rates for psychotherapy and mental health services. We can’t blame you.

Insurance companies are completely unwilling to release their contracted rate information for reason we’ll discuss shortly and as a result, you don’t know how much you’ll be reimbursed for providing psychotherapy and other mental health services.

The truth is there are no guarantees about your contracted rates and this article certainly is not one.Instead, we hope to help illustrate, on a relative basis, the differences between payments based on license, CPT code, insurance company, and location, so you can make the best decision about which insurance companies to work with.

Want to skip all this wall of text nonsense about the intricacies of mental health reimbursement rates and just focus on doing therapy? We offer an mental health billing service to end all your insurance and claims nightmares!

Article Index

  • Why Insurance Companies Don’t Release Reimbursement Data
  • Your Location Impacts Your Mental Health Reimbursement Rate
  • Insurance Reimbursement Rates for Psychotherapy by State
  • Psychotherapy Reimbursement Rates for Private Insurance
  • Your License Impacts Your Insurance Reimbursement Rate for Psychotherapy
  • Medicaid Mental Health Reimbursement Rates [2022]
  • Medicaid License Practitioner Level Information
  • Medicaid Mental Health Reimbursement Rates for Individual Therapy [2022]
  • Your Taxonomy Code Impacts Your Insurance Reimbursement
  • Medicare Reimbursement Rates for Psychotherapy [2022]
  • Provider Demand Effecting Reimbursement
  • How to Choose Insurance Companies for Mental Health Credentialing
  • Summary

Why Mental Health Insurance Companies Don’t Release Reimbursement Rate Information

There are a few reasons that insurance companies won’t let you know what you’ll be paid until you are accepted in their network.

The biggest reason they don’t release contracted rate information is they change their rates daily, depending on a few factors and mechanisms. This is the primary reason you cannot find insurance reimbursement rates for psychotherapy online — they are not “set”.

Your contracted rate will vary compared to colleagues in many cases because it is specific to you.

Factors that effect your insurance reimbursement rate for psychotherapy:

  1. Location, paying more for under-served locales and less for over-served locations.
  2. License, education, and specialization.
  3. Specialization.
  4. Consumer demand at the time of signing your contract.

Insurance Reimbursement Rates for Psychotherapy [2022] (1)

(Tip: Renegotiate Your Contracted Rate Annually)

Your contracted rate for a specific insurance plan or network is set when you sign your initial contract.

Insurance companies tend not to change, nor adjust, your rates for inflation if you do not personally request a raise or update of your fee schedule.

As a result, many providers get stuck with lower insurance reimbursement rates for psychotherapy without realizing they are being underpaid.

We strongly encourage all our providers we work with to request an annual fee schedule adjustment to match inflation. If you haven’t received a raise in pay in the last two years, we suggest you reach out to request a 5%-15% raise in pay.

How Your Location Impacts Your Mental Health Reimbursement Rate

Your location has an enormous impact on your contracted rate.

If you live in San Francisco, Los Angeles, Seattle, or many cities with high levels of education, there tend to be an abundance of mental health providers serving those locales.

On the other hand, if you are only one of a small handful of providers in a town, city, or state, you may see a significantly higher insurance reimbursement rate for psychotherapy.

Want to make the most money per session? You could move to Alaska.

Your location is one of the least flexible aspects that decides your contracted rate with insurance companies but it has a serious impact on your reimbursement rates for psychotherapy.

Consider this a business strategy question you’ll need to answer before settling on an office location.

(Video) Telehealth Billing Guide for Therapists & Mental Health Professionals

The closer you are in proximity to under-served locales, the higher you can expect your rates to be priced.

If you are struggling to pick the right companies to increase your caseload, consider working with our mental health billing service to get these sorts of questions answered, along with all your billing, with way less headache along the way.

Insurance Reimbursement Rates for Psychotherapy Compared by State

Below is an sample list of insurance reimbursement rates for one national insurance company, with roughly the same license, LICSW / Level 3 License, across multiple states, for a 60 minute individual therapy session:

Alaska – AK$100-$110
Maine – ME$60-$85
Ohio – OH$75-$90
Rhode Island – RI$75-$90
Oregon – OR$80-$105
California – CA$80-$85
Georgia – GA$80-$90
Maryland – MD$80-$90
New York – NY$80-$95
Colorado – CO$85-$95
Washington – WA$90-$100
Virginia – VA$90-$105
Pennsylvania – PA$90-$110
Texas – TX$90-$110

Again, these are estimated rates for a typical 60 minute session for an entry-level mental health license. The city you practice in will have a larger impact on your insurance reimbursement rates for psychotherapy than the state you pick.

This is not a representation of what rates will be today or in the future but a general range to expect, rather we are illustrating that each state varies.

Medicare Insurance Reimbursement Rates by State [2022 Rates]

StateFee Schedule AreaCPT Code 90791 Reimbursement Rate 2022Reimbursement Compared to National Rate
NATIONALNATIONAL$195.46100.00%
CA - CaliforniaSANTA CLARA (SANTA CLARA COUNTY)$224.26114.73%
CA - CaliforniaSAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO COUNTY)$225.09115.16%
CA - CaliforniaSAN FRANCISCO (SAN FRANCISCO COUNTY)$219.23112.16%
CA - CaliforniaSAN MATEO (SAN MATEO COUNTY)$219.23112.16%
CA - CaliforniaOAKLAND-BERKLEY (ALAMEDA AND CONTRA COSTA)$219.23112.16%
CA - CaliforniaSAN FRANCISCO-OAKLAND-HAYWARD (MARIN COUNTY)$219.44112.27%
CA - CaliforniaSALINAS (MONTEREY COUNTY)$209.01106.93%
CA - CaliforniaNAPA$209.67107.27%
CA - CaliforniaVALLEJO-FAIRFIELD (SOLANO COUNTY)$209.67107.27%
CA - CaliforniaSANTA CRUZ-WATSONVILLE$209.55107.21%
CA - CaliforniaSANTA ROSA (SONOMA COUNTY)$208.27106.55%
CA - CaliforniaRIVERSIDE-SAN BERNARDINO-ONTARIO (SAN BERNARDINO AND RIVERSIDE COUNTY)$202.15103.42%
CA - CaliforniaBAKERSFIELD (KERN COUNTY)$202.42103.56%
CA - CaliforniaSACRAMENTO-ROSEVILLE-ARDEN-ARCADE (SACRAMENTO, PLACER, YOLO, EL DORADO)$202.86103.79%
CA - CaliforniaCHICO (BUTTE COUNTY)$200.53102.59%
CA - CaliforniaFRESNO$200.53102.59%
CA - CaliforniaHANFORD-CORCORAN (KINGS COUNTY)$200.53102.59%
CA - CaliforniaMADERA$200.53102.59%
CA - CaliforniaMERCED$200.53102.59%
CA - CaliforniaMODESTO (STANISLAUS COUNTY)$200.53102.59%
CA - CaliforniaREDDING (SHASTA COUNTY)$200.53102.59%
CA - CaliforniaSTOCKTON-LODI (SAN JOAQUIN COUNTY)$200.53102.59%
CA - CaliforniaVISALIA-PORTERVILLE (TULARE COUNTY)$200.53102.59%
CA - CaliforniaYUBA CITY (SUTTER, YUBA)$200.53102.59%
CA - CaliforniaCALIFORNIA (ALL OTHER COUNTIES)$200.53102.59%
CA - CaliforniaLOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES COUNTY)$209.34107.10%
CA - CaliforniaLONG BEACH-ANAHEIM (ORANGE COUNTY)$209.34107.10%
CA - CaliforniaOXNARD-THOUSAND OAKS-VENTURA$206.33105.56%
CA - CaliforniaSANTA MARIA-SANTA BARBARA$207.59106.21%
CA - CaliforniaSAN DIEGO-CARLSBAD$206.43105.61%
CA - CaliforniaSAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE$201.63103.16%
CA - CaliforniaEL CENTRO (IMPERIAL COUNTY)$200.63102.65%
HI - HawaiiHAWAII, GUAM, AMERICAN SAMOA, MARSHALL ISLANDS, PALAU, NORTHERN MARIANA ISLANDS, FEDERATED STATES OF MICRONESIA$201.98103.34%
NV - NevadaSTATEWIDE$197.78101.19%
AK - AlaskaSTATEWIDE$271.70139.01%
ID - IdahoSTATEWIDE$187.1995.77%
OR - OregonPORTLAND (CLACKAMAS, MULTNOMAH AND WASHINGTON)$199.43102.03%
OR - OregonREST OF STATE$190.9397.68%
WA - WashingtonWASHINGTON SEATTLE (KING COUNTY)$208.55106.70%
WA - WashingtonREST OF STATE$194.9499.73%
AZ - ArizonaSTATEWIDE$192.5798.52%
MT - MontanaSTATEWIDE$195.3699.95%
ND - North DakotaSTATEWIDE$192.8898.68%
SD - South DakotaSTATEWIDE$192.5098.49%
UT - UtahSTATEWIDE$190.8597.64%
WY - WyomingSTATEWIDE$194.7499.63%
CO - ColoradoSTATEWIDE$196.70100.63%
NM - New MexicoSTATEWIDE$191.4697.95%
OK - OklahomaSTATEWIDE$189.0396.71%
TX - TexasHOUSTON$200.98102.82%
TX - TexasGALVESTON (TARRANT COUNTY)$199.26101.94%
TX - TexasBRAZORIA$199.12101.87%
TX - TexasDALLAS$197.93101.26%
TX - TexasFORT WORTH (TARRANT COUNTY)$195.47100.01%
TX - TexasAUSTIN (TRAVIS COUNTY)$196.07100.31%
TX - TexasREST OF STATE$191.5297.98%
TX - TexasBEAUMONT (JEFFERSON COUNTY)$190.8697.65%
IA - IowaSTATEWIDE$188.6096.49%
KS - KansasSTATEWIDE$188.8096.59%
MO - MissouriMETROPOLITAN ST. LOUIS (JEFFERSON, ST. CHARLES, ST. LOUIS AND ST. LOUIS CITY)$193.8699.18%
MO - MissouriMETROPOLITAN KANSAS CITY (CLAY, JACKSON AND PLATTE)$192.9198.70%
MO - MissouriREST OF STATE$187.9196.14%
NE - NebraskaSTATEWIDE$187.7896.07%
IL - IllinoisCHICAGO (COOK COUNTY)$203.03103.87%
IL - IllinoisSUBURBAN CHICAGO (DUPAGE, KANE, LAKE AND WILL)$201.46103.07%
IL - IllinoisEAST ST. LOUIS (BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN, MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON)$195.81100.18%
IL - IllinoisREST OF STATE$192.2698.36%
MN - MinnesotaSTATEWIDE$193.1298.80%
WI - WisconsinSTATEWIDE$189.6297.01%
AR - ArkansasSTATEWIDE$186.0495.18%
LA - LouisianaNEW ORLEANS (JEFFERSON, ORLEANS, PLAQUEMINES AND ST. BERNARD)$194.5299.52%
LA - LouisianaREST OF STATE$191.0097.72%
MS - MississippiSTATEWIDE$186.7495.54%
IN - IndianaSTATEWIDE$188.4696.42%
MI - MichiganDETROIT (MACOMB, OAKLAND, WASHTENAW AND WAYNE)$198.15101.38%
MI - MichiganREST OF STATE$191.3097.87%
FL - FloridaMIAMI (DADE AND MONROE COUNTY)$203.91104.32%
FL - FloridaFORT LAUDERDALE (BROWARD, COLLIER, INDIAN RIVER, LEE, MARTIN, PALM BEACH, AND ST. LUCIE)$199.41102.02%
FL - FloridaREST OF STATE$194.6599.59%
PR - Puerto RicoPUERTO RICO$195.77100.16%
VI - Virgin IslandsVIRGIN ISLANDS$195.77100.16%
AL - AlabamaSTATEWIDE$189.9897.20%
GA - GeorgiaATLANTA (BUTTS, CHEROKEE, CLAYTON, COBB, DEKALB, DOUGLAS, FAYETTE, FORSYTH, FULTON, GWINNETT, NEWTON, ROCKDALE AND WALTON)$194.9499.73%
GA - GeorgiaREST OF STATE$189.4596.93%
TN - TennesseeSTATEWIDE$188.2296.30%
SC - South CarolinaSTATEWIDE$189.6497.02%
VA - VirginiaSTATEWIDE$194.7799.65%
WV - West VirginiaSTATEWIDE$189.8797.14%
NC - North CarolinaSTATEWIDE$191.3597.90%
DE - DelawareSTATEWIDE$196.87100.72%
DC - Washington, DCDC + MD/VA SUBURBS (DISTRICT OF COLUMBIA; ALEXANDRIA CITY, ARLINGTON, FAIRFAX, FAIRFAX CITY, FALLS CHURCH CITY IN VIRGINIA; MONTGOMERY AND PRINCE GEORGE'S IN MARYLAND)$215.43110.22%
MD - MarylandBALTIMORE/SURROUNDING COUNTIES$205.34105.05%
MD - MarylandREST OF STATE$199.07101.85%
NJ - New JerseyNORTHERN NEW JERSEY (BERGEN, ESSEX, HUDSON, HUNTERDON, MIDDLESEX, MORRIS, PASSAIC, SOMERSET, SUSSEX, UNION AND WARREN)$211.50108.21%
NJ - New JerseyREST OF STATE$207.10105.96%
PA - PennsylvaniaMETROPOLITAN PHILADELPHIA (BUCKS, CHESTER, DELAWARE, MONTGOMERY AND PHILADELPHIA)$203.36104.04%
PA - PennsylvaniaREST OF STATE$192.1798.32%
CT - ConnecticutSTATEWIDE$205.75105.26%
NY - New YorkNYC SUBURBS/LONG ISLAND (BRONX, KINGS, NASSAU, RICHMOND, ROCKLAND, SUFFOLK AND WESTCHESTER)$220.07112.59%
NY - New YorkMANHATTAN$217.56111.31%
NY - New YorkPOUGHKPSIE/N NYC SUBURBS (COLUMBIA, DELAWARE, DUTCHESS, GREENE, ORANGE, PUTNAM, SULLIVAN AND ULSTER)$207.12105.97%
NY - New YorkREST OF STATE$192.2898.37%
NY - New YorkQUEENS$221.56113.35%
ME - MaineSOUTHERN MAINE (CUMBERLAND AND YORK COUNTY)$193.7599.13%
ME - MaineREST OF STATE$189.2296.81%
MA - MassachusettsMETROPOLITAN BOSTON (MIDDLESEX, NORFOLK AND SUFFOLK)$211.15108.03%
MA - MassachusettsREST OF STATE$201.31102.99%
NH - New HampshireSTATEWIDE$196.83100.70%
RI - Rhode IslandSTATEWIDE$200.62102.64%
VT - VermontSTATEWIDE$193.5599.02%
KY - KentuckySTATEWIDE$188.6996.54%
OH - OhioSTATEWIDE$191.9198.18%

Psychotherapy Reimbursement Rates for Private Insurance [2022]

It cannot be stated enough: the following information is not direct information from each of these insurance companies but rather is an average of fee schedules based exclusively on contracts with these companies. These insurance reimbursement rates for psychotherapy vary by state, by license, taxonomy, and other factors.

No one ever has access to contracted rate informationuntilan EOB is issued for out of network providers OR you’ve been accepted as in-network and they’ve given you your fee schedule.

Here is a sample of psychotherapy reimbursement rates for private insurance by major mental health insurance brand:

LowHigh
Aetna$70$88
Cigna$64$86
Magellan$55$73
Anthem Blue Cross$68$91
United Health Care / United Behavioral Health / Optum$67$79
Blue Shield$67$93
Beacon Health Options / Value Option$62$81
Beacon Health Strategies$64$74
MHN$57$69
Molina$55$67

(Again, these are not exact rates but estimated ranges).

Here is a view of the same psychotherapy reimbursement rate for private insurance information after averaging the low and high prices individually and then showing the delta of price differential between these private insurance polices as a relative percentage out of 100%.

Avg HighAvg High
LowHigh$66$77
Aetna$69$84105%109%
Cigna$62$8294%106%
Magellan$52$7079%91%
Anthem Blue Cross$67$88102%114%
United Health Care / United Behavioral Health / Optum$66$78100%101%
Blue Shield$65$8998%116%
Beacon Health Options / Value Option$62$7494%96%
Beacon Health Strategies$60$7291%94%
MHN$57$6986%90%
Molina$52$6679%86%

Here’s an image version that might be easier to read!

Insurance Reimbursement Rates for Psychotherapy [2022] (2)

In summary, some private insurance companies reimburse mental health therapists for far more than others. A great way to quickly learn which companies pay the most is to simply ask your colleagues about their experiences with different reimbursement rates for private insurance companies.

If you’re wondering about which private insurance companies are reimbursing the most in your state with your license, we’re happy to help you fill in the gaps.

How Your License Impacts Your Insurance Reimbursement Rate for Psychotherapy

In most states, mental health therapists are initially licensed as an LPC or LMHC or LPCMH or LCPC or LPCC (and on and on), depending on your state. While it’s safe to assume you already know your license for your state, you can also check this PDF document here to confirm your license and what’s required.

With this license comes, normally, the lowest or entry level rates for working with insurance companies providing mental health services.

You’ve just been licensed and you’re ready to begin working on your own in private practice. Expect rates insurance reimbursement rates for psychotherapy to be in the lowest tier of payment.

45 Minute Individual Therapy60 Minute Individual Therapy
9083490837
LPC, Licensed Professional Counselor$68$77
LMFT, Licensed Marriage and Family Therapist$74$89
LICSW, Licensed Independent Social Workers$68$77
MD / PhD, American Board of Psychiatry and Neurology Certified$88$105

Medicaid Mental Health Reimbursement Rates [2022]

Medicaid requirements for licensing vary state by state. Likewise, Medicaid pays out differing rates based on very specific criteria and coding.

Here’s a link for Medicaid’s PDF on Mental Health Payment Rates.

(Video) Negotiating Insurance Reimbursement For Counselors In Private Practice

Make sure you have one of the following licenses to get credentialed with the medicaid provider(s) in your state:

  • Physician
  • Psychiatrist
  • Physician’s Assistant (PA)
  • Advanced PracticeRegistered Nurse (APRN)
  • Clinical Nurse
  • Specialist/Psychiatric Mental Health (CNSPMH) and NursePractitioner (NP)
  • Licensed Pharmacist
  • Registered Nurse (RN)
  • Licensed PracticalNurse (LPN)
  • Licensed Dietician (LD)
  • Qualified Medication Aide (QMA)
  • Psychologist
  • Licensed ClinicalSocial Worker (LCSW)
  • Licensed Professional Counselor (LPC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Master’s Social Worker(LMSW)
  • Licensed Associate Professional Counselor (LAPC)
  • Licensed Associate Marriage and Family Therapist (LAMFT)
  • Certified Clinical Alcohol and Drug Counselor (CCADC)
  • Master Addiction Counselor (MAC)
  • National Board of Certified Counselors (NBCC)
  • Master Addiction Counselor, (MAC) through National Association of Alcohol and Drug Counselors, (NAADC)
  • Certified Alcohol and Drug Counselor (CADC)
  • Certified Addiction Counselor, Level I (CAC-I)
  • Certified Addiction Counselor, Level II (CAC-II)
  • Registered Alcohol and Drug Technician I, II, III
  • Addiction Counselor Trainees
  • Certified Psychiatric Rehabilitation Professional (CPRP)
  • Certified Peer Specialist (CPS)
  • Paraprofessional (PP)

Medicaid License Practitioner Level Information

Your Medicaid License impacts the “Practitioner Level” that you have which influences your reimbursement rates.

Mental Health License Practitioner Levels:

  • Practitioner Level 1: Physician/Psychiatrist
  • Practitioner Level 2: Psychologist, CNS-PMH
  • Practitioner Level 3: LCSW, LPC, LMFT, RN
  • Practitioner Level 4:
    • LMSW; LAPC; LAMFT
    • Psychologist/LCSW/LPC/LMFT’s supervisee/trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology, functioning within the scope of the practice acts of the state
    • MAC, CAC-II, CADC, CCADC, GCADC (II, III); CAC-I or Addiction Counselor Trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology (addiction counselors may only perform these functions related to treatment of addictive diseases).
  • Practitioner Level 5:
    • CAC-I, RADT (I, II, or III), Addiction Counselor Trainees with high school diploma/equivalent (practitioners at this level may only perform these functions related to treatment of addictive diseases and under the supervision of one of the licensed/credentialed professionals above).

Medicaid Mental Health Reimbursement Rates for Individual Therapy

Below is a table showing the rates that have been determined by Medicaid for these differing license levels for commercial insurance polices:

45-50 minutes
Practitioner Level 2$116.90
Practitioner Level 3$90.03
Practitioner Level 4$60.89
Practitioner Level 5$45.38
75-80 minutes
Practitioner Level 2$194.84
Practitioner Level 3$150.05
Practitioner Level 4$101.48
Practitioner Level 5$75.64

Now you must be wondering: “What??!! Medicaid doesn’t pay that much!!!” And you’re right.

These are the rates that they established as averages nationally based on a huge survey of insurance policies by their relative license. These are the commercial insurance reimbursement rates for psychotherapy determined by Medicaid.

Medicaid mental health reimbursement rates differ in that medicaidreducesthese rates to providers at Practitioner Levels 2-5, which cover all licensed mental health providers except MDs.

Based on data received through surveys of a large sample of agencies currently providing Community Behavioral Health Rehabilitation Services in multiple states, average allocable direct and indirect cost factors were calculated as a percentage of direct personnel costs.

These costs were then calculated for each service and for each applicable practitioner level. All of these cost components were summed to yield an annual cost for the service for the particular practitioner level.

Due to the large difference between the median annual salaries in Level 1 (physicians/psychiatrists) and the other levels, it was necessary to adjust the support and administrative factors applied to the highest level versus the other levels so that the support and administrative costs associated with the highest levels were not over-inflated.

This was accomplished by adjusting the direct and indirect cost factors according to the proportion of personnel costs in an average agency accounted for by the top level versus the other four practitioner levels.

The overall direct services cost factor is 39% and indirect is 15%. Once the factors were adjusted to account for the disparity between physician salaries and the other levels the cost factors became 19% for direct costs and 7% for indirect costs for Level 1 and 45% for direct costs and 17% indirect costs for the remaining four levels.

Source

So, take the above charts and then reduce their numbers and you can expect to get payment more like the following:

45-50 minute therapy session

Medicaid Mental Health Rate

Practitioner Level 2$116.90$72.48
Practitioner Level 3$90.03$55.82
Practitioner Level 4$60.89$37.75
Practitioner Level 5$45.38$28.14
75-80 minute therapy session
Practitioner Level 2$194.84$120.80
Practitioner Level 3$150.05$93.03
Practitioner Level 4$101.48$62.92
Practitioner Level 5$75.64$46.90

Insurance Reimbursement Rates for Psychotherapy [2022] (3)

There are other factors that influence Medicaid rates by state, license, practitioner level, and subcontract with the Medicaid program in that state, so these rates are not exact but will give you a better sense of the differences in license levels and therefore reimbursement rates for mental health services covered by Medicaid.

Here is another example of Medicaid determined private rates; specifically Medicaid Reimbursement Rates for Mental Health Services in Mississippi:

Diagnostic Evaluation90791$121
Psychiatric Diagnostic Evaluation90792$134
AssessmentH0031$93
Prolonged Service 60 min.99354$111
Prolonged Service 30 min add on99355$85
Psychotherapy90832$59
Psychotherapy90834$79
Psychotherapy90837$118
Family Therapy90846$95
Family Therapy90847$99
Group Therapy90853$24
Multi-Family Group Therapy90849$35
Interactive Complexity90785$13
Psychological Evaluation (First Hour)96130$102
Psychological Evaluation (Each Additional Hour)96131$78
Psychological Evaluation (First 30 Minutes)96136$39
Psychological Evaluation (Each Additional 30 Minutes)96137$36
Crisis Response (Face to Face)H2011$30
Crisis Response (Phone)H2011$22

Source

Insurance Reimbursement Rates for Psychotherapy [2022] (4)

Again, these are the rates that have been determined as average payment rates by insurance based on research done by that State’s medicaid program, in this case Mississippi.

(Video) Adolescent Depression

These rates get reduced but these are useful to look at to see what they believe are the average reimbursement rates by procedure code.

This information does not take into account the effect of the license or practitioner level on total reimbursement rate.

How Your Taxonomy Code Impacts Your Insurance Reimbursement Rates for Psychotherapy

Here is a list of the taxonomy codes or specializations that are declared in the National Provider Identifier Registry.

You can simply Google your NPI number to find your license information including your taxonomy. It’s likely to be one of the following:

Psychiatry Taxonomy Codes

  • Addiction Psychiatry – 2084P0802X
  • Child & Adolescent Psychiatry – 2084P0804X
  • Geriatric Psychiatry – 2084P0805X
  • Psychiatry – 2084P0800X

Behavioral Health & Social Service Provider Taxonomy Codes

  • Counselor – 101Y00000X
  • Addiction (Substance Use Disorder) – 101YA0400X
  • Marriage & Family Therapist – 106H00000X
  • Psychoanalyst – 102L00000X
  • Psychologist – 103T00000X
  • Addiction (Substance Use Disorder) – 103TA0400X
  • Adult Development & Aging – 103TA0700X
  • Clinical Child & Adolescent – 103TC2200X
  • Cognitive & Behavioral – 103TB0200X
  • Counseling – 103TC1900X
  • Group Psychotherapy – 103TP2701X
  • Developmental Disabilities – 103TM1800X
  • Psychoanalysis – 103TP0814X
  • Psychotherapy – 103TP2700X
  • Social Worker – 104100000X

These taxonomy codes reflect specializations of treatment related to your specific mental health provider license. Insurance companies are trying to fill out a map of providers across specific locations, as we discussed before, and they are also trying to maximize their specializations within those offerings.

Insurance companies are all trying to fill in the gaps of service offerings per area as well.

Medicaid License Example Case

Imagine a hospital. It would be convenient for them to have multiple mental health providers on staff who specialize in different things.

Some clients need help with homelessness and substance abuse and require specific treatment related to their situations, whereas others are looking for psychotherapy specific to their family or eating disorder or gambling addiction.

For that hospital to top notch, they hire providers who specialize in a variety of services. Insurance companies operate in a similar way.

Treatment specializations require different training and education which are reflected in their licensing and also reimbursement rates.

This is the least predictable factor in influencing your reimbursement rates and is more a reflection of your license and that insurance company needing to fill a gap in service offerings or not.

As a result, it’s better to think about your taxonomy code and insurance reimbursement rates for mental health more in terms of your level of education and license in your state. Your specialization is “optimized” when deciding what you’re going to study or what you will choose to study in the future.

If you don’t want to deal with this mess, consider hiring us to do your billing and handle this for you.

Medicare Reimbursement Rates for Psychotherapy [2022]

Please see our updated Medicare Rates:

CPT CodeDescriptionMedicare Reimbursement Rate 2020Medicare Reimbursement Rate 2021Medicare Reimbursement Rate 2022
90791Psychological Diagnostic Evaluation$140.19$180.75$195.46
90792Psychological Diagnostic Evaluation with Medication Management$157.49$201.68$218.90
90832Individual Psychotherapy, 30 Minutes$68.47$77.81$85.07
90833Individual Psychotherapy with Evaluation and Management Services, 30 minutes$71.00$71.18$77.88
90834Individual Psychotherapy, 45 Minutes$91.18$103.28$112.29
90836Individual Psychotherapy with Evaluation and Management Services, 45 minutes$89.74$90.02$98.30
90837Individual Psychotherapy, 60 Minutes$136.95$152.48$164.84
90838Individual Psychotherapy with Evaluation and Management Services, 60 minutes$118.57$119.33$129.30
90839Individual Crisis Psychotherapy initial 60 min$157.66
90840Individual Crisis Psychotherapy initial 60 min, each additional 30 min$78.64
99201Evaluation and Management Services, Outpatient, New Patient$46.49Not CoveredNot covered
99202Evaluation and Management Services, Outpatient, New Patient$77.48$73.97$80.91
99203Evaluation and Management Services, Outpatient, New Patient$109.92$113.75$124.39
99204Evaluation and Management Services, Outpatient, New Patient$166.86$169.93$185.26
99205Evaluation and Management Services, Outpatient, New Patient$209.75$224.36$244.99
99211Evaluation and Management Services, Outpatient, Established Patient$23.07$23.03$25.71
99212Evaluation and Management Services, Outpatient, Established Patient$45.77$56.88$62.76
99213Evaluation and Management Services, Outpatient, Established Patient$75.32$92.47$100.57
99214Evaluation and Management Services, Outpatient, Established Patient$110.28$131.20$141.78
99215Evaluation and Management Services, Outpatient, Established Patient$147.76$183.19$200.00
99354Prolonged Services$132.26 $132.09$140.26
99355Prolong Services with E/M$100.91$100.33$101.32
90846Family psychotherapy without patient, 50 minutes$103.58$99.10$107.37
90847Family psychotherapy with patient, 50 minutes$107.19$102.59$111.15
96105Assessment of aphasia and cognitive performance$101.54$109.26
96112Developmental testing administration by a physician or qualified health care professional, 1st hr$131.55$141.02
96113Developmental testing administration by a physician or qualified health care professional, each additional hour$58.62$66.54
96116Neurobehavioral status exam performed by a physician or qualified health professional, first hour$97.00$104.73
96121Neurobehavioral status exam performed by a physician or qualified health professional, additional hour$82.35$87.34
96125Standardized cognitive performance test administered by health care professional$107.12$115.69
96127Brief emotional and behavioral assessment$4.89$5.29
96130Psychological testing and evaluation by a physician or qualified health care professional, first hour$120.73$132.70
96131Psychological testing and evaluation by a physician or qualified health care professional, each additional hour$91.42$98.68
96132Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour$133.29$144.80
96133Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour$103.98$112.29
96136Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour$46.76$49.15
96137Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour$41.87$44.24
96138Neuropsychological or psychological test administration and scoring by a technician, first hour$37.34$38.56
96139Neuropsychological or psychological test administration and scoring by a technician, each additional hour$37.34$$39.32

(Source)

Medicare has approached this problem in a similar way by averaging service costs and using those as a basis to reduce fees. Here’s a look at what they suggest normal private insurance rates are by CPT code, nationally:

90832Psytx w pt 30 minutes$68.47
90833Psytx w pt w e/m 30 min$71.00
90834Psytx w pt 45 minutes$91.18
90836Psytx w pt w e/m 45 min$89.74
90837Psytx w pt 60 minutes$136.95
90838Psytx w pt w e/m 60 min$118.57
90839Psytx crisis initial 60 min$142.71
90840Psytx crisis ea addl 30 min$68.47
90845Psychoanalysis$97.31
90846Family psytx w/o pt 50 min$110.28
90847Family psytx w/pt 50 min$114.60
90849Multiple family group psytx$42.17

Source

Medicare reduces insurance reimbursement rates for psychotherapy on a relative basis. Here’s that same charge but with a calculated reduction on rates of 40%:

Suggested Private Rate

Reduced Rate (40% Reduction)

90832Psychotherapy with patient for 30 minutes$68.47$41.08
90833Psychotherapy and evaluation and management with patient for 30 min$71.00$42.60
90834Psychotherapy with patient for 45 minutes$91.18$54.71
90836Psychotherapy and evaluation and management with patient for 45 min$89.74$53.84
90837Psychotherapy with patient for 60 minutes$136.95$82.17
90838Psychotherapy and evaluation and management with patient for 60 min$118.57$71.14
90839Mental health crisis, first 60 minutes$142.71$85.63
90840Mental health crisis, each additional 30 minutes$68.47$41.08
90845Psychoanalysis$97.31$58.39
90846Family psychotherapy without the patient, 50 min$110.28$66.17
90847Family psychotherapy with the patient, 50 min$114.60$68.76
90849Multiple family group psychotherapy$42.17$25.30

The reduced rate here isn’t the exact amount Medicare pays out but represents a rough estimate of the suggested reduction to expect from Medicare. In our experience, Medicare over-estimates the contracted rate for most private insurance companies so their total reduction, while large, still leaves providers with a modest but much higher earning than Medicaid.

(Video) Common Substance Use Disorder Coding and Reimbursement Practices

Part of the reason why is Medicare is more selective with their network.

Mental Health License Requirements for Medicare

Medicare doesn’t cover all licenses and is far more selective than Medicaid about which providers they will allow into their network. As a result, mental health reimbursement rates for Medicare are higher than Medicaid rates by a substantial margin.

Medicare Accepted Mental Health Licenses:

  • Psychiatrist
  • Psychologists
  • Clinical Nurse Practitioners
  • Clinical Social Workers

Mental Health Licenses Not Accepted by Medicare:

  • LMHC
  • LMFT
  • LPC

Source

If you do want to serve an older demographic or have specialized in care tailored to their needs, it’s important to understand the license required for you to be able to be accepted within Medicare.

Mental Health Provider Demand Effecting Reimbursement Rates for Therapy

The sad truth is some of the best panels are totally full and their network map of mental health providers is saturated. There’s nothing you can do when a company like Florida Blue hasn’t accepted mental health providers in years.

The amount of contracted providers per insurance company will have a larger influence on your ability to get in that network or not than it will on what you’ll be paid.

But on the other hand, if a company is easy to get accepted into their network, odds are higher they do not reimburse as much. Again, this is a case by case situation you’ll need to research and address.

How to Choose Mental Health Insurance Companies for Credentialing

Choosing which companies to apply to depends on a number of factors but can fall cleanly into three buckets:

  1. Increasing caseload
  2. Increasing revenue per appointment
  3. Working with a specific demographic

For the best possible guidance, try to pick only two of these three possible options and weight their significance to you in your current private practice.

Are you looking to increase the number of sessions you do? Work with lower paying but higher supplying networks like Medicaid.

Want higher income per client? Look at the Blue Card network (all “Blue” plans in your state).

And if you don’t even know what Blue Card programs apply to your state or you need a free customized quote that’s specific to your needs, we are happy to help. (But not required!) You can reach out about that at our mental health credentialing services page.

Summary of Insurance Reimbursement Rates for Psychotherapy

Mental health reimbursement rates vary dramatically. They depend on your:

  • license,
  • your specialty,
  • your location,
  • and the service map for each insurance company you’re applying to.

Your reimbursement rates are most dramatically influenced by your education and license, baring living in a few locations that are dying for more mental health providers (e.g. Alaska).

Strategically speaking, your first big decision is your level of licensing and continued education you have sought or will seek. Next will be picking an area that is undeserved to the best of your estimation. Finally, consider choosing a specialization that fills in a service gap that is regularly sought after.

From there, pick which insurance companies you’re most interested in working with depending on the demographic you aim to serve. Some companies may pay less but provide you a higher inbound flow of clients (like Medicaid), whereas others might be very challenging to get in-network with but pay much higher (like Blue Card plans).

For specific recommendations for credentialing in your state, feel free to reach out to us at TheraThink for help.

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FAQs

Is 90832 an add on code? ›

CPT Codes 90832-90838 represent psychotherapy. Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837. Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838).

Does Blue Cross cover therapy? ›

Blue Cross Blue Shield plans cover most types of therapy, including individual therapy and child therapy, as well as different types of therapy approaches, including: Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT)

Can 90832 be billed as telehealth? ›

These codes are approved for mental health telehealth billing by both the current procedural terminology (CPT) and the Centers for Medicare Services (CMS): 99201 – 99215 – Evaluation and Management Service Codes. 90791 & 90792 – Diagnostic Interview. 90832 – Psychotherapy for 30 Minutes.

How long is a 90832 session? ›

The times for these codes are: 90832 – Psychotherapy 30 minutes. 90834 – Psychotherapy 45 minutes. 90837 – Psychotherapy 60 minutes.

Can 99214 and 90832 be billed together? ›

Medication management (evaluation and management) and psychotherapy Do not bill CPT codes 99201-99215 and 90832 or 90834 or 90837. It is acceptable to bill CPT codes 99201-99215 and 90833 or 90836 or 90838.

What is the reimbursement for 90832? ›

CPT Code 90832 Reimbursement Rates. This has increased to $77.81 in 2021. 90832 always reimburses less than 90834 and 90837, but similar per unit of time. This is usually around 75% of the 90834 reimbursement rate and around 50% of 90837.

How much does therapy cost? ›

Most individuals spend between $60 to $120 on average for an hour-long session. Given this range, most therapists charge an average rate of $90 per hour. However, various factors impact this cost, such as sliding scale therapy, the type of therapist you see, and the type of therapy session you are attending.

Are therapists worth it? ›

Some research shows that psychotherapy (also known as talk therapy) is effective for up to 75% of people. It can improve the behaviors and emotions that are negatively impacting your mental health. It also results in less disability and fewer sick days, which might be able to offset the actual cost for some people.

Are therapists expensive? ›

Depending on where you live and the level of care you're seeking, the cost of seeing a psychologist can vary. For most parts of the U.S., one session may cost about $100 to $200. If you live in a big metro area, expect to pay more, says Gray Otis, a licensed clinical mental health counselor in Utah.

Can therapists bill for phone calls? ›

Typically, therapists will charge for phone calls with the client if the conversation exceeds a certain amount of time. Calls to family members: Sometimes therapists need additional information from family members, especially if the client is a child.

Does 90837 require a modifier? ›

You can use an HO modifier with all of the standard procedure codes for mental health. 90791, 90834, 90837, etc.

Can 90846 and 90837 be billed together? ›

Codes 90832, 90833, 90834, 90836, 90837, 90838 can be reported on the same-day as codes 90846 and 90847, provided that the services are separate and distinct. Be sure to include modifier 59 to emphasize that the services are separate and distinct. Do not report psychotherapy codes for sessions shorter than 16 minutes.

How do you bill for a 90 minute psychotherapy session? ›

Units vs Extended Session CPT Codes

Rather, what is required to bill for 90 minutes is an add-on code on a new line in box 24 of your CMS1500 form. To bill an insurance claim for a 90 minute individual therapy session: bill 90837. with add-on code 99354.

How do I bill a 75 minute therapy session? ›

If the session lasts for 75 minutes or more, you would use both 90839 and the add-on code 90840 when billing patients and filing claims.

How do you bill a 2 hour therapy session? ›

You'll want to use your typical 90837 CPT code. Then you'll also want to use the Add On CPT code 99354 which declares an additional 30 to 74 minutes of therapy. So any time you do 90 to 2 hours and 14 minutes of therapy, make sure to use the combination of CPT Codes 90837 and +99354.

What is the CPT time rule for psychotherapy? ›

As per the CPT time rule, family psychotherapy codes require at least 26 minutes of service (i.e., greater than ½ of 50 minutes). One may NOT report interactive complexity (90785) with these codes.

Can a psychologist Bill E M codes? ›

Psychologists are NOT permitted to bill E&M codes. E&M are for medical services and not within their "scope of practice".

Can a psychologist Bill 99214? ›

Who can bill with CPT Codes 99213 and 99214? Many medical professionals can bill with CPT Codes 99213 and 96214. The good news is that it is not only for mental health providers or therapists. Behavioral health assessments can be very important tools in the most common of healthcare environments.

What is the reimbursement for 90834? ›

Medicare 2022 90834 Reimbursement Rate: $112.29

There has been a 9.2% increase in reimbursement from 2020 to 2021.

What is the Medicare reimbursement rate for 90837? ›

$132.69

What is the reimbursement rate for 90853? ›

Medicare 2022 CPT Code 90853 Reimbursement Rate: $29.87

If you're struggling to get paid the appropriate amount for your group therapy sessions, we might be able to help.

How much does a therapist make per session? ›

Collections rate – Range: $75 to $125 per session. Several factors are affecting our average hourly rate of collection is for a single hour of psychotherapy. I have seen practices with quite a wide range of collection rates that vary from clinician to clinician. The hourly wage range can be pretty significant.

Why is therapy so expensive with insurance? ›

One of the most important factors for the high cost of therapy is that this profession began in the field of medicine and therefore built just as medicine has in our country: to serve people with the means to pay for it.

How much should you spend on therapy? ›

The price varies depending on where you live, who you see and your insurance. But we can give you a rough idea of what to expect. Without insurance, traditional therapy can cost anywhere from $100 to $200 per session, depending on your diagnosis and treatment.

What field of psychology makes the most money? ›

Psychiatrists prescribe medications for patients with mental illnesses. Psychiatrist positions are by far the highest-paying jobs for psychology majors. The average salary is $217,798, according to PayScale.

Why is starting therapy so hard? ›

It is common to have mixed feelings about starting therapy. Our instincts lead us to stay away from uncomfortable thoughts and feelings. Hesitation about beginning therapy may indicate the presence of something very important to understand about ourselves.

Is therapy proven to work? ›

About 75 percent of people who enter psychotherapy show some benefit from it. Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.

Why are Psychotherapists so expensive? ›

Psychologist insurance fees. Personal insurance fees (if you work for yourself, you must provide your own benefits) Professional association fees (of which there may be several) Professional supervision by another psychologist (required, if you're a provisional psychologist; strongly advised even for seasoned pros)

Why is therapy so unaffordable? ›

In order to receive a license; therapists have to go through a lot of training and years before they can actually work. Lastly, counseling is expensive because there are many bills to pay: Rent and utilities. State licensure fees, each licensure requires annual fees to be paid.

Why is therapy not covered by insurance? ›

In some instances, people choose to pay out of pocket for therapeutic services rather than claim coverage through their insurer. Why? Insurance companies only pay for medically necessary services. They require a mental health diagnosis before they will pay claims.

Can I call my therapist between sessions? ›

When you feel like you need them. They won't just know that you need them. If it is a bad time for they will tell you it is a bad time. If they don't want you to call them they will tell you.

How do you code telehealth psychotherapy? ›

See the complete list of telehealth services covered by Medicare during the public health emergency from the Centers for Medicare & Medicaid Services.
...
Telehealth codes for Medicare reimbursement for telebehavioral health.
CategoryTeleheath CPT codes
Psychoanalysis90845
Group psychotherapy90853
24 more rows
28 Sept 2022

What is a collateral session in therapy? ›

A collateral is usually a spouse, family member, or friend who participates in therapy to further the treatment interests of the patient. Since the collateral is not the subject of the treatment, the collateral is not considered a patient.

Does 90839 pay more than 90837? ›

CPT Code 90839 typically pays slightly more than CPT code 90837 for a 60 minute individual psychotherapy session. 90840 pays a similar rate per time period, about half of what 90839 allows.

How do you justify 90837? ›

How should I bill 90837?
  1. Psychotherapy times are for face-to-face services with the patient and/or family member.
  2. The patient must be present for all or some of the service.
  3. In reporting, choose the code closest to the actual time (i.e., 53 or more minutes for 90837).
  4. Document start and end times.

How many times can you bill 90837? ›

Come back!" CPT code 90837 is another one of the most common CPT codes used by mental health professionals along with 90834 and 90791. Its typical use is for a normal psychotherapy session with a client. Insurers will reimburse this code only once per day, and some only as frequently as twice per week.

Can you Bill 90837 twice on the same day? ›

If two psychotherapy sessions took place on the same day, you would add the two and code one claim with the combined time. Since it is 90 minutes, you would code 90837. Look at the attachment for documentation requirements though.

Can you bill 90837 family session? ›

If a family member is brought into individual psychotherapy sessions intermittently or briefly, you don't have to bill these family codes. You can use individual psychotherapy codes, 90832, 90834 or 90837. Just make sure the intent of the session/s is not the family member's benefit.

Can I use 90837 for couples therapy? ›

The American Medical Association (AMA) clarified in 2016 that CPT codes 90832, 90834, and 90837 were individual therapy codes, and should only be used for a family session if a family member comes once or occasionally into a session where ongoing individual therapy is taking place.

Can I bill for two therapy sessions in the same day? ›

It is not recommended that you break the session into two parts and bill for each. For example, if you did a 90 minute session, it is not recommended that you bill for two 45 minute sessions on the same day, unless the plan tells you to do so, as many plans only allow one hour of therapy per day.

Can 90837 and 90834 be billed together? ›

Since it is an add-on code it must be billed with 90837 or 90847 (90791 and 90834 are not allowed).

What is the CPT code for 50 minute psychotherapy session? ›

This means a traditional 50-minute therapy hour should be billed as 90834; however, this also means that you should be rightfully reimbursed for longer sessions with 90837.

What is the difference between 90837 and 90847? ›

The primary difference between 90847 and 90837 is regarding “who” is there for the therapy. CPT 90847 denotes “plural” family members [1]. You can think of it as psychotherapy with “all” the family members, plus the patient. With CPT 90837, the therapy is provided to the patient, and/or one (singular) family member.

How do you code individual psychotherapy? ›

Traditional face-to-face, individual psychotherapy sessions are usually billed only for 45 minutes (90834). It might be a good idea to get to know this code. You'll likely use this one often. Most mental health professionals use code 90791 for an intake interview and 90847 for family therapy.

What is the ICD 10 code for psychotherapy? ›

2023 ICD-10-PCS Codes GZ5*: Individual Psychotherapy.

How many minutes is a 90837? ›

90837 – Psychotherapy 60 minutes. Some health insurance companies may consider 90834 as the standard psychotherapy session.

What is a billable hour in therapy? ›

Billable hours is easily defined as the number of hours per day a therapist is expected to be delivering billable services.

Why is the therapeutic hour 50 minutes? ›

Instead you get 50 minutes — what therapists refer to as the “50 minute hour.” Why 50 minutes? Because, the party line goes, the extra 10 minutes gives the therapist time to write up a progress note, deal with any billing issues, take a short bathroom break, and get ready for their next client.

Can CPT code 90832 be billed as inpatient? ›

Clinical Social Workers may not render inpatient services (defined as inpatient hospital settings, partial hospitalization settings or skilled nursing homes for beneficiaries who are at that time receiving benefits under Medicare Part A payment for skilled services) represented by these CPT codes: 90832, 90833, 90834, ...

What is an interactive complexity add-on code? ›

The interactive complexity code is used when psychiatric services have been complicated by communication difficulties during the visit. This add-on code is meant to reflect increased intensity, not increased time, and must be used in conjunction with primary service codes.

What is the new CPT code for individual psychotherapy? ›

90837 — Psychotherapy, 60 minutes

Description: Individual psychotherapy, 60 minutes, with client and/or family member.

What is the CPT code for telehealth psychotherapy? ›

Telehealth codes for Medicare reimbursement for telebehavioral health
CategoryTeleheath CPT codes
Psychotherapy90832, 90833, 90834, 90836, 90837, 90838
Psychoanalysis90845
Group psychotherapy90853
Family psychotherapy90846, 90847
22 more rows
28 Sept 2022

How do I bill a 75 minute therapy session? ›

If the session lasts for 75 minutes or more, you would use both 90839 and the add-on code 90840 when billing patients and filing claims.

What is the CPT time rule for psychotherapy? ›

As per the CPT time rule, family psychotherapy codes require at least 26 minutes of service (i.e., greater than ½ of 50 minutes). One may NOT report interactive complexity (90785) with these codes.

How do you justify 90837? ›

How should I bill 90837?
  1. Psychotherapy times are for face-to-face services with the patient and/or family member.
  2. The patient must be present for all or some of the service.
  3. In reporting, choose the code closest to the actual time (i.e., 53 or more minutes for 90837).
  4. Document start and end times.

What qualifies as interactive complexity? ›

During a psychotherapy session, specific communication factors may arise that make it difficult to deliver a service or administer treatment to a patient. This type of scenario is known as interactive complexity, and there are specific CPT codes that psychologists should use when billing for these sessions.

Can 90791 and 90853 be billed together? ›

CPT code 90853 represents group therapy. When medically indicated, the interactive complexity add-on code (+90785) may be billed in conjunction with this code. is for each additional 30 minutes. These codes are reported by themselves and may not be reported with 90791, 90792, 90832-90838, 90785-90899.

What is maladaptive communication? ›

When delivery of care is complicated due managing maladaptive communication among involved parties. Examples of maladaptive communication include: high anxiety. high reactivity. repeated questioning or disagreement.

How do you bill a 2 hour therapy session? ›

You'll want to use your typical 90837 CPT code. Then you'll also want to use the Add On CPT code 99354 which declares an additional 30 to 74 minutes of therapy. So any time you do 90 to 2 hours and 14 minutes of therapy, make sure to use the combination of CPT Codes 90837 and +99354.

What is the reimbursement for 90834? ›

Medicare 2022 90834 Reimbursement Rate: $112.29

There has been a 9.2% increase in reimbursement from 2020 to 2021.

How often can you bill 90837? ›

CPT code 90837 is another one of the most common CPT codes used by mental health professionals along with 90834 and 90791. Its typical use is for a normal psychotherapy session with a client. Insurers will reimburse this code only once per day, and some only as frequently as twice per week.

Can therapists bill for phone calls? ›

Typically, therapists will charge for phone calls with the client if the conversation exceeds a certain amount of time. Calls to family members: Sometimes therapists need additional information from family members, especially if the client is a child.

What is the difference between 90837 and 90834? ›

Both 90834 and 90837 are designed to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes.

Can 90846 and 90837 be billed together? ›

Codes 90832, 90833, 90834, 90836, 90837, 90838 can be reported on the same-day as codes 90846 and 90847, provided that the services are separate and distinct. Be sure to include modifier 59 to emphasize that the services are separate and distinct. Do not report psychotherapy codes for sessions shorter than 16 minutes.

Videos

1. Reimbursement Changes 12 17 14
(MDeverywhere Inc.)
2. CPT Code 90834: Billing Guide by TheraThink
(TheraThink)
3. What Out of Network Providers Should Know About Insurance Billing - Ask a Biller, by SimplePractice
(SimplePractice)
4. What Out of Network Therapists Should Know About Billing - Ask A Biller, presented by SimplePractice
(SimplePractice)
5. Behavioral Health Billing & Coding 101: How to Get Paid
(American Medical Association (AMA))
6. What Goes in Your Notes? Interstate therapy practice and documentation for clients considering...
(Therapy Reimagined)
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