Billing

Client Billing & Insurance

• All clients need to have a credit/debit card on file

• All clients need to have insurance up to date if they want us to bill insurance

• Billing and insurance claims are not the responsibility of the contractor clinicians but training is available if wanting or are willing to learn

• Claims for a week's worth of clients are typically submitted at the end of the day on Fridays

  • A blank claim form can be found here (for your reference)

• Clients who are enrolled in autopay will have their card on file run for payment overnight

• Clients who are not enrolled in autopay will have their card on file run manually

• Initial evaluation claims are submitted to insurance and the client will not have a payment run until the remittance paperwork is received to ensure the correct amount is going to be billed to their card

• Clients with a co-insurance or deductible that needs to be met are not on autopay and are not charged until insurance remittance paperwork comes back 

  • Co-insurance can be processed in advance if the co-insurance % is noted, based on the contracted reimbursement rate

• If a client's card comes up as insufficient funds, expired card, or there's an error message, autopay tries again for a few days and then removes the client from autopay

  • In this event, the client will be asked to update their card on file

  • if the card is not updated and they have a balance, they risk the chance of having sessions suspended until the balance is paid off

• Insurance reimbursement varies depending on the insurance company, some are quick to approve and reimburse, while others take 2-3 weeks, there is no way of controlling how long it will take

Billing Codes for Commercial Insurance

Initial Eval for Psychotherapy: 90791

• • minimum 15 minutes

  • out-of-pocket rate: $175

Psychotherapy, 60min: 90837

• • sessions lasting 53-60+ minutes

  • out-of-pocket rate: $140

Psychotherapy, 45min: 90834

• • sessions lasting 37-52 minutes

  • out-of-pocket rate: $115

Psychotherapy, 30min: 90832

• • sessions lasting 23-36 minutes

  • out-of-pocket rate: $85

Conjoint Psychotherapy w/ Client Present: 90847

• • couples/family sessions are usually listed as 45-50 minutes with most insurance companies, there is no option for a longer conjoint session to have a different reimbursement rate

  • out-of-pocket rate: $140

Conjoint Psychotherapy w/o Client Present: 90846

• out-of-pocket rate: $140

Psychotherapy for Crisis, 60min: 90839

• not offered for out-of-pocket - this is an insurance only billing code

Free Phone Consultation: CONSULT

NO SHOW: 0000

• • change the session code to a NO SHOW so it charges the proper fee

    • If you choose to waive the fee, change the amount in the session box to $0 so the card doesn't get charged

  • Do not charge a no-show fee for Medicaid/CCBH clients - it is not allowed and goes against their contract

LATE CANCELLATIONS: 000

• • change the session code to a LATE CANCELLATION so it charges the proper fee

    • If you choose to waive the fee, change the amount in the session box to $0 so the card doesn't get charged

  • Do not charge a late cancellation fee for Medicaid/CCBH clients - it is not allowed and goes against their contract

60-Minute Psychotherapy (Give an Hour®): Pro-Bono_60

Initial Evaluation for Psychotherapy (Give an Hour®): Pro-Bono_Intake

Late Cancellation (Give an Hour®): Pro-Bono_LC

No Show (Give an Hour®): Pro-Bono_NS

Billing Codes for Medicaid/CCBH

All services are billed in units:

• • 1 unit = 15 minutes

  • 2 units = 30 minutes

  • 3 units = 45 minutes

  • 4 units = 60 minutes, and so on...

• Pay attention to how many units are listed within the appointment, default is 1 unit (15 minutes)

Individual Psychotherapy: H0004 (HB)

• Listed in SP as "H0004 Individual Psychotherapy"

Family/Conjoint Therapy: H0004 (HR)

• Listed in SP as "H0004 . Family/Conjoint Therapy"

Initial Evaluation (initial eval): H0004 (HN)

• Listed in SP as "H0004. Clinical Evaluation - non MD"