How often does insurance allow for a psychiatrist to bill for therapy? Like 90834?

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PistolPete

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I'm wondering if any of you actually out there practicing can help answer this: how often does private insurance allow for a psychiatrist to bill for straight up therapy, such as 90832 or 90834? If I wanted to see a patient for weekly psychodynamic therapy, lets say, for a year, would I actually get paid?

And how would I find out which private insurances pay the best for psychiatrists? Is there some database, or maybe common knowledge, if it's better to accept Aetna vs BCBS etc? Are any of you guys running into any problems coding and getting reimbursed for 99213+90833 visits on a regular basis? The bread and butter of psych is depression and anxiety, which I believe responds best to both meds and therapy so I'd plan on using both and coding for both med management and therapy for most of my visits (or at least that's the plan).

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You want Aetna/BCBS/Humana/Cigna to pay for weekly psychodynamic therapy for a year? 50 sessions, essentially?

I would expect utilization review out the wazoo for that request. Better write one hell of a medical necessity letter/justification.

PS: if you are talking depression or an anxiety dx (panic, PTSD, OCD) meds plus a 16 session CBT protocol is gonna be the standard retort of your friendly neighborhood peer reviewer.
 
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not all psychodynamic psychotherapy goes on forever, it is increasingly brief so he wasn't necessarily saying he would be seeing everyone for a year. Also some patients just refuse to engage in CBT or do not benefit from it. There is evidence supporting psychodynamic psychotherapy in patients with panic disorder, social anxiety disorder, and also depression in the context of borderline personality organization. Also if the patient is seeing a psychiatrist they are probably going to be a bit more complicated than a patient seeing a psychologist, more likely to have failed previous treatments etc.

In terms of insurance, this is going to vary slightly from state to state. Aetna seems to be a bit dodgy, I think APA was suing them because of poor coverage for mental health?

And erg, you may be surprised to hear many of these insurances will cover much more than weekly psychotherapy, some will even pay for more than that or ever full blown analysis!

Yes you can get reimbused for this with insurance, but you will have to decide how much you want to get paid, as it may not be worth your while.
 
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not all psychodynamic psychotherapy goes on forever, it is increasingly brief so he wasn't necessarily saying he would be seeing everyone for a year. Also some patients just refuse to engage in CBT or do not benefit from it. There is evidence supporting psychodynamic psychotherapy in patients with panic disorder, social anxiety disorder, and also depression in the context of borderline personality organization. Also if the patient is seeing a psychiatrist they are probably going to be a bit more complicated than a patient seeing a psychologist, more likely to have failed previous treatments etc.

In terms of insurance, this is going to vary slightly from state to state. Aetna seems to be a bit dodgy, I think APA was suing them because of poor coverage for mental health?

And erg, you may be surprised to hear many of these insurances will cover much more than weekly psychotherapy, some will even pay for more than that or ever full blown analysis!

Yes you can get reimbused for this with insurance, but you will have to decide how much you want to get paid, as it may not be worth your while.

Correct, but I have hard time seeing a request for 50 sessions being approved for a uncomplicated panic disorder or depressive disorder without it being sent to a peer reviewer. I am well aware that many roads lead to roam, but the vast majority of HMOs/HMO plans will want the quickest demostrated path.
 
I'm wondering if any of you actually out there practicing can help answer this: how often does private insurance allow for a psychiatrist to bill for straight up therapy, such as 90832 or 90834? If I wanted to see a patient for weekly psychodynamic therapy, lets say, for a year, would I actually get paid?

And how would I find out which private insurances pay the best for psychiatrists? Is there some database, or maybe common knowledge, if it's better to accept Aetna vs BCBS etc? Are any of you guys running into any problems coding and getting reimbursed for 99213+90833 visits on a regular basis? The bread and butter of psych is depression and anxiety, which I believe responds best to both meds and therapy so I'd plan on using both and coding for both med management and therapy for most of my visits (or at least that's the plan).
If you have a history of prior hospitalization, which is usually the case when I am seeing patients for that level of care, insurance companies are more willing to pay for increased outpatient services. Some of it is dependent on the diagnosis so that can be crucial. On one insurance I can see someone with PTSD for up to 20 sessions, but I can get that increased if they have a major mood disorder. Also, I am pretty sure that insurances companies don't care whether it is a a psychiatrist or psychologist providing 90834.
 
I'm wondering if any of you actually out there practicing can help answer this: how often does private insurance allow for a psychiatrist to bill for straight up therapy, such as 90832 or 90834? If I wanted to see a patient for weekly psychodynamic therapy, lets say, for a year, would I actually get paid?

And how would I find out which private insurances pay the best for psychiatrists? Is there some database, or maybe common knowledge, if it's better to accept Aetna vs BCBS etc? Are any of you guys running into any problems coding and getting reimbursed for 99213+90833 visits on a regular basis? The bread and butter of psych is depression and anxiety, which I believe responds best to both meds and therapy so I'd plan on using both and coding for both med management and therapy for most of my visits (or at least that's the plan).


This is unnecessary. If you see patients for med management AND psychotherapy, you should bill for the add-on code (i.e. 99213+90836). This also reimburses more.

With regard to session limits, this very much depends on the insurance. My own personal insurance, for instance, doesn't have session limits. However, if you start to do twice weekly therapy you might start to get utilization reviews, but so far this hasn't happened. Nevertheless, generally after a number of sessions you would need to file forms for explaining medical need. This should be filled any way in my opinion, because if you are providing ongoing psychotherapy there SHOULD be medical need. I personally do a lot of short course treatment. However, the private practice MDs I know who do a lot of therapy don't have generally issues getting weekly sessions reimbursed for years. So I think that's not as much of a concern. The issue comes up more frequently with bi-weekly or more frequent visits, especially analysts and with patients with severe personality disorder. One guy I know specializes in such treatment for BPD patients, but he usually is able to fight the insurance because of inpatient costs as the previous posters have noted.
 
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Thanks everybody. I'm well aware of the psychotherapy add-on codes for when you combine med management with therapy, but I wanted to see what was possible for therapy alone and if anyone had actual real-world experience with billing this. Looks like insurance might cause some problems for weekly therapy but may be doable with some paperwork.
 
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