Insurance Reimbursments for Psychotherapy

[HirsuteAnthony]

What can a psychiatrist expect when it comes to insurance reimbursments for a ~50 minute psychotherapy session? Thanks.

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[F0nzie]

It's the same CPT code psychologists use. 90806. Do the research and the math. Google is a good resource for reimbursement questions.

 

[IAmAUser]

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[snarfer]

What can a psychiatrist expect when it comes to insurance reimbursments for a ~50 minute psychotherapy session? Thanks.

I get something like an extra $20. Insurance where I practice typically pays $85-100 for each follow up vist regardless of time spent. This is why any patients interested in CBT or FT with me or any other docs I know accept cash only. But we have to produce results too. People usually get better after 6-7 sessions then I spaced them out with routine check up visits. You have to be flexible with your scheduling and have someone you trust and capable at the front desk as well.

 

[nitemagi]

https://ocm.ama-assn.org/OCM/CPTRelativeValueSearchResults.do?

 

[F0nzie]

I get something like an extra $20. Insurance where I practice typically pays $85-100 for each follow up vist regardless of time spent. This is why any patients interested in CBT or FT with me or any other docs I know accept cash only. But we have to produce results too. People usually get better after 6-7 sessions then I spaced them out with routine check up visits. You have to be flexible with your scheduling and have someone you trust and capable at the front desk as well.

90807: "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services"

90805: "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services"

90862: "Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy"

 

[snarfer]

90807: "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services"

90805: "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services"

90862: "Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy"

Correct. checkingbox 90862=$85. checking 90807 or 05= $85+20. If you take insurance only and see 3 pts per hour= $255/hr. If you choose to see 1 pt for both talk and med therapy (the ideal route)=$105. if one factors in all the time spent filling out prior authorizations, refills, filling out disability forms, SSI applications, lawyers request, checking messages, in home support services forms, checking labs/vs, collaterals and such, you can't maintain a practice with the latter option.
These are follow up appt codes.

 

[F0nzie]

Correct. checkingbox 90862=$85. checking 90807 or 05= $85+20. If you take insurance only and see 3 pts per hour= $255/hr. If you choose to see 1 pt for both talk and med therapy (the ideal route)=$105. if one factors in all the time spent filling out prior authorizations, refills, filling out disability forms, SSI applications, lawyers request, checking messages, in home support services forms, checking labs/vs, collaterals and such, you can't maintain a practice with the latter option.
These are follow up appt codes.

An unsettling aspect of private practice outpatient psychiatry, IMO, is the staff support one may need to sacrifice in order to run a practice efficiently with minimal overhead. By insurance standards, a psychiatric intake evaluation is valued at around $150, which IMO is insufficient compensation for the care and continued outpatient treatment of mentally ill patients. The follow up visit reimbursements are just as bad, however, I believe the core issues run deeper than the extra paperwork you mentioned. Here's why:

2 main concerns:

One concern regarding the absence of appropriate staff support, is inheriting a nightmare patient that essentially hires you full-time and a half for $40 in cold hard co-pay cash and feels entitled to call you 24/7 for every non-emergent "crisis". I had a patient that would call me almost everyday in "crisis", but really he just called me to start arguments with me over the phone.

My most serious concern regarding the absence of appropriate staff support is getting a DTS/DTO patient with frequent emergent crises. If I owned a busy practice aimed at treating all types of psychiatric conditions (ie. personality disorders, TBI, psychosis, mania), I would ideally have a secretary, security, a nurse, and a therapist to shield myself from having to address every single complaint on my own. In extreme minimalist setups we hear about psychiatrists getting brutally slain in their home offices. Not recognizing our own limitations, IMHO is the true definition of crazy.

On a separate but related note, I know of a psychiatrist in private practice that charges $500 per hour and sees only high functioning millionaires. He also fires difficult patients on a dime.

 

[snarfer]

One concern regarding the absence of appropriate staff support, is inheriting a nightmare patient that essentially hires you full-time and a half for $40 in cold hard co-pay cash and feels entitled to call you 24/7 for every non-emergent "crisis". I had a patient that would call me almost everyday in "crisis", but really he just called me to start arguments with me over the phone.

My most serious concern regarding the absence of appropriate staff support is getting a DTS/DTO patient with frequent emergent crises. If I owned a busy practice aimed at treating all types of psychiatric conditions (ie. personality disorders, TBI, psychosis, mania), I would ideally have a secretary, security, a nurse, and a therapist to shield myself from having to address every single complaint on my own. In extreme minimalist setups we hear about psychiatrists getting brutally slain in their home offices. Not recognizing our own limitations, IMHO is the true definition of crazy.

On a separate but related note, I know of a psychiatrist in private practice that charges $500 per hour and sees only high functioning millionaires. He also fires difficult patients on a dime.

1) Yes, everyone has this type of patients. Entitled and demanding yet cannot pay for the appointment or treatment. Some even ask if you can come to their home or pick them up! Somehow, they all have Iphones and are on SSI. These folks cancel appointments regularly and want refills. The solution here is to work in a county with a safety net hospital for patients without insurance. You can refer them there. These are often the Axis II with substance and legal problems. Throw in severe Axis III issues and you officially have nightmare on your hand. They talk bad about everyone and likely does the same to you with others. I often chuckle when i hear " I have no idea why that doctor (internist, neuro, GI, endo, psychiatry, etc) gave me that medication. He/she doesn't listen to me."

2) safety is also important. Having a home office, IMO, is not a good idea. It's always good to have an assistant sitting outside and have a security system installed. I think many of us can't afford to hire a LCSW or rehab counselor to deal with social stuff in private practice. If you want to eat and afford a decent school for your children, you do have to deal with social issues frequently. Again, if DMH or a safety net hospital are available, you can always refer these folks there if they continue to have financial, residential or substance issues.


3) Even the patients who can pay cash may become group 1 above. Many can only pay for a few appointments. You are also expected to be available 24/7 too. Calls/emails are expected to be returned quickly. Frequently, a 30 minute follow up can become a 50 family or individual therapy sessions. Quick results are expected as well. Having a good foundation of general medicine and how to manage the bread and butter physical issues are also essential with this group of individuals. They are aware that you are a physician and will 'test' you frequently. I'm really glad I had a good internship/residency and that I like internal medicine stuff.

It isn't easy. Numerous classmates(ob/gyn, neuro, internists, GI,gen surg.) have told me "I don't know how you deal with your patients." Our patients are often the most difficult patients for them.

 

[BobA]

1) Yes, everyone has this type of patients. Entitled and demanding yet cannot pay for the appointment or treatment. Some even ask if you can come to their home or pick them up! Somehow, they all have Iphones and are on SSI. These folks cancel appointments regularly and want refills. The solution here is to work in a county with a safety net hospital for patients without insurance. You can refer them there. These are often the Axis II with substance and legal problems. Throw in severe Axis III issues and you officially have nightmare on your hand. They talk bad about everyone and likely does the same to you with others. I often chuckle when i hear " I have no idea why that doctor (internist, neuro, GI, endo, psychiatry, etc) gave me that medication. He/she doesn't listen to me."

2) safety is also important. Having a home office, IMO, is not a good idea. It's always good to have an assistant sitting outside and have a security system installed. I think many of us can't afford to hire a LCSW or rehab counselor to deal with social stuff in private practice. If you want to eat and afford a decent school for your children, you do have to deal with social issues frequently. Again, if DMH or a safety net hospital are available, you can always refer these folks there if they continue to have financial, residential or substance issues.


3) Even the patients who can pay cash may become group 1 above. Many can only pay for a few appointments. You are also expected to be available 24/7 too. Calls/emails are expected to be returned quickly. Frequently, a 30 minute follow up can become a 50 family or individual therapy sessions. Quick results are expected as well. Having a good foundation of general medicine and how to manage the bread and butter physical issues are also essential with this group of individuals. They are aware that you are a physician and will 'test' you frequently. I'm really glad I had a good internship/residency and that I like internal medicine stuff.

It isn't easy. Numerous classmates(ob/gyn, neuro, internists, GI,gen surg.) have told me "I don't know how you deal with your patients." Our patients are often the most difficult patients for them.

I actually really like outpatient psychiatry, but for all the issues listed above, I don't think I could ever practice it.

Inpatient's the only way to go for me because there are in-house social workers who can work on that kind of thing.

 

[FLpk1girl86]

hmmmmmmm i think 'bout three fiddy