Tips To Determine Your Coverage
Tips on how to determine your coverage for assessment services
Call your insurance carrier and check your coverage carefully to find the answers to the following questions:
- Do you have “out-of-network” benefits?
- Is there a deductible that must be met first and how much is the deductible?
- What is the coverage amount for the assessment, therapy, and interpretive sessions? Usually the insurance company reimburses a percentage of what it has deemed “usual and customary”. Typical CPT codes could include:
- 90791: Psychiatric diagnostic interview
- 90832: Psychotherapy, 30 minutes with patient and/or family member
- 90834: Psychotherapy, 45 minutes with patient and/or family member
- 90837: Psychotherapy, 60 minutes with patient and/or family member
- 90846: Family psychotherapy without the patient present
- 90647: Family psychotherapy with patient present.
- 90791: Initial Consultation
- 96101: Psychoeducational Testing
- 96118: Neuropsychological Testing
- 90887: Interpretive Conference
- How many therapy sessions and/or hours of testing does my plan cover?
- Is approval required from my primary care physician?
- What is the process for getting reimbursed for out of network services?
- For assessment related to medical concerns, ask whether the insurance company covers Health and Behavior Codes, which may be filed under the medical portion of your insurance.
For some individuals there may be a significant deductible on their mental health benefits for an in-network provider such that the cost to see an in-network provider is comparable to the cost for an out-of-network provider.
Things to note before you call your provider
- Most commonly, Dr. Gutow provides psychoeducational evaluation, which may also include neuropsychological tests and/or psychological tests
- Services are provided by a licensed psychologist
- Is there medical need for the testing (e.g. attention, language, etc.)?
