Reimbursement Rate Template: Week 6 Practicum Journal: Reimbursement Rates
Week 6 Practicum Journal: Reimbursement Rates
Reimbursement Rate Template – Reimbursement Rates for Mental Health
Mental health treatment can follow varied modalities according to the diagnosing mental health nurse. Depending on the severity of a condition, a psychiatric mental health nurse practitioner may decide to give an individual psychotherapy, family psychotherapy, group psychotherapy, or in critical cases electroconvulsive therapy. The reimbursement for each type of therapy is different and each one of them has been assigned a unique CTP code. According to cms.gov, the non-facility payment for psychiatric diagnostic evaluation is $136 while the facility price for the same is $128.16. Moreover, if the diagnostic evaluation is combined with medical services, the non-facility price becomes $152.64 while the facility price is $144.36 (“Medicare Fee”, n.d). After the diagnosis, a psychiatrist may decide to recommend any of the available psychotherapy sessions. Importantly, these sessions are characterized by multifarious reimbursement rates. For instance, if a psychiatrist decides to administer 30 minute psychotherapy with family and/or patient, the rates will be $69.12 for non-facility setting and $66.60 for facility setting. In the same breath, if the nurse practitioner decides to use a conjoint psychotherapy, the rates will be reimbursed $111.24 for non-facility setting and $107.28 for facility price. Moreover, a group psychotherapy is $26.64 for non-facility price and $25.20 for facility price. Lastly, in extreme situations, a nurse practitioner may decide to utilize the electroconvulsive therapy. Consequently, the reimbursement prices will be $178.56 and $112.68 for non-setting and setting environments respectively. Fundamentally, all these rates are subject to a conversion factor of 35.9996…….
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Reimbursement Rate Template
Type of Service
eg. -New office visit
-Established office visit
-Inpatient hospital
-individual psychotherapy
-group psychotherapy (see examples below)
CPT code
Private insurer reimbursement rate for PMHNP
Private insurer reimbursement rate for physicians
Medicare
reimbursement rate for PMHNP
Medicare
reimbursement rate for physician
As the PMHNP becomes proficient in diagnosing and treating, it is also important to learn how to bill for your time. The CMS sets up codes to identify the type of service you are providing. You will generally complete this task at the end of the visit as you are documenting the visit with the client. Here are examples of the codes to know:
CPT Codes for Psychiatric and Psychological Procedures
HMSA recognizes the following service codes for the reporting of psychiatric and psychological services. (See Code Books for information on how to obtain the books.)
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CPT Code
Footnote(s)
Description
90791
1
Psychiatric diagnostic evaluation
90792
1,3
Psychiatric diagnostic evaluation with medical services
90832
2
Psychotherapy, 30 minutes with patient and/or family member
90833
2,3
Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service
90834
4
Psychotherapy, 45 minutes with patient and/or family member
90836
3,4
Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service
90837
6
Psychotherapy, 60 minutes with patient and/or family member
90838
3,6
Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service
90839
6
Psychotherapy for crisis; first 60 minutes
90840
2
each additional 30 minutes
90846
4
Family psychotherapy (without the patient present)
90847
4
Family psychotherapy (conjoint psychotherapy) (with patient present)
90849
4
Multiple-family group psychotherapy
90853
4
Group psychotherapy (other than of a multiple-family group)
90870
1, 5
Electroconvulsive therapy (includes necessary monitoring)
96101
1
Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour.
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis.
96118
1
Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis.
Links to websites that discuss this:
https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement
http://www.mb-guide.org/medical-coding-guidelines.html
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