Reimbursement Rate Template – Reimbursement Rates for Mental Health

This article covers Week 6 Practicum Journal: Reimbursement Rates – Reimbursement Rate Template – Reimbursement Rates for Mental Health

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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…….

Reimbursement Rate Template

Type of Serviceeg. -New office visit-Established office visit-Inpatient hospital-individual psychotherapy-group psychotherapy (see examples below)CPT codePrivate insurer reimbursement rate for PMHNPPrivate insurer reimbursement rate for physiciansMedicarereimbursement rate for PMHNPMedicarereimbursement rate for physician
  
  
  
  
  

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Reimbursement Rate Template – Reimbursement Rates for Mental Health
Reimbursement Rate Template – Reimbursement Rates for Mental Health

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.)

CPT CodeFootnote(s)Description
907911Psychiatric diagnostic evaluation
907921,3Psychiatric diagnostic evaluation with medical services
908322Psychotherapy, 30 minutes with patient and/or family member
908332,3Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service
908344Psychotherapy, 45 minutes with patient and/or family member
908363,4Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service
908376Psychotherapy, 60 minutes with patient and/or family member
908383,6Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service
908396Psychotherapy for crisis; first 60 minutes
908402each additional 30 minutes
908464Family psychotherapy (without the patient present)
908474Family psychotherapy (conjoint psychotherapy) (with patient present)
908494Multiple-family group psychotherapy
908534Group psychotherapy (other than of a multiple-family group)
908701, 5Electroconvulsive therapy (includes necessary monitoring)
961011Psychological 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.
961181Neuropsychological 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.

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