Reimbursement Rates

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Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

Learning Objectives

Students will:
  • Analyze reimbursement rates for mental health treatments

To prepare for this Practicum Journal:

  • Research reimbursement rates for various treatment modalities.
  • Compare NP rates to other provider rates.

For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

NURS 6670

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

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.

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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