Medical Billing Forum

Coding => Coding => Topic started by: MJ on April 03, 2009, 03:02:49 PM

Title: CPT coding for mental health
Post by: MJ on April 03, 2009, 03:02:49 PM
Can anyone please give me an idea of what you charge for CPT 90806 & 90808.  Thank you
Title: Re: CPT coding for mental health
Post by: lhough on April 03, 2009, 05:39:41 PM
It is up to each individual provider as to what their fee will be for each service code.  Most that I have worked for charged anywhere between $80 to $100 for 90806.  None of the providers I worked for used 90808, but I would imagaine that they could feasibly charge anywhere between $100 to $130 or so for that service since it is 75-80 minutes versus the 45-50 for 90806.
Title: Re: CPT coding for mental health
Post by: Michele on April 04, 2009, 07:30:02 AM
We bill for several mental health providers.  We too see most fees for 90806 from $80-$100, but it also depends on the provider type.  Our LCSW's charge lower than our PhD's and PsyD's.  It also depends on the area they are practicing in.  We actually have some that charge up to $150, but they are in NYC. 

We do bill for 90808 as well.  That averages from $120-$175, again depending on the provider type and the area.

Michele
Title: Re: CPT coding for mental health
Post by: Michele on April 04, 2009, 07:31:50 AM
I hit post too soon.  :(

Lesley is correct, it really should be up to the provider, but it is ok to suggest to them a range and advise them what the 'going rate' is.  Another resource would be to look it up on the Medicare fee schedule for their area and then up the Medicare allowed amount by 25-30%.

Michele
Title: Re: CPT coding for mental health
Post by: lhough on April 04, 2009, 12:19:35 PM
Michelle is right about the area and the credentials.  That popped into my mind last night that I should have mentioned that.  An LPC may charge a bit less than a LCSW and a PhD or PsyD will charge a higher fee.  And, yes the area in which the practice is will determine the fee as well.  Another thought for finding out what the "going rate" in your area is would be to call other offices.  You could say who you are and why you are calling, but some may not be too cooperative as they may feel you are the "competition".  If you want you could always call in as if you are "shopping around" for a therapist and trying to see how much it will cost you for therapy since you will be self-pay.  It is not uncommon to get calls like this on a given day, not everyone has insurance.
Title: Re: CPT coding for mental health
Post by: PMRNC on April 04, 2009, 12:23:53 PM
Just a little caution.. some PPO plans prohibit doctors from discussing fees so doctors are always advised NOT to discuss fees in general with other physicians.  For the most part if you choose a particular area of practice you will find the rates are pretty close, for example, where I am, the rate for a 90806 is $115-$120 which is pretty close (about 12 providers within 2 counties here)
The closer you are to the bigger cities like NYC, of course the rates are going to be substantially higher, however in the same geographical location they will be pretty close w/out room for price comparison.

Linda Walker
PMRNC
www.billerswebsite.com