Author Topic: What health insurance companies pay the most for mental health CPT 90791 & 90837  (Read 247 times)

sgoforth0616

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Hi guys! I work for a Psychologist and we are trying to maximize our profits. Currently, we bill 90791 for the first appointment and then 90837 for every other appointment thereafter. If the patient stays an hour and a half, I will add 99354 to the 90837. We are taking BCBS, Aetna, and Cigna right now but the allowed amount that Cigna allows for 90837 is only $85, BCBS allows $110.81 and Aetna allows $97.34. Are there any other CPT codes that anyone would recommend for an hour of therapy that perhaps pays better than 90791 and 90837?

To the people that bill other insurance companies, besides BCBS of TX, Cigna, and Aetna, what insurance company do you send claims into and what is the allowed amount for 90837?

Michele

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Hi guys! I work for a Psychologist and we are trying to maximize our profits. Currently, we bill 90791 for the first appointment and then 90837 for every other appointment thereafter. If the patient stays an hour and a half, I will add 99354 to the 90837. We are taking BCBS, Aetna, and Cigna right now but the allowed amount that Cigna allows for 90837 is only $85, BCBS allows $110.81 and Aetna allows $97.34. Are there any other CPT codes that anyone would recommend for an hour of therapy that perhaps pays better than 90791 and 90837?

The coding needs to be done based on what services were provided, not what codes bring in the most so you have to be careful here.  We all want to make sure our providers are being reimbursed properly for all of their services.  It's important that we don't change codes or billing to increase receivables.  The services must be documented in the patient's chart and the codes must match those services.  With that being said, the codes for psychotherapy are pretty straight forward.  I am not aware of any different codes for the services you mentioned above.


To the people that bill other insurance companies, besides BCBS of TX, Cigna, and Aetna, what insurance company do you send claims into and what is the allowed amount for 90837?
 

Insurance carriers usually do not disclose their fee schedules since they are sometimes negotiated and can vary from provider to provider and area to area.  Even two providers in TX could receive completely different allowables.  Medicare does post fee schedules online but with MACRA/MIPS soon each provider will have their own allowable amounts with Medicare as well based on their composite score. 
« Last Edit: March 16, 2018, 09:25:52 AM by Michele »
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