Reimbursement Rates in Indiana.

Posted: December 18th, 2022

Reimbursement Rates in Indiana.

Research reimbursement rates for various treatment modalities.
Compare NP rates to other provider rates In Indiana
Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

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Reimbursement Rates in Indiana
90791(Psychiatric diagnostic evaluation): This code is used in billing diagnostic evaluations performed on clients but does not include the provided medical services. The diagnostic evaluation includesan assessment of the mental status, medical history, family history, etc. (American Medical Association, 2017).Reimbursement Rates in Indiana.
90837 (Psychotherapy to the patient for 60 minutes): The code bill for the psychotherapy services given to the patient for the time range 53 minutes and above. The client undergoes psychotherapy but this can be done in the presence of a family member (American Medical Association, 2017).Reimbursement Rates in Indiana.
90834 (Psychotherapy for 45 minutes): Mental health practitioners use this code to bill for the individual psychotherapy given to the client, and this can be in the presence of a member of the family(Puente, 2018). The time range that should be billed for the psychotherapy provided to the client is between 38-52 minutes.
90853 (Group Psychotherapy): Mental health practitioners utilize this code to bill for billing the psychotherapy services provided to a group of clients and as well as the assessment of each individual’s mental problem. The mental health practitioner identifies group dynamics to modify the behavior and attitude of the group members. Each group member is billed separately for the group psychotherapy session (O’Donnell et al, 2014).
90847 (Family Psychotherapy with the client): The code is utilized in billing for the psychotherapy services provided for the client’s family members and the client as well. in addition, mental health practitioners also used this code to bill for psychotherapy provided to couples(American Medical Association, 2017).Reimbursement Rates in Indiana.

Reimbursement Rates for PMHNP in Indiana
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
Psychiatric diagnostic evaluation 90791 $101.51 $125.56 $ 96.77 $129.03
Psychotherapy, 45 minutes with patient 90834 $85.63 $87.34 $47.17 $62.89
Psychotherapy, 60 minutes with patient 90837 $152 $190 $93.94 $125.25
Family psychotherapy (with patient present) 90847 $132.99 $132.99 $78.69 $104.92
Group psychotherapy 90853 $25.76 $26.28 $22.74 $27.92

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:Reimbursement Rates in Indiana.

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 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.Reimbursement Rates in Indiana.

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

NURS 6670
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

Reimbursement Rates in Indiana.

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 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)Reimbursement Rates in Indiana.
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.Reimbursement Rates in Indiana.

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

Reimbursement Rates in Indiana.