Medicaid Mental Health Reimbursement Rates

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Medicaid Reimbursement Rates For Psychiatrists

Understanding Medicare & Medicaid – Provider Reimbursement | Honest Healthcare

Medicaid rates vary by state plan, carrier, and plan, so these rates below are a rough guide to compare against Medicare rates.

Psychiatry CPT Code Medicaid Reimbursement Rate for Psychiatrists
90791
Psychological Diagnostic Evaluation with Medication Management $85.86
Individual Psychotherapy with Evaluation and Management Services, 30 minutes N/a
Individual Psychotherapy with Evaluation and Management Services, 45 minutes N/a
Individual Psychotherapy with Evaluation and Management Services, 60 minutes N/a
Evaluation and Management Services, Outpatient, New Patient $36.82
Evaluation and Management Services, Outpatient, New Patient $57.82
Evaluation and Management Services, Outpatient, New Patient $81.37
Evaluation and Management Services, Outpatient, New Patient $117.82
Evaluation and Management Services, Outpatient, New Patient $146.89
Evaluation and Management Services, Outpatient, Established Patient $18.10
Evaluation and Management Services, Outpatient, Established Patient $31.36
Evaluation and Management Services, Outpatient, Established Patient $43.23
Evaluation and Management Services, Outpatient, Established Patient $66.80
Evaluation and Management Services, Outpatient, Established Patient $99.95
Prolong Services with E/M $94.89

Keep in mind that rates are negotiated down by state and depend on your geographical area.

You also need to be in-network with their version of Medicaid, be it Medi-Cal in California or a carve out policy through Wellcare.

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Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy.

We understand that it’s important to actually be able to speak to someone about your billing. Every provider we work with is assigned an admin as a point of contact. You’ll always be able to get in touch.

Provider Billing Guides And Fee Schedules

This page contains billing guides, fee schedules, and additional billing materials to help you submit:

  • Prior authorization for services
  • Claims

Coronavirus information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus webpage. For telehealth policies and FAQs, see Telehealth on this page.

Notice: Past billing guides may have broken links. If this occurs, please refer to the most recent guide.

Read Also: Does Medicaid Cover Cortisone Shots

Reimbursement Methods /fee Schedules

Outpatient Behavioral Health and Substance Abuse Services Payment rates are established using state developed relative value weights for outpatient mental health and substance abuse services and a monetary conversion factor , to determine the overall level of payment. Separate CFs are established for public and private programs. Childrens services are paid using the same CF regardless of whether the provider is public or private. Public providers may include governmental and non-governmental providers.

PACT Services A per diem fee has been established for PACT services that are all-inclusive of any and all treatment and rehabilitation intervention services provided in one day by the PACT team. The payment rate does not include room and board.

Indian Health Service Rate

Telemedicine Reimbursement: Medicaid and Private Payers

The Indian Health Service rate is an all-inclusive rate reimbursed to IHS and tribal facilities by CMS for Medicaid-covered services. Billing is per encounter, not per specific service.

  • The IHS rate is mandated by the Department of Health and Human Services and is published yearly in the Federal Register. See the 2021 rate information.
  • Allowable services vary by state

Recommended Reading: How To Check If My Medicaid Was Approved

Get Your Billing Handled

It’s our goal to ensure you simply don’t have to spend unncessary time on your billing.

You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar.

You want to know you can call your billing admin, a real person you’ve already spoken with, and get immediate answers about your claims.

You want to not have to deal with it!

Learn how to offload your mental health insurance billing to professionals, so you can do what you do best.

As private practitioners, our clinical work alone is full-time. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. TheraThink provides an affordable and incredibly easy solution. My daily insurance billing time now is less than five minutes for a full day of appointments. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! Denny and his team are responsive, incredibly easy to work with, and know their stuff. I cannot capture in words the value to me of TheraThink. Thank you. You free me to focus on the work I love!

Medicaid Mental Health Reimbursement Rates Report

The bill requires the department of health care policy and financing to prepare a behavioral health rates report of medicaid reimbursement rates for community mental health providers and independent mental health and substance use treatment providers. The department must hire an independent auditor to prepare the behavioral health rates report. and provide recommendations on the report to be presented to the house of representatives public and behavioral health and human services committee. The department is required , in coordination with the behavioral health rates report, to prepare recommendations based on the audit findings and recommendations to create equitable payment models between providers of community mental health centers and independent mental health and substance use treatment providers providing comparable behavioral health services. The department is required to present the behavioral health rates report and recommendations to the house of representatives public and behavioral health and human services committee.

Read Also: How Can You Qualify For Medicaid

Insurance Reimbursement Rates For Psychiatrists

Our guide on insurance reimbursement rates for psychiatrists will teach you what are the most common psychiatry CPT codes, what are the medicare reimbursement rates for psychiatrists, as well as medicaid reimbursement rates for psychiatric services.  If you're in private practice and hate all of this, reach out about our mental health insurance billing service.

Reimbursement rates for psychiatrists vary by insurance type , psychiatric CPT code rendered, and by each insurance companys rate.

Psychiatrists have a physicians license and cohere at the highest level of reimbursement for Medicaid programs. If your license is lower than a PhD, note that you may not be allowed to render these services, or if you are, your reimbursement rates will be reduced.

If you unsure about your billing, license, CPT codes, rates, or how to get paid but you still want to work with insurance companies in your private practice, consider hiring our mental health billing service to handle all of this for you.

How Your Location Impacts Your Mental Health Reimbursement Rate

Medicaid, MSDH collaborate to increase reimbursement rate for ambulance transportation

Your location has an enormous impact on your contracted rate.

If you live in San Francisco, Los Angeles, Seattle, or many cities with high levels of education, there tend to be an abundance of mental health providers serving those locales.

On the other hand, if you are only one of a small handful of providers in a town, city, or state, you may see a significantly higher insurance reimbursement rate for psychotherapy.

Want to make the most money per session? You could move to Alaska.

Your location is one of the least flexible aspects that decides your contracted rate with insurance companies but it has a serious impact on your reimbursement rates for psychotherapy.

Consider this a business strategy question youll need to answer before settling on an office location.

The closer you are in proximity to under-served locales, the higher you can expect your rates to be priced.

If you are struggling to pick the right companies to increase your caseload, consider working with our mental health billing service to get these sorts of questions answered, along with all your billing, with way less headache along the way.

Recommended Reading: Michigan Medicaid Eligibility For Seniors

More Difficult To Bill Insurance Companies For Mental Health Providers:

The following links go to each companys credentialing website:

Many Medicaid polices are subcontracted out to lower paying organizations. This can skew data downward in comparison to brands that to not facilitate a Medicaid plan in that State.

Likewise, EAP sessions have far more hoops, billing nuance, and prior-to-session manual labor involved in billing. Other EAP plans require their own unique form.

Simplify Your Practice Tip: If you are busy enough, consider dropping new EAPs.

Its worth noting that none of these are impossible to bill but each company has particularities about their claims filing process, operational speed, and subcontracting policy, which can lead to a higher likelihood of problems and a longer claims and revenue cycle.

Summary Of Insurance Reimbursement Rates For Psychotherapy

Mental health reimbursement rates vary dramatically. They depend on your:

  • license,
  • your location,
  • and the service map for each insurance company youre applying to.

Your reimbursement rates are most dramatically influenced by your education and license, baring living in a few locations that are dying for more mental health providers .

Strategically speaking, your first big decision is your level of licensing and continued education you have sought or will seek. Next will be picking an area that is undeserved to the best of your estimation. Finally, consider choosing a specialization that fills in a service gap that is regularly sought after.

From there, pick which insurance companies youre most interested in working with depending on the demographic you aim to serve. Some companies may pay less but provide you a higher inbound flow of clients , whereas others might be very challenging to get in-network with but pay much higher .

For specific recommendations for credentialing in your state, feel free to reach out to us at TheraThink for help.

Also Check: Can Medicaid Take My Settlement Money

Insurance Contracts For Your New Private Practice

There are many state-specific insurance companies that might be a great fit for your transition to a new practice but of these four, you should be able to work with two and get started asap!

  • Aetna
  • Medicaid
  • Optum / UHC

If youre an LPC, LMFT, or newly licensed provider, you might find these companies are a good fit.

Mental Health Provider Demand Effecting Reimbursement Rates For Therapy

Telemedicine Reimbursement: Medicaid and Private Payers

The sad truth is some of the best panels are totally full and their network map of mental health providers is saturated. Theres nothing you can do when a company like Florida Blue hasnt accepted mental health providers in years.

The amount of contracted providers per insurance company will have a larger influence on your ability to get in that network or not than it will on what youll be paid.

But on the other hand, if a company is easy to get accepted into their network, odds are higher they do not reimburse as much. Again, this is a case by case situation youll need to research and address.

Also Check: Compare And Contrast Medicare Advantage Plans And Medicaid Plans

Our Mental Health Insurance Billing Services

  • Daily Claims Filing & Submission
  • Eligibility & Benefits Verification
  • EOB & Payment Accounting
  • Appointment Reminders
  • Appointments Calendar
  • EAP / Medicare / Medicaid / TriCare Billing
  • Credentialing Services
  • Month-by-Month Contract: No risk trial period
  • Free Account Setup – we input your data at signup.
  • Claim Tracking & Updates
  • You can call, text, or email us about any claim, anytime, and hear back that day. We are your billing staff here to help.

Top 4 Insurance Companies For Established & High License Level Providers

Best suited for LCSWs, PsyD, PhD, and MDs:

  • Blue Cross Blue Shield
  • Optum / UHC
  • Investigate which companies are paying the most in your State by asking your colleagues.

    Tip: You will probably need to establish a separate legal business to work with these companies so expect to create an E-IN for your new practice to get paid the best rates.

    Read Also: Free Breast Pump Through Medicaid Texas

    Mental Health Credentialing Recommendations

    In our experience, the higher the reimbursement rate, the higher your license level need be to become in-network with that company.

    If you want to become in-network with higher paying, lower fuss plans, it is likely youll need a longer amount of experience and possibly a track record of working with that plan as a provider in a previous group or agency.

    Some companies, such as many of the BCBS plans, require you to establish a business, E-IN, and group NPI.

    For mental health credentialing, we are quick to recommend Aetna, Cigna, and if your license allows it, Medicare .

    Commercial Insurance Reimbursement Rates For Psychiatrists

    Deep cuts to Medicaid could cause mental health care providers to reduce services

    Commercial insurance rates vary dramatically across companies. Some rates are actually lower by 5% than Medicaid rates.

    While we wish we could give you exact rates for major brands like Aetna, Cigna, United Health Care, or the Blue Cross Blue Shield Network, it is simply impossible to have any estimation of the rates for those companies without knowing the following information:

    • Years Practicing
    • Existing Relationship with Insurance Brand
    • License
    • Specializations in Modalities of Treatment
    • Demographic Expertise

    As such, we simply cannot give you a general sense of what youll be paid because the factors going into your contracted rate vary. For more help with all things insurance billing related, consider handing off your billing to a team of experts who can help.

    If youd rather go alone, get a general sense of which insurance companies pay more less very quickly with this one simple tip:

    Pro Tip: Ask your colleagues which ones pay the most, and which pay the least, in your area.

    In our general experience, here is a modest list of high paying, moderate paying, and low paying companies:

    Read Also: Medicaid Nursing Home Income Limits

    Medicare Reimbursement Rates For Psychotherapy

    Please see our updated Medicare Rates:

    CPT Code
    $42.17 $25.30

    The reduced rate here isnt the exact amount Medicare pays out but represents a rough estimate of the suggested reduction to expect from Medicare. In our experience, Medicare over-estimates the contracted rate for most private insurance companies so their total reduction, while large, still leaves providers with a modest but much higher earning than Medicaid.

    Part of the reason why is Medicare is more selective with their network.

    Why Is Medicaid Hard To Bill For Mental Health Providers

    For the same reason that Medicare is hard to bill, except that each state has their own contract instead of each region . As such, your states Medicaid policy is up to them.

    Each state may have their own system that they have built that might be slow and require many enrollments as well, or they might contract out the insurance coverage to existing commercial insurance companies.

    Example: What you think is UHC is actually Medicaid via UHC and while youre in-network with UHC, youre out of network with their Medicaid network your claims get denied.

    Make sure you understand exactly which Medicaid panels you are enrolling with, including if youre in-network with their commercial or Medicaid or HMO or PPO or EPO plans.

    Don’t Miss: Is Mental Health Covered By Medicaid

    Durable Medical Equipment Prostheses Orthoses And Supplies

    The main DMEPOS payment schedule lists the current maximum payment amounts for many durable medical equipment items, prostheses, orthoses, and medical supplies. It reflects the policy set forth in Ohio Administrative Code Chapter 5160-10.

    The Oxygen payment schedule lists the current maximum payment amounts for oxygen. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-13.

    The Wheelchair payment schedule lists the current maximum payment amounts for wheelchairs, parts, accessories, and related services. It reflects the policy set forth in Ohio Administrative Code rule 5160-10-16.

    Psychotherapy Reimbursement Rates For Private Insurance

    NC Medicaid: CPT Transition Code Information

    It cannot be stated enough: the following information is not direct information from each of these insurance companies but rather is an average of fee schedules based exclusively on contracts with these companies. These insurance reimbursement rates for psychotherapy vary by state, by license, taxonomy, and other factors.

    No one ever has access to contracted rate information until an EOB is issued for out of network providers OR youve been accepted as in-network and theyve given you your fee schedule.

    Here is a sample of psychotherapy reimbursement rates for private insurance by major mental health insurance brand:

    Low
    86%

    Heres an image version that might be easier to read!

    In summary, some private insurance companies reimburse mental health therapists for far more than others. A great way to quickly learn which companies pay the most is to simply ask your colleagues about their experiences with different reimbursement rates for private insurance companies.

    If youre wondering about which private insurance companies are reimbursing the most in your state with your license, were happy to help you fill in the gaps.

    Also Check: Missouri Medicaid Income Limits 2020

    Legislation May Dramatically Increase Access To Mental Health Services For Medicare Patients

    Pending legislation could usher in the ability for older and disabled Americans to access hundreds of thousands more behavioral health care providers.

    Experts say outdated policies currently limit many Medicare policyholders behavioral health care options because swaths of clinicians have remained ineligible for reimbursement for decades. But that could all change thanks to a bill introduced this year.

    The Improving Access to Mental Health Act of 2021 proposes amending the current law that prevents these clinicians from billing Medicare for behavioral healthcare. If passed, the bill would allow clinicians to bill for 75% of a psychologists rate. The bill would also increase the reimbursement rate for clinical social workers from 75% to 85% of this physician fee schedule and allow them to bill Medicare for mental health care they provide to skilled nursing facility patients.

    A lot of Medicare beneficiaries would be unhappy to know that their choices are limited, explained Dr. Heather Jelonek, a Dr. of Behavioral Health and former insurance company network developer.

    The Improving Access to Mental Health Act was introduced to the House of Representatives in March. Since then, a steady stream of cosponsors has cosponsored the bill, mostly recently Democratic Representatives Tom Malinowski , Jamie Raskin , and Ann Kuster on Sept. 3rd.

    the largest mental health crisis of our lifetime

    Id be paying more out of pocket for similar services, explained Jelonek.

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