Blue cross blue shield psychotherapy reimbursement

It is incredibly important to note that none of this information has been generated from, though, because of, or in any way a part of any clinical data, claims data, or insurance processing that we have done within our mental health billing service at TheraThink. All information enclosed is based purely on contracted rates for in-network providers that have been shared with us. Again, no clinical, claims, or private information was used during the creation of this article. We take HIPAA extremely seriously.

Skip ahead to see mental health reimbursement rates by CPT code!

So you want to figure out what are insurance reimbursement rates for psychotherapy and mental health services.  We can’t blame you.

Insurance companies are completely unwilling to release their contracted rate information for reason we’ll discuss shortly and as a result, you don’t know how much you’ll be reimbursed for providing psychotherapy and other mental health services.

The truth is there are no guarantees about your contracted rates and this article certainly is not one.  Instead, we hope to help illustrate, on a relative basis, the differences between payments based on license, CPT code, insurance company, and location, so you can make the best decision about which insurance companies to work with.

Want to skip all this wall of text nonsense about the intricacies of mental health reimbursement rates and just focus on doing therapy?  We offer an mental health billing service to end all your insurance and claims nightmares!

Article Index

Why Mental Health Insurance Companies Don’t Release Reimbursement Rate Information

There are a few reasons that insurance companies won’t let you know what you’ll be paid until you are accepted in their network.

The biggest reason they don’t release contracted rate information is they change their rates daily, depending on a few factors and mechanisms.  This is the primary reason you cannot find insurance reimbursement rates for psychotherapy online — they are not “set”.

Your contracted rate will vary compared to colleagues in many cases because it is specific to you.

Factors that effect your insurance reimbursement rate for psychotherapy:

1. Location, paying more for under-served locales and less for over-served locations.
2. License, education, and specialization.
3. Specialization.
4. Consumer demand at the time of signing your contract.

(Tip: Renegotiate Your Contracted Rate Annually)

Your contracted rate for a specific insurance plan or network is set when you sign your initial contract.

Insurance companies tend not to change, nor adjust, your rates for inflation if you do not personally request a raise or update of your fee schedule.

As a result, many providers get stuck with lower insurance reimbursement rates for psychotherapy without realizing they are being underpaid.

We strongly encourage all our providers we work with to request an annual fee schedule adjustment to match inflation.  If you haven’t received a raise in pay in the last two years, we suggest you reach out to request a 5%-15% raise in pay.

How Your Location Impacts Your Mental Health Reimbursement Rate

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 you’ll 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.

Insurance Reimbursement Rates for Psychotherapy Compared by State

Below is an sample list of insurance reimbursement rates for one national insurance company, with roughly the same license, LICSW / Level 3 License, across multiple states, for a 60 minute individual therapy session:

Alaska – AK$100-$110Maine – ME$60-$85Ohio – OH$75-$90Rhode Island – RI$75-$90Oregon – OR$80-$105California – CA$80-$85Georgia – GA$80-$90Maryland – MD$80-$90New York – NY$80-$95Colorado – CO$85-$95Washington – WA$90-$100Virginia – VA$90-$105Pennsylvania – PA$90-$110Texas – TX$90-$110

Again, these are estimated rates for a typical 60 minute session for an entry-level mental health license.  The city you practice in will have a larger impact on your insurance reimbursement rates for psychotherapy than the state you pick.

This is not a representation of what rates will be today or in the future but a general range to expect, rather we are illustrating that each state varies.

Medicare Insurance Reimbursement Rates by State [2022 Rates]

StateFee Schedule AreaCPT Code 90791 Reimbursement Rate 2022Reimbursement Compared to National RateNATIONALNATIONAL$195.46100.00%CA – CaliforniaSANTA CLARA (SANTA CLARA COUNTY)$224.26114.73%CA – CaliforniaSAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO COUNTY)$225.09115.16%CA – CaliforniaSAN FRANCISCO (SAN FRANCISCO COUNTY)$219.23112.16%CA – CaliforniaSAN MATEO (SAN MATEO COUNTY)$219.23112.16%CA – CaliforniaOAKLAND-BERKLEY (ALAMEDA AND CONTRA COSTA)$219.23112.16%CA – CaliforniaSAN FRANCISCO-OAKLAND-HAYWARD (MARIN COUNTY)$219.44112.27%CA – CaliforniaSALINAS (MONTEREY COUNTY)$209.01106.93%CA – CaliforniaNAPA$209.67107.27%CA – CaliforniaVALLEJO-FAIRFIELD (SOLANO COUNTY)$209.67107.27%CA – CaliforniaSANTA CRUZ-WATSONVILLE$209.55107.21%CA – CaliforniaSANTA ROSA (SONOMA COUNTY)$208.27106.55%CA – CaliforniaRIVERSIDE-SAN BERNARDINO-ONTARIO (SAN BERNARDINO AND RIVERSIDE COUNTY)$202.15103.42%CA – CaliforniaBAKERSFIELD (KERN COUNTY)$202.42103.56%CA – CaliforniaSACRAMENTO-ROSEVILLE-ARDEN-ARCADE (SACRAMENTO, PLACER, YOLO, EL DORADO)$202.86103.79%CA – CaliforniaCHICO (BUTTE COUNTY)$200.53102.59%CA – CaliforniaFRESNO$200.53102.59%CA – CaliforniaHANFORD-CORCORAN (KINGS COUNTY)$200.53102.59%CA – CaliforniaMADERA$200.53102.59%CA – CaliforniaMERCED$200.53102.59%CA – CaliforniaMODESTO (STANISLAUS COUNTY)$200.53102.59%CA – CaliforniaREDDING (SHASTA COUNTY)$200.53102.59%CA – CaliforniaSTOCKTON-LODI (SAN JOAQUIN COUNTY)$200.53102.59%CA – CaliforniaVISALIA-PORTERVILLE (TULARE COUNTY)$200.53102.59%CA – CaliforniaYUBA CITY (SUTTER, YUBA)$200.53102.59%CA – CaliforniaCALIFORNIA (ALL OTHER COUNTIES)$200.53102.59%CA – CaliforniaLOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES COUNTY)$209.34107.10%CA – CaliforniaLONG BEACH-ANAHEIM (ORANGE COUNTY)$209.34107.10%CA – CaliforniaOXNARD-THOUSAND OAKS-VENTURA$206.33105.56%CA – CaliforniaSANTA MARIA-SANTA BARBARA$207.59106.21%CA – CaliforniaSAN DIEGO-CARLSBAD$206.43105.61%CA – CaliforniaSAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE$201.63103.16%CA – CaliforniaEL CENTRO (IMPERIAL COUNTY)$200.63102.65%HI – HawaiiHAWAII, GUAM, AMERICAN SAMOA, MARSHALL ISLANDS, PALAU, NORTHERN MARIANA ISLANDS, FEDERATED STATES OF MICRONESIA$201.98103.34%NV – NevadaSTATEWIDE$197.78101.19%AK – AlaskaSTATEWIDE$271.70139.01%ID – IdahoSTATEWIDE$187.1995.77%OR – OregonPORTLAND (CLACKAMAS, MULTNOMAH AND WASHINGTON)$199.43102.03%OR – OregonREST OF STATE$190.9397.68%WA – WashingtonWASHINGTON SEATTLE (KING COUNTY)$208.55106.70%WA – WashingtonREST OF STATE$194.9499.73%AZ – ArizonaSTATEWIDE$192.5798.52%MT – MontanaSTATEWIDE$195.3699.95%ND – North DakotaSTATEWIDE$192.8898.68%SD – South DakotaSTATEWIDE$192.5098.49%UT – UtahSTATEWIDE$190.8597.64%WY – WyomingSTATEWIDE$194.7499.63%CO – ColoradoSTATEWIDE$196.70100.63%NM – New MexicoSTATEWIDE$191.4697.95%OK – OklahomaSTATEWIDE$189.0396.71%TX – TexasHOUSTON$200.98102.82%TX – TexasGALVESTON (TARRANT COUNTY)$199.26101.94%TX – TexasBRAZORIA$199.12101.87%TX – TexasDALLAS$197.93101.26%TX – TexasFORT WORTH (TARRANT COUNTY)$195.47100.01%TX – TexasAUSTIN (TRAVIS COUNTY)$196.07100.31%TX – TexasREST OF STATE$191.5297.98%TX – TexasBEAUMONT (JEFFERSON COUNTY)$190.8697.65%IA – IowaSTATEWIDE$188.6096.49%KS – KansasSTATEWIDE$188.8096.59%MO – MissouriMETROPOLITAN ST. LOUIS (JEFFERSON, ST. CHARLES, ST. LOUIS AND ST. LOUIS CITY)$193.8699.18%MO – MissouriMETROPOLITAN KANSAS CITY (CLAY, JACKSON AND PLATTE)$192.9198.70%MO – MissouriREST OF STATE$187.9196.14%NE – NebraskaSTATEWIDE$187.7896.07%IL – IllinoisCHICAGO (COOK COUNTY)$203.03103.87%IL – IllinoisSUBURBAN CHICAGO (DUPAGE, KANE, LAKE AND WILL)$201.46103.07%IL – IllinoisEAST ST. LOUIS (BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN, MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON)$195.81100.18%IL – IllinoisREST OF STATE$192.2698.36%MN – MinnesotaSTATEWIDE$193.1298.80%WI – WisconsinSTATEWIDE$189.6297.01%AR – ArkansasSTATEWIDE$186.0495.18%LA – LouisianaNEW ORLEANS (JEFFERSON, ORLEANS, PLAQUEMINES AND ST. BERNARD)$194.5299.52%LA – LouisianaREST OF STATE$191.0097.72%MS – MississippiSTATEWIDE$186.7495.54%IN – IndianaSTATEWIDE$188.4696.42%MI – MichiganDETROIT (MACOMB, OAKLAND, WASHTENAW AND WAYNE)$198.15101.38%MI – MichiganREST OF STATE$191.3097.87%FL – FloridaMIAMI (DADE AND MONROE COUNTY)$203.91104.32%FL – FloridaFORT LAUDERDALE (BROWARD, COLLIER, INDIAN RIVER, LEE, MARTIN, PALM BEACH, AND ST. LUCIE)$199.41102.02%FL – FloridaREST OF STATE$194.6599.59%PR – Puerto RicoPUERTO RICO$195.77100.16%VI – Virgin IslandsVIRGIN ISLANDS$195.77100.16%AL – AlabamaSTATEWIDE$189.9897.20%GA – GeorgiaATLANTA (BUTTS, CHEROKEE, CLAYTON, COBB, DEKALB, DOUGLAS, FAYETTE, FORSYTH, FULTON, GWINNETT, NEWTON, ROCKDALE AND WALTON)$194.9499.73%GA – GeorgiaREST OF STATE$189.4596.93%TN – TennesseeSTATEWIDE$188.2296.30%SC – South CarolinaSTATEWIDE$189.6497.02%VA – VirginiaSTATEWIDE$194.7799.65%WV – West VirginiaSTATEWIDE$189.8797.14%NC – North CarolinaSTATEWIDE$191.3597.90%DE – DelawareSTATEWIDE$196.87100.72%DC – Washington, DCDC + MD/VA SUBURBS (DISTRICT OF COLUMBIA; ALEXANDRIA CITY, ARLINGTON, FAIRFAX, FAIRFAX CITY, FALLS CHURCH CITY IN VIRGINIA; MONTGOMERY AND PRINCE GEORGE’S IN MARYLAND)$215.43110.22%MD – MarylandBALTIMORE/SURROUNDING COUNTIES$205.34105.05%MD – MarylandREST OF STATE$199.07101.85%NJ – New JerseyNORTHERN NEW JERSEY (BERGEN, ESSEX, HUDSON, HUNTERDON, MIDDLESEX, MORRIS, PASSAIC, SOMERSET, SUSSEX, UNION AND WARREN)$211.50108.21%NJ – New JerseyREST OF STATE$207.10105.96%PA – PennsylvaniaMETROPOLITAN PHILADELPHIA (BUCKS, CHESTER, DELAWARE, MONTGOMERY AND PHILADELPHIA)$203.36104.04%PA – PennsylvaniaREST OF STATE$192.1798.32%CT – ConnecticutSTATEWIDE$205.75105.26%NY – New YorkNYC SUBURBS/LONG ISLAND (BRONX, KINGS, NASSAU, RICHMOND, ROCKLAND, SUFFOLK AND WESTCHESTER)$220.07112.59%NY – New YorkMANHATTAN$217.56111.31%NY – New YorkPOUGHKPSIE/N NYC SUBURBS (COLUMBIA, DELAWARE, DUTCHESS, GREENE, ORANGE, PUTNAM, SULLIVAN AND ULSTER)$207.12105.97%NY – New YorkREST OF STATE$192.2898.37%NY – New YorkQUEENS$221.56113.35%ME – MaineSOUTHERN MAINE (CUMBERLAND AND YORK COUNTY)$193.7599.13%ME – MaineREST OF STATE$189.2296.81%MA – MassachusettsMETROPOLITAN BOSTON (MIDDLESEX, NORFOLK AND SUFFOLK)$211.15108.03%MA – MassachusettsREST OF STATE$201.31102.99%NH – New HampshireSTATEWIDE$196.83100.70%RI – Rhode IslandSTATEWIDE$200.62102.64%VT – VermontSTATEWIDE$193.5599.02%KY – KentuckySTATEWIDE$188.6996.54%OH – OhioSTATEWIDE$191.9198.18%

Psychotherapy Reimbursement Rates for Private Insurance [2022]

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 you’ve been accepted as in-network and they’ve given you your fee schedule.

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

LowHighAetna$70$88Cigna$64$86Magellan$55$73Anthem Blue Cross$68$91United Health Care / United Behavioral Health / Optum$67$79Blue Shield$67$93Beacon Health Options / Value Option$62$81Beacon Health Strategies$64$74MHN$57$69Molina$55$67

(Again, these are not exact rates but estimated ranges).

Here is a view of the same psychotherapy reimbursement rate for private insurance information after averaging the low and high prices individually and then showing the delta of price differential between these private insurance polices as a relative percentage out of 100%.

Avg HighAvg HighLowHigh$66$77Aetna$69$84105%109%Cigna$62$8294%106%Magellan$52$7079%91%Anthem Blue Cross$67$88102%114%United Health Care / United Behavioral Health / Optum$66$78100%101%Blue Shield$65$8998%116%Beacon Health Options / Value Option$62$7494%96%Beacon Health Strategies$60$7291%94%MHN$57$6986%90%Molina$52$6679%86%

Here’s 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 you’re wondering about which private insurance companies are reimbursing the most in your state with your license, we’re happy to help you fill in the gaps.

How Your License Impacts Your Insurance Reimbursement Rate for Psychotherapy

In most states, mental health therapists are initially licensed as an LPC or LMHC or LPCMH or LCPC or LPCC (and on and on), depending on your state.  While it’s safe to assume you already know your license for your state, you can also check this PDF document here to confirm your license and what’s required.

With this license comes, normally, the lowest or entry level rates for working with insurance companies providing mental health services.

You’ve just been licensed and you’re ready to begin working on your own in private practice.  Expect rates insurance reimbursement rates for psychotherapy to be in the lowest tier of payment.

45 Minute Individual Therapy60 Minute Individual Therapy9083490837LPC, Licensed Professional Counselor$68$77LMFT, Licensed Marriage and Family Therapist$74$89LICSW, Licensed Independent Social Workers$68$77MD / PhD, American Board of Psychiatry and Neurology Certified$88$105

Medicaid Mental Health Reimbursement Rates [2022]

Medicaid requirements for licensing vary state by state.  Likewise, Medicaid pays out differing rates based on very specific criteria and coding.

Here’s a link for Medicaid’s PDF on Mental Health Payment Rates.

Make sure you have one of the following licenses to get credentialed with the medicaid provider(s) in your state:

• Physician

• Psychiatrist

• Physician’s Assistant (PA)

• Advanced Practice 

  Registered Nurse (APRN)

• Clinical Nurse

• Specialist/Psychiatric Mental Health (CNSPMH) and Nurse 

  Practitioner (NP)

• Licensed Pharmacist  

• Registered Nurse (RN)

• Licensed Practical 

  Nurse (LPN)

• Licensed Dietician (LD)

• Qualified Medication Aide (QMA)

• Psychologist

• Licensed Clinical 

  Social Worker (LCSW)

• Licensed Professional Counselor (LPC)

• Licensed Marriage and Family Therapist (LMFT)

• Licensed Master’s Social Worker(LMSW)

• Licensed Associate Professional Counselor (LAPC)

• Licensed Associate Marriage and Family Therapist (LAMFT)

• Certified Clinical Alcohol and Drug Counselor (CCADC) 

• Master Addiction Counselor (MAC)

• National Board of Certified Counselors (NBCC)

• Master Addiction Counselor, (MAC) through National Association of Alcohol and Drug Counselors, (NAADC) 

• Certified Alcohol and Drug Counselor (CADC)

• Certified Addiction Counselor, Level I (CAC-I)

• Certified Addiction Counselor, Level II (CAC-II)

• Registered Alcohol and Drug Technician I, II, III

• Addiction Counselor Trainees

• Certified Psychiatric Rehabilitation Professional (CPRP)

• Certified Peer Specialist (CPS)

• Paraprofessional (PP)

Medicaid License Practitioner Level Information

Your Medicaid License impacts the “Practitioner Level” that you have which influences your reimbursement rates.

Mental Health License Practitioner Levels:

• Practitioner Level 1: Physician/Psychiatrist

• Practitioner Level 2: Psychologist, CNS-PMH 

• Practitioner Level 3: LCSW, LPC, LMFT, RN 

• Practitioner Level 4:

  • LMSW; LAPC; LAMFT

  • Psychologist/LCSW/LPC/LMFT’s supervisee/trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology, functioning within the scope of the practice acts of the state

  • MAC, CAC-II, CADC, CCADC, GCADC (II, III); CAC-I or Addiction Counselor Trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology (addiction counselors may only perform these functions related to treatment of addictive diseases). 

• Practitioner Level 5:

  • CAC-I, RADT (I, II, or III), Addiction Counselor Trainees with high school diploma/equivalent (practitioners at this level may only perform these functions related to treatment of addictive diseases and under the supervision of one of the licensed/credentialed professionals above).

Medicaid Mental Health Reimbursement Rates for Individual Therapy

Below is a table showing the rates that have been determined by Medicaid for these differing license levels for commercial insurance polices:

45-50 minutesPractitioner Level 2$116.90Practitioner Level 3$90.03Practitioner Level 4$60.89Practitioner Level 5$45.3875-80 minutesPractitioner Level 2$194.84Practitioner Level 3$150.05Practitioner Level 4$101.48Practitioner Level 5$75.64

Now you must be wondering:  “What??!! Medicaid doesn’t pay that much!!!”  And you’re right.

These are the rates that they established as averages nationally based on a huge survey of insurance policies by their relative license.  These are the commercial insurance reimbursement rates for psychotherapy determined by Medicaid.

Medicaid mental health reimbursement rates differ in that medicaid reduces these rates to providers at Practitioner Levels 2-5, which cover all licensed mental health providers except MDs.

Based on data received through surveys of a large sample of agencies currently providing Community Behavioral Health Rehabilitation Services in multiple states, average allocable direct and indirect cost factors were calculated as a percentage of direct personnel costs.

These costs were then calculated for each service and for each applicable practitioner level. All of these cost components were summed to yield an annual cost for the service for the particular practitioner level.

Due to the large difference between the median annual salaries in Level 1 (physicians/psychiatrists) and the other levels, it was necessary to adjust the support and administrative factors applied to the highest level versus the other levels so that the support and administrative costs associated with the highest levels were not over-inflated.

This was accomplished by adjusting the direct and indirect cost factors according to the proportion of personnel costs in an average agency accounted for by the top level versus the other four practitioner levels.

The overall direct services cost factor is 39% and indirect is 15%. Once the factors were adjusted to account for the disparity between physician salaries and the other levels the cost factors became 19% for direct costs and 7% for indirect costs for Level 1 and 45% for direct costs and 17% indirect costs for the remaining four levels.

Source

So, take the above charts and then reduce their numbers and you can expect to get payment more like the following:

45-50 minute therapy session

Medicaid Mental Health Rate

Practitioner Level 2$116.90$72.48Practitioner Level 3$90.03$55.82Practitioner Level 4$60.89$37.75Practitioner Level 5$45.38$28.1475-80 minute therapy sessionPractitioner Level 2$194.84$120.80Practitioner Level 3$150.05$93.03Practitioner Level 4$101.48$62.92Practitioner Level 5$75.64$46.90

There are other factors that influence Medicaid rates by state, license, practitioner level, and subcontract with the Medicaid program in that state, so these rates are not exact but will give you a better sense of the differences in license levels and therefore reimbursement rates for mental health services covered by Medicaid.

Here is another example of Medicaid determined private rates; specifically Medicaid Reimbursement Rates for Mental Health Services in Mississippi:

Diagnostic Evaluation90791$121Psychiatric Diagnostic Evaluation90792$134AssessmentH0031$93Prolonged Service 60 min.99354$111Prolonged Service 30 min add on99355$85Psychotherapy90832$59Psychotherapy90834$79Psychotherapy90837$118Family Therapy90846$95Family Therapy90847$99Group Therapy90853$24Multi-Family Group Therapy90849$35Interactive Complexity90785$13Psychological Evaluation (First Hour)96130$102Psychological Evaluation (Each Additional Hour)96131$78Psychological Evaluation (First 30 Minutes)96136$39Psychological Evaluation (Each Additional 30 Minutes)96137$36Crisis Response (Face to Face)H2011$30Crisis Response (Phone)H2011$22

Source

Again, these are the rates that have been determined as average payment rates by insurance based on research done by that State’s medicaid program, in this case Mississippi.

These rates get reduced but these are useful to look at to see what they believe are the average reimbursement rates by procedure code.

This information does not take into account the effect of the license or practitioner level on total reimbursement rate.

How Your Taxonomy Code Impacts Your Insurance Reimbursement Rates for Psychotherapy

Here is a list of the taxonomy codes or specializations that are declared in the National Provider Identifier Registry.

You can simply Google your NPI number to find your license information including your taxonomy.  It’s likely to be one of the following:

Psychiatry Taxonomy Codes

• Addiction Psychiatry – 2084P0802X

• Child & Adolescent Psychiatry – 2084P0804X

• Geriatric Psychiatry – 2084P0805X

• Psychiatry – 2084P0800X

Behavioral Health & Social Service Provider Taxonomy Codes

• Counselor – 101Y00000X

• Addiction (Substance Use Disorder) – 101YA0400X

• Marriage & Family Therapist – 106H00000X

• Psychoanalyst – 102L00000X

• Psychologist – 103T00000X

• Addiction (Substance Use Disorder) – 103TA0400X

• Adult Development & Aging – 103TA0700X

• Clinical Child & Adolescent – 103TC2200X

• Cognitive & Behavioral – 103TB0200X

• Counseling – 103TC1900X

• Group Psychotherapy – 103TP2701X

• Developmental Disabilities – 103TM1800X

• Psychoanalysis – 103TP0814X

• Psychotherapy – 103TP2700X

• Social Worker – 104100000X

These taxonomy codes reflect specializations of treatment related to your specific mental health provider license.  Insurance companies are trying to fill out a map of providers across specific locations, as we discussed before, and they are also trying to maximize their specializations within those offerings.

Insurance companies are all trying to fill in the gaps of service offerings per area as well.

Medicaid License Example Case

Imagine a hospital.  It would be convenient for them to have multiple mental health providers on staff who specialize in different things.

Some clients need help with homelessness and substance abuse and require specific treatment related to their situations, whereas others are looking for psychotherapy specific to their family or eating disorder or gambling addiction.

For that hospital to top notch, they hire providers who specialize in a variety of services.  Insurance companies operate in a similar way.

Treatment specializations require different training and education which are reflected in their licensing and also reimbursement rates.

This is the least predictable factor in influencing your reimbursement rates and is more a reflection of your license and that insurance company needing to fill a gap in service offerings or not.

As a result, it’s better to think about your taxonomy code and insurance reimbursement rates for mental health more in terms of your level of education and license in your state.  Your specialization is “optimized” when deciding what you’re going to study or what you will choose to study in the future.

If you don’t want to deal with this mess, consider hiring us to do your billing and handle this for you.

Medicare Reimbursement Rates for Psychotherapy [2022]

Please see our updated Medicare Rates:

CPT CodeDescriptionMedicare Reimbursement Rate 2020Medicare Reimbursement Rate 2021Medicare Reimbursement Rate 202290791Psychological Diagnostic Evaluation$140.19$180.75$195.4690792Psychological Diagnostic Evaluation with Medication Management$157.49$201.68$218.9090832Individual Psychotherapy, 30 Minutes$68.47$77.81$85.0790833Individual Psychotherapy with Evaluation and Management Services, 30 minutes$71.00$71.18$77.8890834Individual Psychotherapy, 45 Minutes$91.18$103.28$112.2990836Individual Psychotherapy with Evaluation and Management Services, 45 minutes$89.74$90.02$98.3090837Individual Psychotherapy, 60 Minutes$136.95$152.48$164.8490838Individual Psychotherapy with Evaluation and Management Services, 60 minutes$118.57$119.33$129.3090839Individual Crisis Psychotherapy initial 60 min$157.6690840Individual Crisis Psychotherapy initial 60 min, each additional 30 min$78.6499201Evaluation and Management Services, Outpatient, New Patient$46.49Not CoveredNot covered99202Evaluation and Management Services, Outpatient, New Patient$77.48$73.97$80.9199203Evaluation and Management Services, Outpatient, New Patient$109.92$113.75$124.3999204Evaluation and Management Services, Outpatient, New Patient$166.86$169.93$185.2699205Evaluation and Management Services, Outpatient, New Patient$209.75$224.36$244.9999211Evaluation and Management Services, Outpatient, Established Patient$23.07$23.03$25.7199212Evaluation and Management Services, Outpatient, Established Patient$45.77$56.88$62.7699213Evaluation and Management Services, Outpatient, Established Patient$75.32$92.47$100.5799214Evaluation and Management Services, Outpatient, Established Patient$110.28$131.20$141.7899215Evaluation and Management Services, Outpatient, Established Patient$147.76$183.19$200.0099354Prolonged Services$132.26 $132.09$140.2699355Prolong Services with E/M$100.91$100.33$101.3290846Family psychotherapy without patient, 50 minutes$103.58$99.10$107.3790847Family psychotherapy with patient, 50 minutes$107.19$102.59$111.1596105Assessment of aphasia and cognitive performance$101.54$109.2696112Developmental testing administration by a physician or qualified health care professional, 1st hr$131.55$141.0296113Developmental testing administration by a physician or qualified health care professional, each additional hour$58.62$66.5496116Neurobehavioral status exam performed by a physician or qualified health professional, first hour$97.00$104.7396121Neurobehavioral status exam performed by a physician or qualified health professional, additional hour$82.35$87.3496125Standardized cognitive performance test administered by health care professional$107.12$115.6996127Brief emotional and behavioral assessment$4.89$5.2996130Psychological testing and evaluation by a physician or qualified health care professional, first hour$120.73$132.7096131Psychological testing and evaluation by a physician or qualified health care professional, each additional hour$91.42$98.6896132Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour$133.29$144.8096133Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour$103.98$112.2996136Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour$46.76$49.1596137Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour$41.87$44.2496138Neuropsychological or psychological test administration and scoring by a technician, first hour$37.34$38.5696139Neuropsychological or psychological test administration and scoring by a technician, each additional hour$37.34$$39.32

(Source)

Medicare has approached this problem in a similar way by averaging service costs and using those as a basis to reduce fees.  Here’s a look at what they suggest normal private insurance rates are by CPT code, nationally:

90832Psytx w pt 30 minutes$68.4790833Psytx w pt w e/m 30 min$71.0090834Psytx w pt 45 minutes$91.1890836Psytx w pt w e/m 45 min$89.7490837Psytx w pt 60 minutes$136.9590838Psytx w pt w e/m 60 min$118.5790839Psytx crisis initial 60 min$142.7190840Psytx crisis ea addl 30 min$68.4790845Psychoanalysis$97.3190846Family psytx w/o pt 50 min$110.2890847Family psytx w/pt 50 min$114.6090849Multiple family group psytx$42.17

Source

Medicare reduces insurance reimbursement rates for psychotherapy on a relative basis.  Here’s that same charge but with a calculated reduction on rates of 40%:

Suggested Private Rate

Reduced Rate (40% Reduction)

90832Psychotherapy with patient for 30 minutes$68.47$41.0890833Psychotherapy and evaluation and management with patient for 30 min$71.00$42.6090834Psychotherapy with patient for 45 minutes$91.18$54.7190836Psychotherapy and evaluation and management with patient for 45 min$89.74$53.8490837Psychotherapy with patient for 60 minutes$136.95$82.1790838Psychotherapy and evaluation and management with patient for 60 min$118.57$71.1490839Mental health crisis, first 60 minutes$142.71$85.6390840 Mental health crisis, each additional 30 minutes$68.47$41.0890845Psychoanalysis$97.31$58.3990846Family psychotherapy without the patient, 50 min$110.28$66.1790847Family psychotherapy with the patient, 50 min$114.60$68.7690849Multiple family group psychotherapy$42.17$25.30

The reduced rate here isn’t 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.

Mental Health License Requirements for Medicare

Medicare doesn’t cover all licenses and is far more selective than Medicaid about which providers they will allow into their network.  As a result, mental health reimbursement rates for Medicare are higher than Medicaid rates by a substantial margin.

Medicare Accepted Mental Health Licenses:

• Psychiatrist
• Psychologists
• Clinical Nurse Practitioners
• Clinical Social Workers

Mental Health Licenses Not Accepted by Medicare:

• LMHC
• LMFT
• LPC

Source

If you do want to serve an older demographic or have specialized in care tailored to their needs, it’s important to understand the license required for you to be able to be accepted within Medicare.

Mental Health Provider Demand Effecting Reimbursement Rates for Therapy

The sad truth is some of the best panels are totally full and their network map of mental health providers is saturated.  There’s nothing you can do when a company like Florida Blue hasn’t 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 you’ll 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 you’ll need to research and address.

How to Choose Mental Health Insurance Companies for Credentialing

Choosing which companies to apply to depends on a number of factors but can fall cleanly into three buckets:

1. Increasing caseload
2. Increasing revenue per appointment
3. Working with a specific demographic

For the best possible guidance, try to pick only two of these three possible options and weight their significance to you in your current private practice.

Are you looking to increase the number of sessions you do?  Work with lower paying but higher supplying networks like Medicaid.

Want higher income per client? Look at the Blue Card network (all “Blue” plans in your state).

And if you don’t even know what Blue Card programs apply to your state or you need a free customized quote that’s specific to your needs, we are happy to help.  (But not required!)  You can reach out about that at our mental health credentialing services page.

Summary of Insurance Reimbursement Rates for Psychotherapy

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

• license,
• your specialty,
• your location,
• and the service map for each insurance company you’re 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 (e.g. Alaska).

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 you’re 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 (like Medicaid), whereas others might be very challenging to get in-network with but pay much higher (like Blue Card plans).

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