Insurance Reimbursement Rates for Psychiatrists [2024]
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 (Commercial, Medicare, or Medicaid), psychiatric CPT code rendered, and by each insurance company’s 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. (Source)
If you are 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.
Article Index
- Billing Tips
- Most Common Psychiatry CPT Codes
- Medicare Reimbursement Rates for Psychiatrists
- Medicaid Reimbursement Rates for Psychiatrists
- Commercial Insurance Reimbursement Rates for Psychiatrists
- Maximize Your Reimbursement
Reimbursement for Psychiatric Services: Billing Tips
Here are some quick take away’s from this article:
- Intake sessions pay maximally, bill them appropriately.
- Regular visits of low to moderate severity are most common.
- Medicare pays quite well.
- Medicaid pays providers low amounts but sustains an enormous volume of new and established clients.
Most Common Psychiatry CPT Codes
While there are many obscure and obtuse CPT Codes for Psychiatry, it’s most efficient to learn the most commonly billed psychiatry CPT codes and their corresponding time allotments.
Note that with evaluation and management services, chose CPT codes by complexity, not time. Time in treatment often increases when complexity increases.
| CPT Code | CPT Code Description | Typical Code time |
|---|---|---|
| 90791 | Psychological Diagnostic Evaluation | 60 |
| 90792 | Psychological Diagnostic Evaluation with Medication Management | 60 |
| 90832 | Individual Psychotherapy, 30 Minutes | 30 |
| 90833 | Individual Psychotherapy with Evaluation and Management Services, 30 minutes | 30 |
| 90834 | Individual Psychotherapy, 45 Minutes | 45 |
| 90836 | Individual Psychotherapy with Evaluation and Management Services, 45 minutes | 45 |
| 90837 | Individual Psychotherapy, 60 Minutes | 60 |
| 90838 | Individual Psychotherapy with Evaluation and Management Services, 60 minutes | 60 |
| 99201 | Evaluation and Management Services, Outpatient, New Patient | 10 |
| 99202 | Evaluation and Management Services, Outpatient, New Patient | 20 |
| 99203 | Evaluation and Management Services, Outpatient, New Patient | 30 |
| 99204 | Evaluation and Management Services, Outpatient, New Patient | 45 |
| 99205 | Evaluation and Management Services, Outpatient, New Patient | 60 |
| 99211 | Evaluation and Management Services, Outpatient, Established Patient | 5 |
| 99212 | Evaluation and Management Services, Outpatient, Established Patient | 10 |
| 99213 | Evaluation and Management Services, Outpatient, Established Patient | 15 |
| 99214 | Evaluation and Management Services, Outpatient, Established Patient | 25 |
| 99215 | Evaluation and Management Services, Outpatient, Established Patient | 40 |
| 99354 | Prolonged Services | 60 |
| 99355 | Prolong Services with E/M | 60 |
Common Psychiatric CPT Codes
Medicare Reimbursement Rates for Psychiatrists
Medicare pays psychiatrists surprisingly well. Unfortunately, they now require electronic billing, which involves complex online enrollments for completion.
If you’re struggling with billing your medicare claims, or are plagued by mental health insurance billing in general, consider utilizing our billing service at TheraThink to solve your problems.
Below are the 2023 Medicare’s reimbursement rates for psychiatry:
| CPT Code | Description | Medicare Reimbursement Rate 2022 | Medicare Reimbursement Rate 2023 | Medicare Reimbursement Rates 2024 |
|---|---|---|---|---|
| 90791 | Psychological Diagnostic Evaluation | $195.46 | $174.86 | $169.29 |
| 90792 | Psychological Diagnostic Evaluation with Medication Management | $218.90 | $196.55 | $190.57 |
| 90832 | Individual Psychotherapy, 30 Minutes | $85.07 | $75.57 | $76.95 |
| 90833 | Individual Psychotherapy with Evaluation and Management Services, 30 minutes | $77.88 | $69.47 | $70.73 |
| 90834 | Individual Psychotherapy, 45 Minutes | $112.29 | $99.97 | $101.51 |
| 90836 | Individual Psychotherapy with Evaluation and Management Services, 45 minutes | $98.30 | $88.11 | $89.39 |
| 90837 | Individual Psychotherapy, 60 Minutes | $164.84 | $147.07 | $149.64 |
| 90838 | Individual Psychotherapy with Evaluation and Management Services, 60 minutes | $129.30 | $116.57 | $118.53 |
| 90839 | Individual Crisis Psychotherapy initial 60 min | $157.66 | $141.31 | $144.07 |
| 90840 | Individual Crisis Psychotherapy initial 60 min, each additional 30 min | $78.64 | $70.15 | $71.38 |
| 99201 | Evaluation and Management Services, Outpatient, New Patient | Not covered | Not covered | Not covered |
| 99202 | Evaluation and Management Services, Outpatient, New Patient | $80.91 | $72.86 | $71.06 |
| 99203 | Evaluation and Management Services, Outpatient, New Patient | $124.39 | $112.84 | $109.69 |
| 99204 | Evaluation and Management Services, Outpatient, New Patient | $185.26 | $167.40 | $164.38 |
| 99205 | Evaluation and Management Services, Outpatient, New Patient | $244.99 | $220.95 | $216.77 |
| 99211 | Evaluation and Management Services, Outpatient, Established Patient | $25.71 | $23.38 | $22.92 |
| 99212 | Evaluation and Management Services, Outpatient, Established Patient | $62.76 | $56.93 | $55.67 |
| 99213 | Evaluation and Management Services, Outpatient, Established Patient | $100.57 | $90.82 | $89.39 |
| 99214 | Evaluation and Management Services, Outpatient, Established Patient | $141.78 | $128.43 | $126.07 |
| 99215 | Evaluation and Management Services, Outpatient, Established Patient | $200.00 | $179.94 | $177.47 |
| 99354 | Prolonged Services | $140.26 | Not covered | Not covered |
| 99355 | Prolong Services with E/M | $101.32 | Not covered | Not covered |
| 90846 | Family psychotherapy without patient, 50 minutes | $107.37 | $95.56 | $95.94 |
| 90847 | Family psychotherapy with patient, 50 minutes | $111.15 | $99.63 | $100.53 |
| 96105 | Assessment of aphasia and cognitive performance | $109.26 | $98.27 | $94.30 |
| 96112 | Developmental testing administration by a physician or qualified health care professional, 1st hr | $141.02 | $126.74 | $121.81 |
| 96113 | Developmental testing administration by a physician or qualified health care professional, each additional hour | $66.54 | $59.98 | $58.94 |
| 96116 | Neurobehavioral status exam performed by a physician or qualified health professional, first hour | $104.73 | $93.19 | $90.37 |
| 96121 | Neurobehavioral status exam performed by a physician or qualified health professional, additional hour | $87.34 | $75.91 | $73.67 |
| 96125 | Standardized cognitive performance test administered by health care professional | $115.69 | $103.36 | $100.53 |
| 96127 | Brief emotional and behavioral assessment | $5.29 | $4.74 | $4.58 |
| 96130 | Psychological testing and evaluation by a physician or qualified health care professional, first hour | $132.70 | $120.30 | $117.88 |
| 96131 | Psychological testing and evaluation by a physician or qualified health care professional, each additional hour | $98.68 | $86.75 | $84.15 |
| 96132 | Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour | $144.80 | $130.13 | $126.07 |
| 96133 | Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour | $112.29 | $98.95 | $95.61 |
| 96136 | Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour | $49.15 | $42.70 | $40.93 |
| 96137 | Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour | $44.24 | $39.31 | $37.00 |
| 96138 | Neuropsychological or psychological test administration and scoring by a technician, first hour | $38.56 | $34.23 | $33.73 |
| 96139 | Neuropsychological or psychological test administration and scoring by a technician, each additional hour | $$39.32 | $35.24 | $34.71 |
Medicaid Reimbursement Rates for Psychiatrists
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 | CPT Code Description | Medicaid Reimbursement Rate for Psychiatrists |
|---|---|---|
| 90791 | Psychological Diagnostic Evaluation | $103.14 |
| 90792 | Psychological Diagnostic Evaluation with Medication Management | $85.86 |
| 90832 | Individual Psychotherapy, 30 Minutes | $42.90 |
| 90833 | Individual Psychotherapy with Evaluation and Management Services, 30 minutes | N/a |
| 90834 | Individual Psychotherapy, 45 Minutes | $60.31 |
| 90836 | Individual Psychotherapy with Evaluation and Management Services, 45 minutes | N/a |
| 90837 | Individual Psychotherapy, 60 Minutes | $81.59 |
| 90838 | Individual Psychotherapy with Evaluation and Management Services, 60 minutes | N/a |
| 99201 | Evaluation and Management Services, Outpatient, New Patient | $36.82 |
| 99202 | Evaluation and Management Services, Outpatient, New Patient | $57.82 |
| 99203 | Evaluation and Management Services, Outpatient, New Patient | $81.37 |
| 99204 | Evaluation and Management Services, Outpatient, New Patient | $117.82 |
| 99205 | Evaluation and Management Services, Outpatient, New Patient | $146.89 |
| 99211 | Evaluation and Management Services, Outpatient, Established Patient | $18.10 |
| 99212 | Evaluation and Management Services, Outpatient, Established Patient | $31.36 |
| 99213 | Evaluation and Management Services, Outpatient, Established Patient | $43.23 |
| 99214 | Evaluation and Management Services, Outpatient, Established Patient | $66.80 |
| 99215 | Evaluation and Management Services, Outpatient, Established Patient | $99.95 |
| 99354 | Prolonged Services | $97.16 |
| 99355 | 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.
Our billing service finds out if you’re in-network for each of your client’s plans via our eligibility and benefits verification calls we provide our providers.
You might want to save yourself the time and mess that is Medicaid and outsource your billing.
Commercial Insurance Reimbursement Rates for Psychiatrists
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
- Continued Education
- Languages Spoken
- Location
- Hours
- Specializations in Modalities of Treatment
- Demographic Expertise
As such, we simply cannot give you a general sense of what you’ll 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 you’d 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 one’s 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:
High Paying Insurance Reimbursement Rates for Psychiatry:
Blue Cross Blue Shield- BCBS Federal Employee Program
- Anthem
- Regence
- Premera
- Medicare
- Aetna
Moderate Paying Insurance Reimbursement Rates for Psychiatry:
- Value Options / Beacon
- Cigna
- United Health Care / Optum / United Behavioral Health
Low Paying Insurance Reimbursement Rates for Psychiatry:
- Medicaid
- Magellan
- Molina
Maximize Your Reimbursement
While it’s useful to know about the reimbursement rates for psych services, what is more important is knowing how to successfully bill these various CPT codes to the appropriate payer, knowing your claims will be paid.
We have a whole slew of information about how to do your own mental health billing, but the fact of the matter is that still just takes a lot of time.
We created the service that does that for you (your mental health billing, claims, calls, eligibility and benefits, handling denials, EOB accounting) so you can focus on your job: providing high quality mental health services.
Reach out to our billing team at TheraThink to learn how we can relieve your insurance billing headache.
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