Insurance Reimbursement Rates for Psychiatrists [2019]

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 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

Reimbursement for Psychiatric Services: Billing Tips

Here are some quick take away’s from this article:

  1. Intake sessions pay maximally, bill them appropriately.
  2. Regular visits of low to moderate severity are most common.
  3. Medicare pays quite well.
  4. 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 CodeCPT Code DescriptionTypical Code time
90791Psychological Diagnostic Evaluation60
90792Psychological Diagnostic Evaluation with Medication Management60
90832Individual Psychotherapy, 30 Minutes30
90833Individual Psychotherapy with Evaluation and Management Services, 30 minutes30
90834Individual Psychotherapy, 45 Minutes45
90836Individual Psychotherapy with Evaluation and Management Services, 45 minutes45
90837Individual Psychotherapy, 60 Minutes60
90838Individual Psychotherapy with Evaluation and Management Services, 60 minutes60
99201Evaluation and Management Services, Outpatient, New Patient10
99202Evaluation and Management Services, Outpatient, New Patient20
99203Evaluation and Management Services, Outpatient, New Patient30
99204Evaluation and Management Services, Outpatient, New Patient45
99205Evaluation and Management Services, Outpatient, New Patient60
99211Evaluation and Management Services, Outpatient, Established Patient5
99212Evaluation and Management Services, Outpatient, Established Patient10
99213Evaluation and Management Services, Outpatient, Established Patient15
99214Evaluation and Management Services, Outpatient, Established Patient25
99215Evaluation and Management Services, Outpatient, Established Patient40
99354Prolonged Services60
99355Prolong Services with E/M60
Common Psychiatric CPT Codes

Common Psychiatric CPT Codes

Source

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 2019 Medicare’s reimbursement rates for psychiatry:

Psychiatry CPT CodeCPT Code DescriptionMedicare Reimbursement Rate for Psychiatrists
90791Psychological Diagnostic Evaluation$140.19
90792Psychological Diagnostic Evaluation with Medication Management$157.49
90832Individual Psychotherapy, 30 Minutes$68.47
90833Individual Psychotherapy with Evaluation and Management Services, 30 minutes$71.00
90834Individual Psychotherapy, 45 Minutes$91.18
90836Individual Psychotherapy with Evaluation and Management Services, 45 minutes$89.74
90837Individual Psychotherapy, 60 Minutes$136.95
90838Individual Psychotherapy with Evaluation and Management Services, 60 minutes$118.57
99201Evaluation and Management Services, Outpatient, New Patient$46.49
99202Evaluation and Management Services, Outpatient, New Patient$77.48
99203Evaluation and Management Services, Outpatient, New Patient$109.92
99204Evaluation and Management Services, Outpatient, New Patient$166.86
99205Evaluation and Management Services, Outpatient, New Patient$209.75
99211Evaluation and Management Services, Outpatient, Established Patient$23.07
99212Evaluation and Management Services, Outpatient, Established Patient$45.77
99213Evaluation and Management Services, Outpatient, Established Patient$75.32
99214Evaluation and Management Services, Outpatient, Established Patient$110.28
99215Evaluation and Management Services, Outpatient, Established Patient$147.76
99354Prolonged Services$132.26
99355Prolong Services with E/M$100.91

Source

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 CodeCPT Code DescriptionMedicaid Reimbursement Rate for Psychiatrists
90791Psychological Diagnostic Evaluation$103.14
90792Psychological Diagnostic Evaluation with Medication Management$85.86
90832Individual Psychotherapy, 30 Minutes$42.90
90833Individual Psychotherapy with Evaluation and Management Services, 30 minutesN/a
90834Individual Psychotherapy, 45 Minutes$60.31
90836Individual Psychotherapy with Evaluation and Management Services, 45 minutesN/a
90837Individual Psychotherapy, 60 Minutes$81.59
90838Individual Psychotherapy with Evaluation and Management Services, 60 minutesN/a
99201Evaluation and Management Services, Outpatient, New Patient$36.82
99202Evaluation and Management Services, Outpatient, New Patient$57.82
99203Evaluation and Management Services, Outpatient, New Patient$81.37
99204Evaluation and Management Services, Outpatient, New Patient$117.82
99205Evaluation and Management Services, Outpatient, New Patient$146.89
99211Evaluation and Management Services, Outpatient, Established Patient$18.10
99212Evaluation and Management Services, Outpatient, Established Patient$31.36
99213Evaluation and Management Services, Outpatient, Established Patient$43.23
99214Evaluation and Management Services, Outpatient, Established Patient$66.80
99215Evaluation and Management Services, Outpatient, Established Patient$99.95
99354Prolonged Services$97.16
99355Prolong 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.

Source 1

Source 2

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:

  • commercial insurance reimbursement rate for psychiatryYears 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.