Find out which mental health insurance companies pay you the most!
- Mental Health Reimbursement Ranges
- Average Payment Per Insurance Company
- Credentialing Recommendations for New Practices & Established Practices
- Highest Paying Insurance Companies for Mental Health
- Which Companies Are The Hardest to Bill
- Medicare Reimbursement Rates [Search by CPT Code]
- Tips on Avoiding Low Reimbursement
Commercial Insurance Reimbursement for Mental Health
Find out which insurance companies pay mental health providers the best in our interactive charts below:
Mental Health Insurance Reimbursement Ranges
None of these values represent what you will be paid or are a guarantee of payment nor do the represent the rates each insurance company may or may not reimburse.
Average Payment Per Insurance Company
These are payment averages that do not represent the rates of any of the aforementioned insurance companies are a not a guarantee of any rate or payment amount.
|Insurance Company Name||Avg Payment||Competitive||Difficult to Bill|
|BCBS HighMark||Above Avg||Yes||No|
|BCCS Carefirst||Above Avg||Yes||No|
|Beacon Health Options / Value Options||Avg||No||Yes|
|Blue Shield||Below Avg||No||No|
|Beacon Health Stategies||Below Avg||No||Yes|
|Blue Shield MHSA / Magellan||Below Avg||No||Yes|
|Coordinated Care||Below Avg||No||No|
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 you’ll 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.
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!
- Optum / UHC
If you’re an LPC, LMFT, or newly licensed provider, you might find these companies are a good fit.
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.
Difficulty Working With Each Company
Not all companies are easy to work with even if they pay well. Medicaid can be the trickiest of them all, not listed here.
Most Competitive Insurance Companies for Mental Health Providers:
The following links go to each company’s credentialing website:
To sum things up, the Blue Cross and Blue Shield network across the United States is one of the highest reimbursing and most competitive plans to work with.
Inquire about your local BCBS within google by typing in “Blue Cross Blue Shield” + your state’s name. Each state runs their BCBS in their own way so ask colleagues as well.
More Difficult to Bill Insurance Companies for Mental Health Providers:
The following links go to each company’s credentialing website:
- Beacon Health Options / Value Options
- Beacon Health Stategies
- Blue Shield MHSA / Magellan
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 (authorizations) involved in billing. Other EAP plans require their own unique form.
Simplify Your Practice Tip: If you are busy enough, consider dropping new EAPs.
It’s 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.
Medicare subcontracts out to many different subcontractors like Noridian or Palmetto or Novitas or NGS or WPS or FCSO.
Each contractor has their own electronic claims submission enrollment requirements, forms, and process. Each system is clunky and the enrollments take quite some time. Most clients also have a secondary insurance company to bill alongside their Medicare coverage.
We take care of this enrollment process and secondary claims submission and follow-up for our providers at TheraThink.
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 (see Medicare map). As such, your state’s 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 you’re in-network with UHC, you’re 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 you’re in-network with their commercial or Medicaid or HMO or PPO or EPO plans.
Tips on Avoiding Low Paying & Complex Plans
Avoid subcontracted plans if you don’t understand them. When a plan is subcontracted out to a different insurance provider, often times that network is smaller and offers different, lower rates. (This isn’t always the case!)
Avoid plans requiring authorization. This means most often Medicaid, EAPs, and out-of-network coverage.
Avoid low paying plans. Ask your colleagues which plans pay the worst. See if you can make your practice work without utilizing those lower-paying plans. With that being said, if those plans serve a large amount of clients, you may benefit from taking a pay cut to increase your caseload.
Avoid Medicaid. Sadly, Medicaid pays poorly and is overly complex, often requiring license-level modifiers and taxonomy codes. The reason I would recommend working with Medicaid is to establish a very busy practice (perhaps with a billing team on your side) and/or because you want to serve this population of folks in need.
Medicare Psych Reimbursement Rates by CPT Code:
Medicare pays well! Find the rate that Medicare pays per mental health CPT code in 2021 below.
|CPT Code||Description||Medicare Reimbursement Rate 2020||Medicare Reimbursement Rate 2021|
|90791||Psychological Diagnostic Evaluation||$140.19||$180.75|
|90792||Psychological Diagnostic Evaluation with Medication Management||$157.49||$201.68|
|90832||Individual Psychotherapy, 30 Minutes||$68.47||$77.81|
|90833||Individual Psychotherapy with Evaluation and Management Services, 30 minutes||$71.00||$71.18|
|90834||Individual Psychotherapy, 45 Minutes||$91.18||$103.28|
|90836||Individual Psychotherapy with Evaluation and Management Services, 45 minutes||$89.74||$90.02|
|90837||Individual Psychotherapy, 60 Minutes||$136.95||$152.48|
|90838||Individual Psychotherapy with Evaluation and Management Services, 60 minutes||$118.57||$119.33|
|99201||Evaluation and Management Services, Outpatient, New Patient||$46.49||Not Covered|
|99202||Evaluation and Management Services, Outpatient, New Patient||$77.48||$73.97|
|99203||Evaluation and Management Services, Outpatient, New Patient||$109.92||$113.75|
|99204||Evaluation and Management Services, Outpatient, New Patient||$166.86||$169.93|
|99205||Evaluation and Management Services, Outpatient, New Patient||$209.75||$224.36|
|99211||Evaluation and Management Services, Outpatient, Established Patient||$23.07||$23.03|
|99212||Evaluation and Management Services, Outpatient, Established Patient||$45.77||$56.88|
|99213||Evaluation and Management Services, Outpatient, Established Patient||$75.32||$92.47|
|99214||Evaluation and Management Services, Outpatient, Established Patient||$110.28||$131.20|
|99215||Evaluation and Management Services, Outpatient, Established Patient||$147.76||$183.19|
|99355||Prolong Services with E/M||$100.91||$100.33|
|90847||Family psychotherapy with patient, 50 minutes||$107.19||$102.59|
|90846||Family psychotherapy without patient, 50 minutes||$103.58||$99.10|
|96105||Assessment of aphasia and cognitive performance||$101.54|
|96112||Developmental testing administration by a physician or qualified health care professional, 1st hr||$131.55|
|96113||Developmental testing administration by a physician or qualified health care professional, each additional hour||$58.62|
|96116||Neurobehavioral status exam performed by a physician or qualified health professional, first hour||$97.00|
|96121||Neurobehavioral status exam performed by a physician or qualified health professional, additional hour||$82.35|
|96125||Standardized cognitive performance test administered by health care professional||$107.12|
|96127||Brief emotional and behavioral assessment||$4.89|
|96130||Psychological testing and evaluation by a physician or qualified health care professional, first hour||$120.73|
|96131||Psychological testing and evaluation by a physician or qualified health care professional, each additional hour||$91.42|
|96132||Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour||$133.29|
|96133||Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour||$103.98|
|96136||Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour||$46.76|
|96137||Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour||$41.87|
|96138||Neuropsychological or psychological test administration and scoring by a technician, first hour||$37.34|
|96139||Neuropsychological or psychological test administration and scoring by a technician, each additional hour||$37.34|
You can use these rate differences as estimates on the rate changes for private insurance companies, however it’s best to ensure the specific CPT code you want to use is covered by insurance.
Call and verify eligibility and benefits or hire a billing team to take care of it for you.
|CPT Code||Add-On Code||Medicare Reimbursement||CPT Code Description|
|90791||$145.44||Psychiatric Diagnostic Evaluation (usually just one/client is covered)|
|90832||$71.10||Psychotherapy, 30 minutes (16-37 minutes).|
|90834||$94.55||Psychotherapy, 45 minutes (38-52 minutes).|
|90837||$141.47||Psychotherapy, 60 minutes (53 minutes and over).|
|90846||$103.58||Family or couples psychotherapy, without patient present.|
|90847||$107.19||Family or couples psychotherapy, with patient present.|
|90853||$28.15||Group Psychotherapy (not family).|
|90839||$147.61||Psychotherapy for crisis, 60 minutes (30-74 minutes).|
|90840||$70.74||Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 90839.|
|90404||$0||Cigna / MHN EAP CPT Code. These two companies use a unique CPT code for EAP sessions.|
|96101||$0||Psychological testing, interpretation and reporting by a psychologist (per Hour)|
|90880||$111.16||Hypnotherapy limit 10 units/hours per application|
|90849||$36.81||Multiple family group psychotherapy|
|90785||$15.52||Interactive complexity. Example: play therapy using dolls or other toys. This is an interactive complexity add-on code that is not a payable expense. This code only indicates that the treatment is complex in nature.|
|90863||$0||Pharmacologic Management after therapy.|
|99050||$0||Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.|
|99051||$0||Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.|
|99354||$132.09||Additional time after the additional time of 74 minutes. Adding another 30 minutes. (Only use if the duration of your session is at least 90 minutes for 90837 or 80 minutes for 90847).|
|99355||$100.33||Additional time after first 60 minutes. First additional 30 to 74 minutes.|
|90840||$70.74||30 additional minutes of psychotherapy for crisis. Used only in conjunction with CPT 90839.|
|90833||$72.90||30 minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, then has 30 minute session.|
|90836||$92.39||45 minute psychotherapy add-on. Example: Clinical Nurse Specialist evaluates medication response, then has 45 minute session.|
|90792||$160.96||Psychiatric Diagnostic Evaluation with medical services (usually just one/client is covered)|
|99201||$46.56||Evaluation and Management – New Patient Office Visit – 10 Minutes|
|99202||$77.23||Evaluation and Management – New Patient Office Visit – 20 Minutes|
|99203||$109.35||Evaluation and Management – New Patient Office Visit – 30 Minutes|
|99204||$167.09||Evaluation and Management – New Patient Office Visit – 45 Minutes|
|99205||$211.12||Evaluation and Management – New Patient Office Visit – 60 Minutes|
|99211||$23.46||Evaluation and Management – Established Patients – 5 Minutes|
|99212||$46.19||Evaluation and Management – Established Patients – 10 Minutes|
|99213||$76.15||Evaluation and Management – Established Patients – 15 Minutes|
|99214||$110.43||Evaluation and Management – Established Patients – 25 Minutes|
|99215||$148.33||Evaluation and Management – Established Patients – 40 Minutes|
|90833||$72.90||Evaluation and Management code for 30 minutes of psychiatry (used with 90832).|
|90836||$92.39||Evaluation and Management code for 45 minutes of psychiatry (used with 90834).|
|90838||$121.26||Evaluation and Management code for 60 minutes of psychotherapy (used with 90837).|
|99415||$10.11||First 30 additional minutes of prolonged services for evaluation and management|
|99416||$4.33||Each 30 additional minutes of prolonged services for evaluation and management|
|96105||$105.74||Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour|
|96125||$111.88||Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report|
|96110||$0.00||Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument|
|96112||$140.39||Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory, and/ or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour|
|96113||$62.80||Each additional 30 minutes (List separately in addition to code for primary procedure)|
|96127||$5.05||Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument|
|96116||$99.61||Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both faceto-face time with the patient and time interpreting test results and preparing the report; first hour|
|96121||$86.25||Each additional hour (List separately in addition to code for primary procedure)|
|96130||$121.98||Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour|
|96131||$93.83||Each additional hour (List separately in addition to code for primary procedure)|
|96132||$136.42||Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour|
|96133||$102.49||Each additional hour (List separately in addition to code for primary procedure)|
|96136||$48.00||Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes|
|96137||$44.03||Each additional 30 minutes (List separately in addition to code for primary procedure)|
|96138||$38.62||Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes|
|96139||$38.62||Each additional 30 minutes (List separately in addition to code for primary procedure)|
|90867||$0||Therapeutic repetitive transcranial magnetic stimulation (TMS); initial|
|90868||$0||Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent|
|90869||$0||Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent motor threshold re-determination with delivery and management|
|90870||$180.09||Electroconvulsive therapy (ECT)|
|90875||$0||Individual psychophysiological therapy incorporating biofeedback training, 30 minutes|
|90876||$0||Individual psychophysiological therapy incorporating biofeedback, 45 minutes|
|90885||$0||Psychiatric evaluation of records|
|90887||$0||Interpretation or explanation to family|
|90889||$0||Preparation of psychiatric report|
|90899||$0||Unlisted psychiatric service or procedure|
|90901||$41.50||Biofeedback training by any modality|
|90911||$0||Biofeedback training, including EMG and/or manometry|
|H0016||$0||Alcohol and/or drug services; medical/somatic|
|H0017||$0||Behavioral health; short-term residential, without room and board|
|H0018||$0||Behavioral health; short-term residential|
|H0019||$0||Behavioral health; long-term residential|
|H0020||$0||Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)|
|H0021||$0||Alcohol and/or drug training service (for staff and personnel not employed by providers)|
|H0022||$0||Alcohol and/or drug intervention service (planned facilitation)|
|H0023||$0||Behavioral health outreach service (planned approach to reach a targeted population)|
|H0024||$0||Behavioral health prevention information dissemination service (one-way direct or non-direct contact with service audiences to affect knowledge and attitude)|
|H0025||$0||Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)|
|H0026||$0||Alcohol and/or drug prevention process service, community-based (delivery of services to develop skills of impactors)|
|H0027||$0||Alcohol and/or drug prevention environmental service (broad range of external activities geared toward modifying systems in order to mainstream prevention through policy and law)|
|H0028||$0||Alcohol and/or drug prevention problem identification and referral service (e.g., student assistance and employee assistance programs), does not include assessment|
|H0029||$0||Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g., alcohol free social events)|
|H0030||$0||Behavioral health hotline service|
|H0031||$0||Mental health assessment, by non-physician|
|H0032||$0||Mental health service plan development by non-physician|
|H0033||$0||Oral medication administration, direct observation|
|H0034||$0||Medication training and support|
|H0035||$0||Mental health partial hospitalization, treatment,|
|H0036||$0||Community psychiatric supportive treatment, face-to-face,|
|H0037||$0||Community psychiatric supportive treatment program|
|H0039||$0||Assertive community treatment, face-to-face|
|H0040||$0||Assertive community treatment program|
|H0041||$0||Foster care, child, non-therapeutic|
|H0042||$0||Foster care, child, non-therapeutic|
|H0045||$0||Respite care services, not in the home|
|H0046||$0||Mental health services, not otherwise specified|
|H0047||$0||Alcohol and/or other drug abuse services, not otherwise specified|
|H0048||$0||Alcohol and/or other drug testing: collection and handling only, specimens other than blood|
|H0049||$0||Alcohol and/or drug screening|
|H0050||$0||Alcohol and/or drug services, brief intervention|
|H1000||$0||Prenatal care, at-risk assessment|
|H1001||$0||Prenatal care, at-risk enhanced service; antepartum management|
|H1002||$0||Prenatal care, at risk enhanced service; care coordination|
|H1003||$0||Prenatal care, at-risk enhanced service; education|
|H1004||$0||Prenatal care, at-risk enhanced service; follow-up home visit|
|H1005||$0||Prenatal care, at-risk enhanced service package (includes h1001-h1004)|
|H1011||$0||Non-medical family planning education|
|H2000||$0||Family assessment by licensed behavioral health professional for state defined purposes|
|H2001||$0||Comprehensive multidisciplinary evaluation|
|H2010||$0||Rehabilitation program, per 1/2 day|
|H2011||$0||Comprehensive medication services|
|H2012||$0||Crisis intervention service|
|H2013||$0||Behavioral health day treatment|
|H2014||$0||Psychiatric health facility service|
|H2015||$0||Skills training and development|
|H2016||$0||Comprehensive community support services|
|H2017||$0||Comprehensive community support services|
|H2018||$0||Psychosocial rehabilitation services|
|H2019||$0||Psychosocial rehabilitation services|
|H2020||$0||Therapeutic behavioral services|
|H2021||$0||Community-based wrap-around services|
|H2022||$0||Community-based wrap-around services|
|H2025||$0||Ongoing support to maintain employment|
|H2026||$0||Ongoing support to maintain employment|
|H2028||$0||Sexual offender treatment service|
|H2029||$0||Sexual offender treatment service|
|H2030||$0||Mental health clubhouse services|
|H2031||$0||Mental health clubhouse services|
|H2033||$0||Multisystemic therapy for juveniles|
|H2034||$0||Alcohol and/or drug abuse halfway house services|
|H2035||$0||Alcohol and/or other drug treatment program|
|H2036||$0||Alcohol and/or other drug treatment program|
|H2037||$0||Developmental delay prevention activities, dependent child of client|
Credentialing Advice for Mental Health Providers
Some companies require you to register a legal business, E-IN, and group NPI. You might decide you don’t want to bother with all of that added work.
Read our article about how to start a new private practice to learn how, even if you’re transitioning away from a behavioral health group practice.
Try to avoid companies that require the use of taxonomy codes, license level modifiers, EDI enrollments, and prior authorizations. This does dramatically limit the companies you can work with, but it will save you time, headache, and frustration.
If you want to be able to work with all companies without any problems, any reputable insurance billing service will be able to help do the aforementioned billing complexities without you having to be involved.
Consider hiring a service like TheraThink that exclusively does mental health insurance billing.