Mental Health Reimbursement Rates by Insurance Company

Find our which mental health insurance companies pay you the most!

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

insurance payment comarison
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 NameAvg PaymentCompetitiveDifficult to Bill
BCBS HorizonHighYesNo
BCBS EmpireHighYesNo
BCBS HighMarkAbove AvgYesNo
BCCS CarefirstAbove AvgYesNo
AetnaAbove AvgNoNo
RegenceAbove AvgYesNo
AnthemAbove AvgYesNo
Beacon Health Options / Value OptionsAvgNoYes
MagellanBelow AvgNoNo
Blue ShieldBelow AvgNoNo
Beacon Health StategiesBelow AvgNoYes
CompsychBelow AvgNoYes
Blue Shield MHSA / MagellanBelow AvgNoYes
Coordinated CareBelow AvgNoNo
MolinaBelow AvgNoYes

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.

For mental health credentialing, we are quick to recommend Aetna, Cigna, and if your license allows it, Medicare (not eligible: LPC, LMFT).

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
  • Cigna
  • Medicaid
  • 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:

  1. Blue Cross Blue Shield
  2. Medicare
  3. Aetna
  4. 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:

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 contract mapWhy Is Medicare Hard to Bill for Mental Health Providers?

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 pays well!  Find the rate that Medicare pays per mental health CPT code in 2020 below.

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 CodeAdd-On CodeMedicare ReimbursementCPT Code Description
90791$145.44Psychiatric Diagnostic Evaluation (usually just one/client is covered)
90832$71.10Psychotherapy, 30 minutes (16-37 minutes).
90834$94.55Psychotherapy, 45 minutes (38-52 minutes).
90837$141.47Psychotherapy, 60 minutes (53 minutes and over).
90846$103.58Family or couples psychotherapy, without patient present.
90847$107.19Family or couples psychotherapy, with patient present.
90853$28.15Group Psychotherapy (not family).
90839$147.61Psychotherapy for crisis, 60 minutes (30-74 minutes).
90840$70.74Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 90839.
90404$0Cigna / MHN EAP CPT Code. These two companies use a unique CPT code for EAP sessions.
96101$0Psychological testing, interpretation and reporting by a psychologist (per Hour)
90880$111.16Hypnotherapy limit 10 units/hours per application
90849$36.81Multiple family group psychotherapy
90785$15.52Interactive 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$0Pharmacologic Management after therapy.
99050$0Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
99051$0Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.
99354$132.09Additional 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$100.33Additional time after first 60 minutes. First additional 30 to 74 minutes.
90840$70.7430 additional minutes of psychotherapy for crisis. Used only in conjunction with CPT 90839.
90833$72.9030 minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, then has 30 minute session.
90836$92.3945 minute psychotherapy add-on. Example: Clinical Nurse Specialist evaluates medication response, then has 45 minute session.
90792$160.96Psychiatric Diagnostic Evaluation with medical services (usually just one/client is covered)
99201$46.56Evaluation and Management – New Patient Office Visit – 10 Minutes
99202$77.23Evaluation and Management – New Patient Office Visit – 20 Minutes
99203$109.35Evaluation and Management – New Patient Office Visit – 30 Minutes
99204$167.09Evaluation and Management – New Patient Office Visit – 45 Minutes
99205$211.12Evaluation and Management – New Patient Office Visit – 60 Minutes
99211$23.46Evaluation and Management – Established Patients – 5 Minutes
99212$46.19Evaluation and Management – Established Patients – 10 Minutes
99213$76.15Evaluation and Management – Established Patients – 15 Minutes
99214$110.43Evaluation and Management – Established Patients – 25 Minutes
99215$148.33Evaluation and Management – Established Patients – 40 Minutes
90833$72.90Evaluation and Management code for 30 minutes of psychiatry (used with 90832).
90836$92.39Evaluation and Management code for 45 minutes of psychiatry (used with 90834).
90838$121.26Evaluation and Management code for 60 minutes of psychotherapy (used with 90837).
99415$10.11First 30 additional minutes of prolonged services for evaluation and management
99416$4.33Each 30 additional minutes of prolonged services for evaluation and management
96105$105.74Assessment 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$111.88Standardized 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$0.00Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument
96112$140.39Developmental 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$62.80Each additional 30 minutes (List separately in addition to code for primary procedure)
96127$5.05Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
96116$99.61Neurobehavioral 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$86.25Each additional hour (List separately in addition to code for primary procedure)
96130$121.98Psychological 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$93.83Each additional hour (List separately in addition to code for primary procedure)
96132$136.42Neuropsychological 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$102.49Each additional hour (List separately in addition to code for primary procedure)
96136$48.00Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes
96137$44.03Each additional 30 minutes (List separately in addition to code for primary procedure)
96138$38.62Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
96139$38.62Each additional 30 minutes (List separately in addition to code for primary procedure)
90867$0Therapeutic repetitive transcranial magnetic stimulation (TMS); initial
90868$0Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent
90869$0Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent motor threshold re-determination with delivery and management
90870$180.09Electroconvulsive therapy (ECT)
90875$0Individual psychophysiological therapy incorporating biofeedback training, 30 minutes
90876$0Individual psychophysiological therapy incorporating biofeedback, 45 minutes
90882$0Environmental manipulation
90885$0Psychiatric evaluation of records
90887$0Interpretation or explanation to family
90889$0Preparation of psychiatric report
90899$0Unlisted psychiatric service or procedure
90901$41.50Biofeedback training by any modality
90911$0Biofeedback training, including EMG and/or manometry
H0016$0Alcohol and/or drug services; medical/somatic
H0017$0Behavioral health; short-term residential, without room and board
H0018$0Behavioral health; short-term residential
H0019$0Behavioral health; long-term residential
H0020$0Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)
H0021$0Alcohol and/or drug training service (for staff and personnel not employed by providers)
H0022$0Alcohol and/or drug intervention service (planned facilitation)
H0023$0Behavioral health outreach service (planned approach to reach a targeted population)
H0024$0Behavioral health prevention information dissemination service (one-way direct or non-direct contact with service audiences to affect knowledge and attitude)
H0025$0Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)
H0026$0Alcohol and/or drug prevention process service, community-based (delivery of services to develop skills of impactors)
H0027$0Alcohol 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$0Alcohol and/or drug prevention problem identification and referral service (e.g., student assistance and employee assistance programs), does not include assessment
H0029$0Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g., alcohol free social events)
H0030$0Behavioral health hotline service
H0031$0Mental health assessment, by non-physician
H0032$0Mental health service plan development by non-physician
H0033$0Oral medication administration, direct observation
H0034$0Medication training and support
H0035$0Mental health partial hospitalization, treatment,
H0036$0Community psychiatric supportive treatment, face-to-face,
H0037$0Community psychiatric supportive treatment program
H0038$0Self-help/peer services
H0039$0Assertive community treatment, face-to-face
H0040$0Assertive community treatment program
H0041$0Foster care, child, non-therapeutic
H0042$0Foster care, child, non-therapeutic
H0043$0Supported housing
H0044$0Supported housing
H0045$0Respite care services, not in the home
H0046$0Mental health services, not otherwise specified
H0047$0Alcohol and/or other drug abuse services, not otherwise specified
H0048$0Alcohol and/or other drug testing: collection and handling only, specimens other than blood
H0049$0Alcohol and/or drug screening
H0050$0Alcohol and/or drug services, brief intervention
H1000$0Prenatal care, at-risk assessment
H1001$0Prenatal care, at-risk enhanced service; antepartum management
H1002$0Prenatal care, at risk enhanced service; care coordination
H1003$0Prenatal care, at-risk enhanced service; education
H1004$0Prenatal care, at-risk enhanced service; follow-up home visit
H1005$0Prenatal care, at-risk enhanced service package (includes h1001-h1004)
H1011$0Non-medical family planning education
H2000$0Family assessment by licensed behavioral health professional for state defined purposes
H2001$0Comprehensive multidisciplinary evaluation
H2010$0Rehabilitation program, per 1/2 day
H2011$0Comprehensive medication services
H2012$0Crisis intervention service
H2013$0Behavioral health day treatment
H2014$0Psychiatric health facility service
H2015$0Skills training and development
H2016$0Comprehensive community support services
H2017$0Comprehensive community support services
H2018$0Psychosocial rehabilitation services
H2019$0Psychosocial rehabilitation services
H2020$0Therapeutic behavioral services
H2021$0Community-based wrap-around services
H2022$0Community-based wrap-around services
H2023$0Supported employment
H2024$0Supported employment
H2025$0Ongoing support to maintain employment
H2026$0Ongoing support to maintain employment
H2027$0Psychoeducational service
H2028$0Sexual offender treatment service
H2029$0Sexual offender treatment service
H2030$0Mental health clubhouse services
H2031$0Mental health clubhouse services
H2032$0Activity therapy
H2033$0Multisystemic therapy for juveniles
H2034$0Alcohol and/or drug abuse halfway house services
H2035$0Alcohol and/or other drug treatment program
H2036$0Alcohol and/or other drug treatment program
H2037$0Developmental 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.

Billing Advice

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.

Reach Out

Consider hiring a service like TheraThink that exclusively does mental health insurance billing.

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