INSURANCE

I am  not a participant or network provider for ANY insurance plan. Patients pay me directly at the time of service by cash, checks , or credit card (credit card charge includes a 3% bank service charge).  I will provide a monthly statement showing what  already been paid to me, and all the appropriate codes which patients themselves can sent to their insurance company, using the forms provided to them by their insurance in order  to get reimbursement according to the benefits of their plan.

Prior-Authorization for Medications:

Some medications require prior authorization by insurance to be covered.  I will fill out such prior authorizations when routine.  However, sometimes authorizations are much more complex, take a long time, require appeal letters to be witten, cals to be made and other significant demands on my time.  If these activities take more than 10min, I will charge a patient for my time at that point, or else we can work on this while in session together.

Medicare Patients:

I have "opted-out" of Medicare. This means that, although I can see Medicare patients, they will receive NO REIMBURSEMENT from Medicare for my services.  Medicare patients are required to fill out an acknowledgement that I am opted-out and that Medicare wil not reimburse for my services.

Medicaid (Medical Assistance) Patients:

At this time, I can see patients who have Medicaid (Maryland Medical Assistance).  However, since I am NOT an enrolled provider in the program (I am a "OPR" provider--Ordering, Prescribing, Referring, but not billing) , the State of Maryland will not reimburse patients for my fees.

An Note On CPT Codes & Insurance Reimbursement:

          CPT codes describing psychiatric services for insurance billing were put into place starting in 2013. These will appear on my statements. This coding system is based on the nature and complexity of interventions and medical decision making during a session as well as time doing psychotherapy.

For patients being prescribed medication, most sessions will have TWO CODES depending on how the time is spend:

    ---One code (9921x), called an E&M code.  It captures the time and complexity that is spent thinking medically--symptoms, side effects, dosage adjustment, medication choices, ordering or reviewing lab tests, my physical and neurological observations,  focusing on other medical problems, etc. The value of ‘x’ will vary.

    --The other code (9083x) refers to any talking psychotherapy done in the session, based on the time spent doing that (determining the value of ‘x’).

       --Sometimes sessions may be entirely one kind of activity, not both, so those will have only a single code.

These codings will not affect my published fees that patients pay me, only the amount of reimbursement from medical insurance to you if you chose to seek insurance reimbursement. My appointments remain set by time and billed by time exclusively.  I use the traditional model for psychiatry: my fees are strictly based on the time spent, not on what is done during the session.  Yet, the CPT codes do reflect what is done during the session, so they might vary visit-to-visit.  So your insurance reimbursement may accordingly vary visit-to-visit.  My total charges though will not,  except if times of the  appointments vary.

The following CPT codes are the commonly used ones in psychiatry.  Check with your insurer for it’s latest payment schedule for these codes.

Commonly used CPT codes for psychiatric treatment

Initial evaluation: 90792 or 99205

E&M codes:  99213, 99214, or 99215

   these can be used alone or often in combination with:

“Add-On” Psychotherapy Codes:  90833, 90836, or 90838

When a session has ONLY therapy

  and no E&M code applies: 90832, (half hour( or 9083  (hour)