Guidelines for Checking Insurance Benefits
Call the Mental Health Number on the back of your insurance card.
Ask if you have out-of-network mental health benefits.
If no, end the call.
If yes, ask if you have coverage for the CPT codes that may apply to you (see below).
If you indeed have coverage, find out if you need pre-certification and how it is obtained.
Call or email your provider with information about pre-certification documents, if necessary.
If you need further assistance, call our office at 443-906-1132
Other important questions for your insurance provider:
What is my deductible and has it been met? [If not met, once I pay the deductible, what is my copay/coinsurance?]
How many sessions per calendar year does my plan cover?
What is the coverage amount for an out-of-network therapy session?
What documentation/information is required to submit for insurance reimbursement?
Are telehealth sessions covered?
Possible CPT codes for therapy clients:
90791 Initial evaluation session/consultation
90837 Psychotherapy sessions
90846 Family therapy without patient present
90847 Family therapy with patient present
Possible CPT codes for evaluation/testing clients:
90791 Initial evaluation session/consultation
96130 Psychological testing evaluation services; first hour
96131 Psychological testing evaluation services; each additional hour
96136 Psychological or neuropsychological test administration; first 30 minutes
96137 Psychological or neuropsychological test administration; each additional 30 minutes
96146 Psychological testing with computer
A note about Telehealth sessions:
Per the Maryland Health Care Commission: "Private Payors are required to cover telehealth services that otherwise are covered via face-to-face. The law is Maryland Insurance Code §15-139. It is best to reach out to the individual payor to determine their policy around telehealth reimbursement and billing procedures. CareFirst's policies is available by searching their Medical Policies on their page."