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?
- 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:
- 96101 Psychological testing
- 96103 Psychological testing with computer
- 90846 Family therapy without patient present (feedback sessions)
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."