Guide for Parents: Insurance Reimbursement for Assessments
While we do not directly process insurance or submit paperwork to your insurance company, we assist clients by providing a superbill for possible reimbursement. A superbill will be generated at the end of the assessment once all appointments have been completed. The superbill will contain a breakdown of all the appointment types and services performed during the assessment.
It’s important to keep in mind that there are many individual factors that determine possible reimbursement including your plan coverage limits, co-insurance amounts, deductible, and out-of-pocket maximums. All of our providers are considered “Out of Network.” In our experience, reimbursement can vary greatly from the upper limit of 50% reimbursement of fees to very little to no reimbursement. Sometimes assessment fees can still be credited towards your deductible even if there is no reimbursement.
Families may wish to explore possible coverage for mental health services before beginning the assessment to understand if they may be eligible for reimbursement, and if so, what amount they might expect to receive. When calling your insurance company, you can provide them the CPT Codes ahead of time which will appear on the superbill.
CPT Codes:
90791 for the intake appointment (2 hours)
96136 for testing (1/2 hour)
+96137 (up to 11 hours)
96132 for the feedback (1 hour)
+96133 remaining feedback hours (2 hours)
+96133 also for scoring and report writing
Working with an insurance advocate can often be helpful in maximizing your reimbursement and appealing denials. If you plan to work with an insurance advocate, it is critical that you begin the process as soon as possible while you are scheduling your appointments with us as this process is time sensitive.
