Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.
In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.
Learning Objectives
Students will:
- Analyze reimbursement rates for mental health treatments
To prepare for this Practicum Journal:
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Order Paper Now- Research reimbursement rates for various treatment modalities.
- Compare NP rates to other provider rates.
For this Practicum Journal:
Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.
NURS 6670
Reimbursement Rate Template
| Type of Service
eg. -New office visit -Established office visit -Inpatient hospital -individual psychotherapy -group psychotherapy (see examples below) |
CPT code | Private insurer reimbursement rate for PMHNP | Private insurer reimbursement rate for physicians | Medicare
reimbursement rate for PMHNP |
Medicare
reimbursement rate for physician |
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As the PMHNP becomes proficient in diagnosing and treating, it is also important to learn how to bill for your time. The CMS sets up codes to identify the type of service you are providing. You will generally complete this task at the end of the visit as you are documenting the visit with the client. Here are examples of the codes to know:
CPT Codes for Psychiatric and Psychological Procedures
HMSA recognizes the following service codes for the reporting of psychiatric and psychological services. (See Code Books for information on how to obtain the books.)
| CPT Code | Footnote(s) | Description |
| 90791 | 1 | Psychiatric diagnostic evaluation |
| 90792 | 1,3 | Psychiatric diagnostic evaluation with medical services |
| 90832 | 2 | Psychotherapy, 30 minutes with patient and/or family member |
| 90833 | 2,3 | Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service |
| 90834 | 4 | Psychotherapy, 45 minutes with patient and/or family member |
| 90836 | 3,4 | Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service |
| 90837 | 6 | Psychotherapy, 60 minutes with patient and/or family member |
| 90838 | 3,6 | Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service |
| 90839 | 6 | Psychotherapy for crisis; first 60 minutes |
| 90840 | 2 | each additional 30 minutes |
| 90846 | 4 | Family psychotherapy (without the patient present) |
| 90847 | 4 | Family psychotherapy (conjoint psychotherapy) (with patient present) |
| 90849 | 4 | Multiple-family group psychotherapy |
| 90853 | 4 | Group psychotherapy (other than of a multiple-family group) |
| 90870 | 1, 5 | Electroconvulsive therapy (includes necessary monitoring) |
| 96101 | 1 | Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour.
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis. |
| 96118 | 1 | Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis. |
Links to websites that discuss this:
http://www.mb-guide.org/medical-coding-guidelines.html
12/29/2020 Rubric Detail – Blackboard Learn
https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16781899_1&rubric_id=_2083044_1 1/2
Rubric Detail Select Grid View or List View to change the rubric’s layout.
Excellent Good Fair Poor
Quality of Work Submitted: The extent of which work meets the assigned criteria and work re�ects graduate level critical and analytic thinking.
27 (67.5%) – 30 (75%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
24 (60%) – 26 (65%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.
21 (52.5%) – 23 (57.5%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.
0 (0%) – 20 (50%)
Assignment super�cially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Quality of Work Submitted: The purpose of the paper is clear.
5 (12.5%) – 5 (12.5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.
4 (10%) – 4 (10%)
Purpose of the assignment is stated, yet is brief and not descriptive.
3.5 (8.75%) – 3.5 (8.75%) Purpose of the assignment is vague or o� topic.
0 (0%) – 3 (7.5%)
No purpose statement was provided.
Name: PRAC_6670_Week7_Assignment3_Rubric EXIT
Grid View List View
12/29/2020 Rubric Detail – Blackboard Learn
https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16781899_1&rubric_id=_2083044_1 2/2
Excellent Good Fair Poor
Written Expression and Formatting
Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, �ow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused– neither long and rambling nor short and lacking substance.
5 (12.5%) – 5 (12.5%)
Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity
4 (10%) – 4 (10%)
Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity 80% of the time.
3.5 (8.75%) – 3.5 (8.75%) Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity 60%- 79% of the time.
0 (0%) – 3 (7.5%)
Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity < 60% of the time.
Total Points: 40
Name: PRAC_6670_Week7_Assignment3_Rubric
EXIT
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