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:

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

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:

https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement

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