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Plans, Billing Codes, and Authorizations

I am credentialed with most Sanford and Avera health plans. As of July 5, 2024, I am no longer participating with Wellmark, Anthem, or BlueCross plans.

I am a South Dakota Medicaid and Medicare provider, and I am a Federal Medicare provider. Medicaid rules prohibit me from credentialing with Medicaid in other states or billing as an out-of-network provider for Medicaid in other states.

I am not in-network with any other insurances. If your insurance company tells you otherwise, they are mistaken. Some insurance companies have listed me as in-network even though I did not apply or sign a contract with them. Because my practice is just me, I have to be selective with which companies I credential with in order to run my business. I base these decisions on the admin time required to bill each company as well as the reimbursement rates. If I cannot sustainably accept the offered contract, I do not credential with that company.

In addition to these insurances, I provide EAP therapy services through Lyra Health, Modern Health, and Spring Health. Check with your employer regarding your benefits and coverage.

If I am not in-network with your insurance, I can provide you with a superbill that allows you to request reimbursement from your insurance company after you have paid for the services directly. I can also use Thrizer to bill out-of-network.

I provide EAP therapy services through Lyra Health, Modern Health, and Spring Health.

Under the ACA, health insurance plans are required to cover mental health. However, I recommend calling your insurance company at the customer support number on the back of your card to get information about coverage, deductibles, co-pays, and prior authorizations.

Since most of my sessions are conducted via telehealth, all billing codes also include a telehealth specifier. Ask your insurance provider if telehealth sessions are covered under your policy.

Please be aware that insurance companies reserve the right to deny coverage even if they have told you that a service is covered. I recommend getting the name of the representative you spoke with, an identification number for the call, and note the date and time of the call.

Please also be aware that, if your insurance denies coverage or does not cover the full cost of services, you are responsible for your balance. If this occurs, I can work with you on setting up a payment plan that fits your budget.

I use the following billing codes in my practice:

90791: Diagnostic interview/intake. This code is used to bill your first session or a new intake session if you have not been seen for more than six months.

90837: One-hour appointment, which is any appointment lasting longer than 53 minutes.

90834: 45-minute appointment, which is an appointment lasting 38 minutes to 52 minutes.

90832: Half-hour appointment, which is an appointment lasting 16 minutes to 37 minutes.

90839: Crisis session, which is an appointment of up to 60 minutes for crisis intervention.

96136/96137: Psychological testing administration, measured in 30 minute increments. Administration lasting 16-45 minutes is billed as one unit. The first code is for the first half hour of testing, with additional units billed as the second code.

96130/96131: Psychological testing interpretation and report writing, measured in 60 minute increments. The first hour is billed as the first billing code, with additional units billed as the second code.

If your insurance changes, or you lose coverage, please let me know right away so that you are not surprised with a bill. If you have a deductible plan, note that the deductible typically starts over on January 1, so your bill might increase at this time.

Pampas Flower
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