Insurance
Plans, Billing Codes, and Authorizations
I am credentialed with most Wellmark, BlueCross, and Anthem insurance plans. I am credentialed with Sanford Health Insurance but am unable to accept certain employee plans with Sanford. I am credentialed with Avera Health Insurance. I am a South Dakota Medicaid provider and a South Dakota Medicare Provider. I am able to accept Federal Medicare. If you are unsure if I am in-network with your insurance plan, I recommend calling them and asking about your coverage at the a customer service number on the back of your insurance card.
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I provide EAP therapy services through Spring Health and Lyra Health.
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Unfortunately, because I am located in South Dakota, I am not permitted to credential with Medicaid in other states even if I am licensed to practice there.
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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.
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Since all 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.
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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.
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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.
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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.
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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.
