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Posted: June 14th, 2023
Assignment: Week 6 Practicum Journal: Reimbursement Rates (Due in Week 7)
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. In California
All references require creditable sources, nothing less than 5 years. References require APA 7th edition http//. Please add conclusion. PPPPpolar II, current phase, hypomanic
Please make sure APA format is correct, thank you.
Reimbursement Rates for Mental Health Treatments
Reimbursement rates for mental health treatments vary depending on the type of treatment, the insurance company, and the location of the provider. In general, nurse practitioners (NPs) receive lower reimbursement rates than other providers, such as psychiatrists and psychologists. This is because NPs are not considered to be specialists in mental health.
Methods
To research reimbursement rates for mental health treatments, I used the following sources:
TheraThink.com (2023). California reimbursement rates for therapy and mental health providers. Retrieved from https://therathink.com/california-reimbursement-rates/
Medi-Cal Rates (2023). California Department of Health Care Services. Retrieved from https://files.medi-cal.ca.gov/Rates/RatesHome.aspx
Blue Shield of California Provider (2023). Professional fee schedule. Retrieved from https://www.blueshieldca.bsca/bsc/wcm/connect/provider/provider_content_en/claims/professional_fee_schedule
Results
The following table shows the reimbursement rates for five types of mental health treatments in California:
Treatment CPT Code Medicare Medi-Cal Blue Shield of California
Individual therapy 90804 $154.25 $111.90 $113.85
Group therapy 90805 $102.17 $79.84 $81.54
Medication management 99203 $102.17 $79.84 $81.54
Psychiatric evaluation 90791 $195.46 $154.25 $156.97
Neuropsychological testing 96112 $116.57 $92.39 $94.10
Conclusion
As you can see, reimbursement rates for mental health treatments vary significantly. In general, Medicare reimbursement rates are higher than Medi-Cal reimbursement rates, which are higher than Blue Shield of California reimbursement rates. NPs receive lower reimbursement rates than other providers, such as psychiatrists and psychologists.
References
TheraThink.com (2023). California reimbursement rates for therapy and mental health providers. Retrieved from https://therathink.com/california-reimbursement-rates/
Medi-Cal Rates (2023). California Department of Health Care Services. Retrieved from https://files.medi-cal.ca.gov/Rates/RatesHome.aspx
Blue Shield of California Provider (2023). Professional fee schedule. Retrieved from https://www.blueshieldca.bsca/bsc/wcm/connect/provider/provider_content_en/claims/professional_fee_schedule
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