Fee Schedule and Payment Policy

Attention:

"Fee Schedule and Payment Policy" is currently being revised.  Fees and policies may be different than what is seen here.  Please contact Dr. Hines if you have a question about a particular fee or policy while revision continues.

 

Dr. Hines' fee schedule is listed below.

Each service offered is listed by name and by CPT code. The five digit number in front of the fee is called the "CPT" code. These are universally used in the US. They describe what service was rendered, where it was rendered, it's complexity and other variables. Below are only some of many psychiatric CPT codes used. I have tried to explain the visits listed here. Charges and payments are based on the CPT code, as well as the diagnosis and other factors. OV means office visit.

 

Initial Neuropsychiatric Evaluation:

OV90801: $500.00 per hour

This is for a new patient. A history and review of symptoms is taken, a Mental Status Exam is performed, a physical exam is ordered, usually done by the individual's primary care MD, labs are checked and other testing or brain imaging may be ordered . Technically no medication should be prescribed until all of the above have been completed. With this information, the psychiatrist now formulates a differential diagnosis, and a treatment plan. Follow up visits are scheduled with the severity of an individuals diagnosis being the guideline for when a follow up visit is scheduled. The initial visit may take an hour or two. At the follow up appointment, the diagnosis is discussed, labs reviewed, and treatment options are discussed, with the pros and cons of the treatment plan and those of no treatment and alternative treatments.

 

Initial Neuropsychiatric Consultation:

OV99241 (minimal problem, 15 minutes):  $125.00

OV99242 (low severity problem, 20 - 30 minutes):  $150.00

OV99243 (moderate severity problem, 45 minutes):  $300.00

OV99244 (moderate to high severity, 60 minutes):  $425.00

OV99245 (moderate to high severity, 80 minutes): $500.00 

 

Fee is time based The different codes reflect amount of time spent, complexity and other variables. A consultation is very much like an initial evaluation. One difference is that a consultation is usually requested by another physician. Also, findings are communicated to the referring physician. No treatment is performed. Guidelines or suggestions for treatment may be made, however. Once care is initiated by the psychiatrist, it is no longer a "Consultation".

 

Medication Management alone:

OV90862 (5-10 minutes) : $85.00

 

Generally, a brief medication visit of 5 - 10 minutes is indicated for individuals who are relatively stable, and need only minor medication adjustments, or monitoring alone.

 

Medical Psychotherapy:

"Medical psychotherapy" includes management of your medications and other complicating medical problems in addition to psychotherapy.

OV90805 (20 minutes) : $125.00

OV90805 (30 minutes) : $150.00

OV90807 (45 minutes) : $300.00

OV90807 (60 minutes) : $425.00

OV90809 (75 minutes) : $500.00

 

Types of Psychotherapy most frequently used :

Educational, Cognitive Behavioral Therapy, Interpersonal therapy, Insight-oriented or Psychodynamic psychotherapy, Behavioral Modifying, Meditation, Biofeedback, Supportive. social skills coaching.

 

Family Psychotherapy (without patient present)

OV90846 $500.00 per hour

 

Family Psychotherapy, with patient present

OV90847 $500.00 per hour

 

Marital Psychotherapy

OV90849 $500/00 per hour

 

Medical Evaluation and Management Services:

(see Consultations and phone calls)

 

Telephone Calls

Brief EM99213 (10 - 15 minutes) $85.00

Intermediate EM99214 (20 - 30 minutes) $125.00 - $150.00

Extended EM99215 (45 - 80 minutes) $300.00 - $500.00

Phone calls are sometimes "bundled" Their time may be added to an office visit, especially if it is within a day or two of the call. Otherwise they are charged for by time, complexity , severity of problem.

These are billed on a time basis, usually the same as the same amount of time in the office would cost. (please see above medical psychotherapy fees). If a call is after hours, in the middle of the night, on weekends or holidays, or is of an emergency nature, an additional surcharge is allowed and coded with CPT modifiers -21, 0r -22.

Most insurance companies will not routinely cover the cost of phone calls, so you will probably need to pay for all of it yourself. We do encourage you to explain to your insurance company why the call was necessary, and how it ultimately saves them money, as well. Many episodes of depression and mania can be averted by prompt adjustments in medication and or environmental interventions over the phone, followed by an office visit as soon as possible. 

 

Group Therapy:

OV90853

$125.00/per person/per session

(90 minutes - usually around 6 people in a group)

6 weeks commitment requested

Typically groups are small, and focused on education and coping with specific disorders or issues.

 

Online Medical Evaluation

Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient.

0074T $300.00 per hour

Biofeedback:  90901

OV90875 (10 - 40 minutes ):  $300.00

OV90876 ( 45 - 80 minutes):  $500.00 

 

Environmental Interventions with agencies, employers or institutions for medical management services on a psychiatric patient's behalf.

90882 $300.00 per hour

 

Psychiatric Evaluation of hospital records, other psychiatric reports, psychometric or projective tests and other accumulated data for medical diagnostic purposes.

90885 $500.00 per hour

 

Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient:

90887 $300.00 per hour

 

Preparation of report of patient's psychiatric status, history, treatment or progress (Other than for legal or consultative purposes) for other physicians, agencies or insurance carriers .

90889 $500.00 per hour

 

Unlisted psychiatric service or procedure

90899 $500.00 per hour

 

Special Services, Procedures and Reports

Reports, insurance forms, disability reports, internet searches: $500.00/hour

 

99050 Services provided outside regular office hours, on weekends, or on holidays (10% surcharge)

 

99051 Services regularly scheduled after hours, on weekends or holidays (Surcharge of 10%)

 

99056 Services usually provided in the office, provided outside the office at the request of the patient (ie home visits)  $500.00 per hour.

 

99071 Educational materials provided to the patient, at physician's expense (cost)

 

99078 Education to a group of patients by the physician

$500.00- $1000.00 per hour

 

99080 Special Reports, such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form. $500.00 per hour.

 

99082 Unusual travel:  Cost depends on specifics.

 

Medical Evaluation and Management Services:

 

These CPT Codes are meant to describe a more general type of service, less specific to psychiatry, for example, management of migraine headaches, endocrine imbalances , or short term treatment of other medical problems, until you are able to get in to see your internist or primary care physician. In addition to the time spent "face-to-face" with the physician, other factors are included in determining the reimbursement level, such as complexity or urgency of the situation, or amount of paperwork or phone calls involved.  

 

There are many EIM codes but Dr. Hines primarily uses psychiatric CPT codes as they better describe psychiatric services.

 

The CPT guidelines also factor in what the doctor does and how severe or complicated your medical condition is.

 

If a call is after hours, in the middle of the night, on weekends or holidays, or is of an emergency nature, an additional surcharge is allowed and coded with CPT modifiers -21, 0r -22.

 

Most insurance companies will not routinely cover the cost of phone calls, so you will probably need to pay for all of it yourself.  Dr. Hines does encourage you to explain to your insurance company why the call was necessary, and how it ultimately saves them money, as well. Many episodes of depression and mania can be averted by prompt adjustments in medication and or environmental interventions over the phone, followed by an office visit as soon as possible. If you are unable to pay for the phone charges and have an appointment in a day or two, the phone charges can be "bundled" in to your visit. Sometimes insurance companies will then cover the phone call if it is worked into your office visit.

 

Missed appointments.

If you are not having an emergency, yet do not show up or call to cancel, there will be a $25.00 fee, Other people are often waiting for cancellations and they can't use the time if you don't call to cancel.

 

 

"CPT" Codes: What are they?

The services provided by a physician are identified by their "CPT code". Every year the A.M.A. publishes an updated version of the Current Procedural Terminology, a book which describes in detail specific actions which physicians perform. Every procedure has a specific combination of letters and numbers to describe it called it's "CPT Code". This must be listed on your invoice, and describes the specific service or services which have been rendered to you. Reimbursement is based on the work done, documented with these codes.

For example, OV90801 is the CPT code for an Office Visit, during which you receive your initial Neuropsychiatric evaluation. If the same evaluation were performed somewhere else, such as a hospital, or during a visit to your home, the CPT codes might be different. E/M codes are "Evaluation and Management" codes

Legal Consultations/Medical Testimony:

$500.00/hour for legal research 99075

 

$1000.00/hr for depositions or court appearances, with a five hour minimum per day, plus costs incidental to the court appearances. Forty Eight hour cancellation notice required, and payment is necessary in advance. Cashier's check or money order for prepayment. Medical Testimony 99076.

 

Payment Policy

 

Full payment for services is due before or at the time of your visit. This helps Dr. Hines be more efficient and spend more of her time taking care of your medical needs, rather than spending hours on insurance filing and billing. Thank you.

This practice is a fee-for-service practice. If you use insurance, Dr. Hines will provide you with a "Superbill", which you can attach to your claim form and submit. The superbill has the information which insurance companies need to process your claim. Be aware however, that some people choose not to submit their claims. When you submit a claim, the insurance company now has a record of your diagnosis, which is entered into a national computerized database. Not everyone feels comfortable with this. Dr. Hines will still give you the superbill, which you may also use for tax purposes.

Insurance Issues:

Depending on your insurance, you may choose to submit your charges for reimbursement. . It is always a good idea to check out your insurance before you begin treatment, so you will know from the beginning how much, if any of your treatment will be covered, and what you need to do for it to be covered, i.e. -preauthorization of visits, etc. There should be a number to call on the back of your insurance card. You might ask specific questions, such as:

1) How much reimbursement is there for participating providers?

2) What are your "usual and customary" charges for OV90801, OV90805, OV90807, OV90862?  Each insurance company "decides" what the UCR's are.  They do not reflect what psychiatrists actually charge usually or customarily.

3) Obtain the name of the person with whom you spoke, and write down all the answers you are given.

4) Is pre-certification necessary? For what codes? How is it obtained?

5) Know that you may receive many different answers, depending on with whom you talk. If the person does not seem sure about their answers, request to speak with their supervisor and ask the questions again.

6)  Dr. Hines is not a participating provider for any insurance company.  She does primarily psychotherapy with med management and insurance companies often do not cover this by an MD. Master's level and PhD are preferred by the companies due to lower fees.

 

Medicare:

Dr. Hines is not a participating provider for Medicare or Medicaid.

She has been in the past, but it cost more than the care itself to hire a "specialist" to do the extensive paperwork, filing and appealing of decisions. There are many psychiatrists who accept Medicare and/ or Medicaid. Medicare and Medicaid should be able to refer you to such a physician.  They are often in group practices or see patients for shorter periods of time.

 

Referrals to low cost treatment providers:

Unfortunately, neuropsychiatric care is usually covered at a significantly lower rate than most other medical conditions, except infertility and "cosmetic" plastic surgery, which are frequently not covered at all.  *NOTE*  As of January 1st, 2010, insurance companies are required by law to pay at the same rate as they do on other medical problems.  However, they are not required to offer mental health benefits at all.

 

Given this, Dr. Hines believes it is important to discuss if and how your financial situation is impacting your treatment. To minimize this, we encourage you to explore all the options which are available, so you can tailor your treatment plan in such a way that it does not create even more stress for you. There are locations in the community where people can be seen on a sliding scale basis. This means that the cost depends on your income. There are also resources in the community which are free or very inexpensive. Dr. Hines encourages individuals to take advantage of these resources. Some of them are listed at the end of this page.

 

PAYMENT

Cash, Personal Check, VISA, MasterCard, Discover and American Express. The practice is fee for service, which means you are expected to pay for services at the time of your visit. You will receive a receipt with information insurance companies will need. You may then submit this to your insurance company which may or may not cover services. 

It is best to call them ahead of your first visit to clarify what they will cover. Dr. Hines is not a participating provider for any insurance companies at this time. She is also not a Medicare or Medicaid provider. 

Dr. Hines offers phone consults when appropriate. She reserves the right to charge extra for weekends, holidays and calls after regular business hours. Insurance companies do not generally reimburse for phone calls, but  there are some occasions where it is still cost effective, especially when a well timed call can prevent hospitalization.

 

 

Community Resources

 

1.Your Insurance may not cover anything on your visits unless you see a participating provider. If you need to use your insurance, call the number on the back of your card. Ask what they cover on a non-participating provider. A Participating provider? Ask them to help you find a participating provider if you need one. You may very well be able to see this doctor for a co-pay only.

2.Medicare and Medicaid. Many doctors accept one or both of these. Medicare and Medicaid can tell you names of doctors who accept these insurances.

3. Some Community Resources for sliding scale or reduced fees:

 Provident Counseling: 314-533-8200 / 1-800-782-1008

Care and Counseling: 314-878-4340

Catholic Family and Children's Services:  636-391-9966

Lutheran Family and Children's Services:  314-837-0931

St. Louis University, Wohl Clinic:  314-577-8711

Washington University Clinic, Renard:  314-362-5065

St. Louis County Resources:  314-615-7471

In Jefferson County, Comtrea has locations in Festus and Arnold

 

SLIDING SCALE:  

Dr. Hines has been in practice for 23 years.  For the past 18 years she has not raised her fees and has seen many people for much lower than her fees.  This was for people who could not afford her full fees. Due to the current economy this is no longer possible.  The fees have been increased as posted on this website.  Dr. Hines will try to work with each of you so you can still afford treatment or will refer you to a community resource which offers sliding scale or low cost fees.

 

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