Fee Schedule:
CPT Code or Name; Description; Fee in US Dollars
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90791; Initial Diagnostic Evaluation; $200
90832; Psychotherapy, 16-37 minutes; $125
90834; Psychotherapy, 38-52 minutes; $150
90837; Psychotherapy ≥ 53 minutes; [This fee is the hourly rate that is also used for all prorated calculations]; $175
90853; Group Psychotherapy; $75
98966-98968; Telephone Assessment & Management; Prorated based on amount of time spent at hourly rate.
98970-98972; Online Digital Evaluation & Mgt [Responding to Email & Text Messages] Prorated based on the amount of time spent at hourly rate
Late Cancelation Fee; We Require 24-Hour Notice for Cancelation; You are Responsible for Fee of Missed Appointment.
99446; Interprofessional Consultation of medical consultative discussion and review 5-10 minutes; $75
99447; Interprofessional Consultation 11-20 minutes; $100
99448; Interprofessional Consultation 21-30 minutes; $160
99449; Interprofessional Consultation ≥ 31 minutes; $200
Production of Records; Our costs for reproducing, accessing, and delivering paper or electronic forms; $.50 Per Page
Intervention (Developmental or Educational); May include Educational Therapy (not clinical services), Educational Support, Developmental Training; $50 per session.
Court & Legal Fees; Hourly cost of records review, research, preparation, and testimony; $500
NOTE: This Good Faith Estimate explains your therapist's rate for each service provided. Your therapist will collaborate with you throughout your treatment to determine how many sessions and/or services you may need to receive the greatest benefit based on your Diagnosis(es)/presenting clinical concerns.
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Your Good Faith Estimate:
# Times ___ for 1st Service X Cost Per Service $___ = $______
# Times ___ for 2nd Service X Cost Per Service $___ = $______
# Times ___ for 3rd Service X Cost Per Service $___ = $______
# Times ___ for 4th Service X Cost Per Service $___ = $______
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Add All Services Above for Estimate TOTAL = $______**
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**Please note that Place of Service [In-Office V. Telemental Health] is not delineated above as charges are same.
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