GOOD FAITH ESTIMATE
This Good Faith Estimate explains your therapist’s rate for each available service. 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.
Please note that there is no difference for estimated fees whether services are provided in-office or via telehealth.
TABLE OF SERVICES AND FEES As of 12/1/2023
| Service code (CPT Code) | Description | Fee for Service |
| 90791 | Initial Diagnostic Evaluation | $250 |
| 90834 | Psychotherapy, 38-50 minutes | $160 |
| +90836 | Psychotherapy patient with family, with Evaluation & Management; 45 min (Add-on to 90834) | $80 |
| 90837 | Psychotherapy ≥ 50 minutes (This fee is the hourly rate & used for all prorated calculations as indicated) | $210 |
| +90838 | Psychotherapy patient with family, with Evaluation & Management; 60 min (Add-on to 90837) | $100 |
| +90785 | Interactive Add-on (ie: play therapy, EMDR) | $60 |
| 90839 | Psychotherapy for a Crisis (30-74 minutes) | $215 |
| +90840 | Psychotherapy for a Crisis (Add-on code for each additional 30 mins) | $85 |
| 90846 | Family Psychotherapy without Patient Present, 50 minutes | $210 |
| 90847 | Family Psychotherapy with Patient Present, 50 minutes | $210 |
| 90853 | Group Psychotherapy | $115 |
| 98966-98968 | Telephone Assessment & Management 98966: 5-10 minutes 98967: 11-20 minutes 98968: 21-30 minutes | Prorated @ Code 90837 rate, based on the amount of time spent 98966: $35 98967: $70 98968: $105 |
| 98970-98972 | Online Digital Evaluation & Mgt (Responding to Email & Text Messages) 98970: 5-10 minutes 98971: 11-20 minutes 98972: 21-30 minutes | Prorated @ Code 90837 rate, based on the amount of time spent 98970: $35 98971: $70 98972: $105 |
| 99242 – 99244 | Office Consultation for New or Established Patient 99242: 30 minutes 99243: 40 minutes 99244: 60 minutes | Prorated @ Code 90837 rate, based on the amount of time spent 99242: $105 99243: $140 99244: $210 |
| Cancelation Fee | Your Therapist Requires a 24-hour Cancelation Notice. You are responsible for the fee if the notice is given less than 24 hours prior to the scheduled appointment time, or missed without notification. | $145 |
| 00000 | Patient Contact- 60 min | $210 |
| 00001 Legal Fees | This includes Subpoenas, legal consultations, and depositions. Also may include travel time to and from venues if necessary. A $3000 retainer will be required for legal fees. | $340/hr and can be prorated based on time spent |
| 00002 Case Management | Letters, reports, consultations (These are not covered by insurance) | Prorated @ Code 90837 rate, based on the amount of time spent |
| 00003 Production of Records | Will require 30 days to complete after written authorization | $60 |
Please note that Place of Service (in office vs. telemental health) is not delineated above since the charges are identical