CENTER FOR BEHAVIORAL HEALTH AND SLEEP DISORDERS

Billing

• Patients with Insurance: It is not always possible to determine patient eligibity or provide in-network status. Sometimes, it takes an intial visit until these details are clearer. Hence, you might be charged a fee for the visit upto equivalent of self pay.

• Patients may have copays, deductibles and/or coinsurance. Note that these amounts may vary depending on your insurance plan. An active credit card has to be on file to bill the amounts at the time of checking for the appointment. Cash or check is also acceptable. Failure to pay may lead to cancellation of the appointment.

• If sleep studies are ordered, the pertinent sleep lab determines eligibility and bills for the technical component whereas the sleep lab or the interpreting sleep physician (likely Dr. Adury) will be billing for the professional component.

• You might receive monthly statements if any fees are due, with links to payment.

• If you have any questions about your dues, a phone number will be provided, so you can call.  

Coding

• Initial assessment are 45 minutues to an hour or longer. The E/M codes for such visits are 99203, 99204 or 99205. If time has been spent in counseling, add-on codes will be used in adddition to the above codes. These add-on codes are 90833, 90836, or 90838 which are time dependent and have their own fee structure.

• Another type of Initial Assessment code is 90872 (Psychiatric Diagnostic Evaluation with Medical Services). 

• Follow-up E/M codes can be 99213, 99214 or 99215. Again, add-on therapy codes mentioned above can be used in conjunction with these codes.

 

Self-pay fees for Office Visits:

• 1 hour Initial Assessment: $300

• 30 minute Follow-up: $200

• 45 minute Follow-up: $275

 

TMS Codes:

• 90867: Initial, including cortical mapping, motor threshold determination, delivery and management

• 90868: Subsequent delivery and management per session

• 90869: Subsequent motor threshold redetermination with delivery and management

 

Sleep study codes: These have a technical component billed by the sleep lab and a professional component billed by the interpreting sleep physician.

• 95810: Polysomnography age 6 or older, sleep staging with 4 or more additional parameters of sleep attended by a technologist

• 95811: Polysomnography age 6 or older, sleep staging with 4 or more additional parameters of sleep, with initiation of positive airway pressure therapy or bilevel ventilation, attended by a technologist

• 95805: Mean sleep latency test or maintenance of wakefulness test, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

• 95800: Sleep study unattended, simultaneous recording, heart rate, oxygen saturation, respiratory analysis and sleep time

• 95801: Sleep study unattended, simultaneous recording, heart rate, oxygen saturation, and respiratory analysis