Good Morning,

I hope you can supply some answers to this question/debate that is appearing in my professional communities/networks this year.  There are some very sound therapies that require 75 minutes or longer to deliver a full intervention.  While I would like to use these therapies and see them as most beneficial for my clients, I am in several insurance networks and most of my clients use insurance to pay for sessions.  As far as I know, the main billing code for a mental health session – 90837 – only pays for 53 minutes.  Is it unethical to charge clients for additional time beyond the limits that insurance will pay?  Is there an ethical way to collect fees for same day sessions longer than 53 minutes if a client wants to use insurance?

Greetings Carrie,

That’s a great question. First, I believe a 90837 actually pays for 60 minutes of psychotherapy. However, many insurance companies don’t accept the code, or they simply reimburse the exact same amount for a 90837 as they do for a 90834 (45 minutes psychotherapy). (Some do pay more for a 90837, just make sure you check!).

  • 90791 (diagnostic evaluation without medical services, no time designation)
  • 90832 (30 minutes)
  • 90834 (45 minutes)
  • 90837 (60 minutes)

Now, as for your question about charging clients for extra time. It’s a good question! I’ve actually looked into this question quite a bit.
The answer seems to be that YES, one can bill clients for the extra time. It doesn’t violate your contract with insurance companies because it’s something that insurance does not pay for. In addition, you can charge extra fees for psychological tests, books, or any other services insurance doesn’t pay for–and you can set any rates you want for those services.

However, you cannot require clients to participate in any of the extended sessions or additional services. MDVIP got themselves into some conflict with insurance companies by requiring patients to pay $1500 a year for an elaborate physical that the insurance companies wouldn’t pay for. The problem wasn’t the physical per se, but the fact that one can’t join MDVIP without paying the $1500, or opt out of the physical without paying for it.

This isn’t unethical, but it’s in almost all cases either a violation of your contract with insurance companies, or it just goes against the essence of what being in network with insurance companies means–which is that clients will have access to your services and only need to pay their pre-designated co-pay.

I hope this helps!