Insurance & Fees

The providers at the CAPSS offices each have their own independent private practices and, as such, they each manage their own schedule, availability, fees, and insurance panels.

Fees

As independent practices, each provider’s fees are specific to their practice. Generally, therapy appointments are over $200 per 50-minute session. Comprehensive evaluations typically range from $2500-$5500 depending on complexity and type of evaluation. IQ Testing rates are posted on each provider’s self-scheduling link. Your provider will clarify their specific payment policies, but generally, clients are responsible for payment at the time of service.

Insurance

Most of the providers at CAPSS are not paneled with any insurance companies, and are considered “Out-of-Network” (OON) providers. One of our psychiatric nurse practitioners, Jeovana Oshan, ARNP, is in-network with a number of insurances (Premera Blue Cross WA, Cigna, Regence, Carelon Behavioral Health, Quest Behavioral Health, Aetna, & Optum). None of our providers are contracted with state-sponsored insurance plans such as Medicaid (Apple Health, Molina, etc.) or Medicare. You can read each provider’s individual webpage for details on which insurances, if any, they accept in their practice.

Insurance Reimbursement Tips

Even though most of our providers are Out-of-Network with most insurance plans, many of our clients find they are eligible for some amount of reimbursement for OON services from their insurance plan. OON coverage is unique to each insurance company and plan. We encourage you to contact your insurer prior to getting started, to inquire about your OON benefits for services. We suggest asking your insurance company the following information:

  • Do I have Out-of-Network coverage?

  • What are my Out-of-Network benefits?

  • Do I need a referral or prior authorization to see an Out-of-Network provider?

  • What is my annual deductible, and what amount has already been met this year?

  • After I meet my deductible, what percentage or dollar amount of the visit cost will I be reimbursed for? (Note: Be sure to reference the specific CPT codes your provider will be billing- see below)

  • Is there a limit to how many sessions (for therapy clients), “units” (for testing clients), or dollar amount I can be reimbursed for per year?

  • Will Telehealth (video) services be reimbursed by my plan?

  • What is the process to submit claims for reimbursement?

Services are billed using Current Procedural Terminology (CPT) codes, which are 5-digit codes specific to each service. Your provider can give you a “superbill”, which is the document that has all of the information that the insurance company will need in order to process your reimbursement. Prior to calling your insurance company, clarify with your provider which CPT code(s) they will bill, so that you can ask your insurance company specifically.

Common assessment CPT codes:

  • 90791 (intake appointment)

  • 96136 and 96137 (psychological test administration and scoring)

  • 96130 and 96131 (psychological evaluation services)

  • 96132 and 96133 (neuropsychological evaluation services)

Common therapy CPT codes:

  • 90791 (intake appointment)

  • 90832 (individual therapy 25-30 minutes)

  • 90834 (individual therapy 45-50 minutes)

  • 90837 (individual therapy 55-60 minutes)

  • 90846 (parent session without child present)

Common group CPT codes:

  • 90849 (multifamily group therapy)- Parenting Anxious Kids/ Teens

  • 90853 (group therapy)- Thriving Tweens

Telehealth visits are typically designated by adding "-95" to the above codes (e.g., 90834-95 is the CPT code for a 50-minute video therapy session).

Using FSA & HSA Accounts

Many families also use their FSA or HSA accounts to pay for medically-necessary services at CAPSS (e.g., comprehensive evaluations, medication visits, and individual and group therapy). Note that standalone IQ testing for school admissions is not typically reimbursed by insurance or by HSA/ FSA accounts due to it being educational in nature rather than medically-necessary).

Your individual provider can assist you with any additional information about their specific services and billing practices.