Generally how much does a Psychiatrist get payed for a follow up or initial?

[experiment113]

Hi all, I've been trying to read about coding and payment for Psychiatrists. When all is said and done, how much does insurance give a psychiatrist for follow up medical management, medical management and psychotherapy, etc and initials?
Thanks.

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[clausewitz2]

This is basically impossible to answer as a generic question.

What geographic area, what setting, what insurance(s), what codes are being billed, child or adult etc... You need to specify some.

 

[experiment113]

This is basically impossible to answer as a generic question.

What geographic area, what setting, what insurance(s), what codes are being billed, child or adult etc... You need to specify some.

North east, outpatient, medcare/medicaid, Adult.

 

[calvnandhobbs68]

North east, outpatient, medcare/medicaid, Adult.

Medicare and Medicaid are going to pay vastly different rates. You should be able to find Medicaid pretty easily based on whatever state it is and whatever code you’re looking for. Spoiler alert: it’ll suck.

Also you’re obviously a med student based on your other posts. So not sure what the point of this info is. If you were a resident actively searching for jobs, practices may share their average rates they were getting from insurers but even that can vary.

 

[experiment113]

Medicare and Medicaid are going to pay vastly different rates. You should be able to find Medicaid pretty easily based on whatever state it is and whatever code you’re looking for. Spoiler alert: it’ll suck.

Also you’re obviously a med student based on your other posts. So not sure what the point of this info is. If you were a resident actively searching for jobs, practices may share their average rates they were getting from insurers but even that can vary.

It was just a question I had. Not sure what the point of you searching my other posts or wondering what the point of this info is.

 

[TexasPhysician]

$30-250 are rough numbers. They are all over the place.

 

[Stagg737]

North east, outpatient, medcare/medicaid, Adult.

Step 1: Look up your MAC locality (geographic region) here: https://www.cms.gov/files/document/cy2020-locality-key.pdf
Step 2: Go to this website: Overview of the Medicare Physician Fee Schedule Search
Step 3: Agree to terms
Step 4: Type in billing codes you want to search. Probably 99213-215 for f/up (could also add 90833 for therapy add-on) and either 99204/205 or 90792 for initial evals.
Step 5: Select "all modifiers" from the drop down.
Step 6: Find your MAC in the results

You can play around with the search, but it will also search for specific MACs, localities, or RVUs as well as other things. For example, what you're looking for in Massachusetts depending on where you physically practice in the state would have a maximum non-facility fee (office setting) for 99214 between 135.79 to 145.75 and a max facility fee of 103.21 to 108.81. Keep in mind, those numbers are maximum reimbursements from CMS and not what you may actually collect.

As said, there's a ton of variation based on geography, what codes you bill, payor type, etc and some of that info isn't really accessible to most people (even practicing physicians) without contracts.

 

[hamstergang]

Step 4: Type in billing codes you want to search. Probably 99213-215 for f/up (could also add 90833 for therapy add-on) and either 99214/215 or 90792 for initial evals.

You mean 99204/205 for initial evals.

 

[Stagg737]

You mean 99204/205 for initial evals.

Fixed, thanks for the catch.

 

[dl2dp2]

$30-250 are rough numbers. They are all over the place.

Kinda interesting. This basically implies that by definition if you are at Medicaid or FQHC your salary is a line item rather than based on billing.

 

[calvnandhobbs68]

Kinda interesting. This basically implies that by definition if you are at Medicaid or FQHC your salary is a line item rather than based on billing.

Your salary should absolutely not be based on billing if you see a large proportion of medicaid patients in a practice setting. In the regions I've looked, Medicaid pays about 50% less per code than private insurance. Add that to the fact that you can't charge Medicaid patients no-show fees (or fees for anything really) and quite honestly Medicaid is more of a money loser than it's worth for most practices unless you're getting some sort of government support/extra funding. This ends up then translating into stuffing patients into 15min slots to make the same amount of money (barely) you would for seeing private insurance patients in 30min slots and hoping some no-show since your salary isn't usually based on any productivity incentive.

 

[dl2dp2]

Your salary should absolutely not be based on billing if you see a large proportion of medicaid patients in a practice setting. In the regions I've looked, Medicaid pays about 50% less per code than private insurance. Add that to the fact that you can't charge Medicaid patients no-show fees (or fees for anything really) and quite honestly Medicaid is more of a money loser than it's worth for most practices unless you're getting some sort of government support/extra funding. This ends up then translating into stuffing patients into 15min slots to make the same amount of money (barely) you would for seeing private insurance patients in 30min slots and hoping some no-show since your salary isn't usually based on any productivity incentive.

I recently had several meetings where the executive directors of medium-sized private clinic systems intimated to me that there are other ways to get revenue dollars from groups of Medicaid patients, and under certain circumstances, they are required to have MD staff. These things are very opaque, state/system-dependent and often ad-hoc based on the situational policy which is buried somewhere dud to reactions to some transient event (i.e. media coverage).

The following can be considered euphemisms rather than reality during salary negotiation in a Medicaid driven system.
1. "We can't pay you $X because the salary line is not budgeted for $X by the state".
2. "We are losing money on you."
3. "By definition this job cannot pay market salary."

The fact that you are having a conversation with them means that they have some reason to not use an NP for this role. Negotiate nicely but aggressively.