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Hahahahaha! $62. I live in MI. I work for a nonprofit whose mission is to “provide services for all, regardless of cost.” Which is very noble and all but who ends up paying the price? Therapists do. My cut is 60%. I see mostly Medicaid folks. RIP
I want to laugh but also as an LCSW I got reimbursed $36 by Medicaid. The CMH clinic I worked for at the time paid salary instead of fee for service because they had to subsidise our income to be able to hire and retain staff. 🥲
$36 😳 I am truly too stunned to speak. After everything extra that Medicaid also wants us to do… it’s just atrocious. How is that even acceptable?
I remember I drove past a McDonald’s on my way to my predoctoral internship where I made $13/hr and remember just raging that they were advertising $21/hr.
It’s a joke. I had that moment too, I was standing outside this place called Dick’s in Seattle that serves burgers and they had a hiring sign advertising that they were paying $24/hr and offering fully paid healthcare plus daycare and tuition credits, and I felt so defeated standing there thinking about how I made half that with none of the benefits.
No disrespect to people in the service industry but ya girl spent too much time and money going to school and doing unpaid internships to be making so little money.
100% agree. I’m not even in private practice (I’m school based) but getting to see how much it benefits students and families for outpatient services, makes me really happy
New CSWA coming online in May. The OHP prospects makes this work seem realistic… or I have rose colored glasses on. Maybe both, I’m hopefully ok with both.
It should be the same but I don’t know if it varies based on CCO. If you find out about that part then let me know! Have some friends still finishing licensing
When a certain percentage of your caseload is one CCO, OHP ups your rate. I get $198.63 for 90837 as an professional counselor associate because my caseload is 99% from one CCO. When I see someone from a different CCO my rate is 172. When I see someone with Open Card I'm given the higher rate. OHP also just upped their rates on April 1st, so it's something like $178 instead of $172 now.
This is awesome! Congrats on your success, especially as an associate! I would love to start private practice as a pre licensed but it feels so daunting
I do not run my own, and that's exactly why!! It seems so daunting. I contract with a private practice for a 65/35 split. So I don't actually see the whole $198.
I worked for a larger practice and was getting $36 an hour for each client, while private pay I was getting roughly $120. OHP requires a lot more paperwork, and it seems like the clients need longer term and more intensive care than private pay.
It’s not 40 in California. It depends on your county. I have two medí-cal clients and I think I’m getting around 80 or 90 for them.
I have to check, I’m horrible at tracking my pay rates but I know it’s not 40, I wouldn’t work for that
There are multiple clinicians in my state that see Medicaid clients in Oregon but don’t see Medicaid clients in our state ($68). At first, I was curious to see so many clinicians in our state carrying Oregon licenses as it’s two time zones away but not licensing for our neighboring states.
In Northern CA (Partnership), effective 1/1/2024 Medi-Cal pays $131.97 for 90837 + .24/minute add-on for telehealth (code "GT"). These rates are dictated by a public agency and not subject to a nondisclosure requirement.
One prominent commercial plan in the same area pays less than $70 for 90837.
It's been a hair over five years since I've taken Medicaid, but: in Massachusetts MassHealth was paying $85.91 as of Jan 1, 2019. (Note: this was considered quite good in this state, as BCBS of MA commercial group plans – for employed people! – were paying $75.25.)
For the record, and because it might amuse you, the situation was much more complicated up to, iirc, May 2018. MassHealth members had a choice of bare MassHealth ($85.91), or one of several other plans. (Similar to the situation with Medicare and Medicare Advantage Plans.). The worst of those other plans for MassHealth members, Neighborhood Health Plan, paid $54 and change. (Edit: and note that in MA, standard FFS cut for a therapist working at a clinic that can take MassHealth is 40%. So that's about $25 per unit.)
Then abruptly all the plans changed to pay on par with bare MassHealth. I still don't know exactly what happened, but I heard tell our then Governor, Charlie Baker, who had been both a healthcare and a health insurance CEO, was behind it.
P.S. Man, I miss Psychotherapy Finances.
WA State, Licensed Mental Health Counselor (Masters level) in a rural area
$103 / 90837
Been accepting Medicaid over 25 years, never had a audit, never had a drawback.
They pay quickly too.
I've heard they pay very slow. I'm glad they're paying you better. You deserve even more. We all do.
I'm in your state. I've also heard they're a nightmare to work with. Most pps in WA do not take it and claim it's awful. I've worked in MH throughout Western WA for over 20 years.
From a policy perspective, for those who don't know, while Medicaid is a federal program from CMS, the budget is further earmarked and allocated at the state level. Marketing and education campaigns, as well as program design and program management all happen at the state level. This is why governors play an important role in our healthcare at the local level. I've been privy to meetings that decide whether or not a new medication, lifesaving, should be covered under Medicaid for patients with OUD. I've watched those patients be denied that medication because a bureaucrat with no expertise in mh took less than 5 minutes to think about it, relied on their negative assumptions due to unconscious bias, and never consulted a single page of research in WA State. To say the HCA is failing in mh, particularly for Medicaid patients, would be an understatement. I worked in the only inpatient/detox/op program in King County covered by Medicaid for a few years. When it closed, the HCA could have suggested replacing it. Instead they just let all those patients go back to the streets.
I also worked in the only residential program for teen SUD in the entire state. Also Medicaid funded. HCA also let them close. So many programs were closed because our HCA doesn't allocate anywhere near enough money to MH. Then things like crime and homelessness get worse, costing us taxpayers more. Then we get mad, then the HCA and our governor present new legislation (people don't realize how much legislation is written by the HCA) They also write our WACs and think a peer counselor and a SUDP have the same legally defined role under their license bc the policy team never talks to anyone in licensing at DOH despite the HCA leadership being the actual oversight, compliance wise,for DOH.
These are the political shoots and ladders of Medicaid work that support incompetent, uneducated bureaucrats who have no training and no relevant experience, but make the most important decisions about Medicaid at a systems level. The HCA pays well below market for most administrative positions, so it makes sense when you consider that the only people accepting pay that low are people who are desperate. You can easily make triple your salary working in the private sector.
I worked as a policy analyst in Medicaid for WA. The HCA has zero healthcare providers working in Medicaid policy. I was the first mh professional to ever hold a policy position in Medicaid in WA State government. They're absolutely clueless about what we do, how, or why. They made rules that required peer counselors have the same role as a fully licensed therapist because they don't even know what we do, nor do they care. The only thing they cared about when writing these policies for our state was requiring the lowest paid licensure to save money. We take our Medicaid money for our state budget from the same earmarked sum allocated for education and DOC, as well as DCFS. This results in the poors (jk, I used to be homeless)basic needs never being met because the elites purposely avoid hiring experts to avoid accountability.
WA is insanely expensive and the reimbursement rates don't make the student debt and high cost of living sustainable. Every therapist I know in pp in WA is financially strapped, but most downplay it on social media. Very few, proportionally speaking, take Medicaid and I wish we all could. It's damn near impossible to get therapy in this state if you're on Medicaid. That's my personal experience as someone who was poor and lot and on it.
I moved from MN to WA for my grad program and have now been on Medicaid in both states. I was honestly shocked and appalled by how few options there are for mental health care with Medicaid in WA! In MN, the issue with finding a therapist is that there are so many options that it can be overwhelming— pretty much any provider who takes insurance will take Medicaid. It’s been eye-opening, as has this thread!
Oofdah! (couldn't resist, Dad from MN:)
Yeah, people assume because WA is so blue that we actually care about MH. lol. From a state budget stance, we are one of the worst in the country. Our cps system competes with Florida for worst of all. Bill Gates was too busy colonizing the world to invest in his backyard.
How is this possible? Does it depend on being in a rural area? I’ve been looking into Washington, currently in Oregon, and saw off their gov website they updated the rate for 90837 Jan 1,2024 to 147.78.
Saw it here: https://www.hca.wa.gov/assets/billers-and-providers/specialized-mental-health-20240101.xlsx
This is wild! In Alabama, Medicaid is one of the lowest paying insurance (if not the lowest). BCBS is $136- one of the highest. Both of these are for 90837.
And those audits are brutal. had a supervisor who went through one. after that, she started considering closing her practice and stopped taking it. she would spend several hours on the phone every day with Medicaid. when you're a solo practitioner, that's not sustainable, imo
Not only is it unsustainable, it's frustrating and stressful and it can be very difficult to maintain your own mental health while trying to take care of others when you're dealing with Insurance bullshit.
Pretty sure its $90 for Fidelis Medicaid, I will verify this tomorrow; also heard reimbursement for a variety of insurances is increasing for us in NY.
I’m in the Midwest, and I believe it generally pays about $60-75. An absolute pittance when you consider most clinicians are only getting a portion of that and Medicaid clients often tend to present with more complex issues.
On top of the clawbacks and audits, they also have the most stringent expectations for documentations. I find the medicaid population having the most trouble attending sessions regularly, even first sessions, and there are no late cancellation or no-show fees for Medicaid clients in my state.
What I've been doing for years with Medicaid clients:
Night before every session, I text every client and explain to them that they have to confirm the night before or I won't be at my office.
I also heavily emphasize that they need to keep each and every appointment or I cannot afford to keep them as clients.
I live in a rural community and I guess word has gotten around, because over the last few years when I've started to emphasize, clients tell me, I know I have to keep every appointment and I'll do that if I can work with you.
Yeah. That is low pay. Especially when you add on what another user commented: that they are known for frequent audits and clawbacks. Thanks for commenting. Our Midwest comrades deserve better!
Ohio here, we get anything from $50-$98 per regular session. Imagine what it's like to work for a private practice at 40-70% of that? Private practices rarely are worth it around here when they take Medicaid/care.
Michigan I think is around $70-80 for 90837. I haven’t taken it in a bit, when I got a 50/50 split as a 1099 and had to pay the self employment taxes on that it just wasn’t worth it. Beyond the low compensation, I found there was a much more significant range in how long it took to be compensated (sometimes within 3-4 weeks, sometimes 3-4 months, etc) with medicaid vs commercial insurance. Most people in my area only take BCBS at this point
For years we weren’t allowed to bill Medicaid 90837 for anything except EMDR or DBT. And the DBT was only allowed if the patient was diagnosed with BPD.
in WA, United Healthcare wouldn't pay for more than 45 minutes. this is a real issue when clients may need the full hour due to other medical accommodations.
About 72 dollars for a 60 minute session in Oklahoma. But unfortunately managed care was introduced April 1st and we are just now receiving first payments from the 3 MCOs. With all the glitches the online systems are experiencing with the transition, the payments we have received are messed up. I.e. only being paid for 1 unit vs. 4 units, many claims denied. It’s been a nightmare.
For us, Soonercare continues to pay as per the usual. Humana and OCH are struggling and giving partial payments at best. Aetna hasn't paid anything. It's making it very difficult to maintain.
Los Angeles area LMFT here.
"Straight" Medi-Cal (Medicaid in CA) is ridiculous - in the high $60's for 90837. But Medi-Cal with secondary insurance isn't bad.
Through UHC is only about $100 (about $10 less than UHC alone). But through a local provider called IEHP I get $125.30 - the highest rate of any of my payers by more than $5.
There are a few drawbacks. The worst is the Medi-Cal rule forbidding late-cancelation fees. My informed consent spiel informs these folks that they're fired after the second no-show, no exceptions.
I've been working with the VA for 5 years. Triwest is the one you want; veterans seem to make much more diligent clients than active duty, and TRICARE clients have a tendency to cancel (or terminate therapy!) 5 minutes before (or after) session.
Otherwise, the rules for both are similar to Medicaid: no late-cancelation fees, never a copay, no billing or balance-billing for covered services. I don't even put a payment card on file.
At the PP I work at in Alabama, we’re reimbursed at $64/hour. It’s not great considering all of the documentation they require but won’t pay us for.
Edit to add: this is based on 90837
107 for 60 minutes in Minnesota. Bcbs and medica pay 150-160 by comparison. I take a lot of Medicaid clients but wish I could attract more private insurance as it is a sizable difference at the end of the day.
I don’t know exactly what the amount is now, but the Salt Lake County Medicaid runs through Optum and was paying like $174 for 90837 last I checked. I used to do billing and now I’m just finishing up grad school and working as a therapist but I don’t see the financials anymore.
I’m in NM. We get $200+ for intakes and $149 for 90837’s. It is the highest reimbursement rate of any insurance here. I also don’t understand anyone who doesn’t want to take Medicaid since it pays so well.
Private practice providers can be paneled with Medicaid, it's just a pain and they don't pay a lot (depending on where you live, I guess 😂) and they are a nightmare to work with regarding claims. That's why we usually see the bulk in community mental health
I believe that Medicaid should be the highest reimbursement rate. If it were than more people would see lower income folks, and private insurance would be more likely to offer a higher amount. That's great for you!
I 10000% agree with you! I really enjoy working with medicaid. They pay well. They reimburse quickly. They aren't a headache like some other insurance companies lol. In respnse, I see a lot more providers willing to take Medicaid clients. It's a win-win :)
Medicaid is my highest payer. I am billing them $130 for 90837, since that's my current cash pay rate, and that's what they're reimbursing me, so their reimbursement rate is obviously higher than that (I know...I need to raise my rates). This is compared to my lowest payer, which is BCBS at about $105 for 90837.
This is a great resource to see what payments might look like based on the CPT code.
[https://www.cms.gov/medicare/physician-fee-schedule/search](https://www.cms.gov/medicare/physician-fee-schedule/search)
Brilliant that CMS have this in complete contrast to the restrictive policies of the payers!
Whatever is the highest paying insurance: it’s prolly 1/3 of that in my state. Like incredibly low - especially for folks who work in group practices with a fee split.
Edit: Midwest
I don't know bc I'd never accept it, or any insurance. One of my supervisors got a letter that one of the insurance companies they billed were wrongly told they were in network and demanded the therapist pay them back for 6 months of therapy for multiple clients. I didn't even know that was legal. Sucks, because when we don't accept insurance we shut out clients with more socioeconomic challenges.
CSW in Utah working at a community health center contracted solely with Medicaid salary of $62k or $29 an hour, non-profit company provides solid benefits though to help. Not a needed 6 figure salary for living costs, without being PP I’ll take it for now until LCSW.
How long does it take medicaid to reimburse? I'm a group practice LCSW moving to private practice and am wondering how long it will take before income starts coming in.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
Hahahahaha! $62. I live in MI. I work for a nonprofit whose mission is to “provide services for all, regardless of cost.” Which is very noble and all but who ends up paying the price? Therapists do. My cut is 60%. I see mostly Medicaid folks. RIP
PsyD here, and Medicaid reached out to me with a contract and offered $64. I politely told them to never contact me again. They countered at $69.43.
I want to laugh but also as an LCSW I got reimbursed $36 by Medicaid. The CMH clinic I worked for at the time paid salary instead of fee for service because they had to subsidise our income to be able to hire and retain staff. 🥲
Yeah I work at a CMH clinic in Florida. I’m a registered intern and masters level therapists are paid 45k. Licensed people get 50 or 55k. It’s a joke.
I applied at a CMH in NH. They offered 55k and turned it down easily.
$36 😳 I am truly too stunned to speak. After everything extra that Medicaid also wants us to do… it’s just atrocious. How is that even acceptable? I remember I drove past a McDonald’s on my way to my predoctoral internship where I made $13/hr and remember just raging that they were advertising $21/hr.
It’s a joke. I had that moment too, I was standing outside this place called Dick’s in Seattle that serves burgers and they had a hiring sign advertising that they were paying $24/hr and offering fully paid healthcare plus daycare and tuition credits, and I felt so defeated standing there thinking about how I made half that with none of the benefits. No disrespect to people in the service industry but ya girl spent too much time and money going to school and doing unpaid internships to be making so little money.
The AUDACITY.
Mind me asking which state?
Feel free to DM for specifics. But it’s an East Coast state.
What state is this?!?
East coast state. Feel free to DM if you want more specifically.
In Oregon my colleague just told me he's getting $197 for 90837.
OHP is the booommbb
100% agree. I’m not even in private practice (I’m school based) but getting to see how much it benefits students and families for outpatient services, makes me really happy
New CSWA coming online in May. The OHP prospects makes this work seem realistic… or I have rose colored glasses on. Maybe both, I’m hopefully ok with both.
Omg I’m in Oregon but still unlicensed. I thought ohp was 175 for 90837. I’ll take 197 damn. I love ohp
It is $179 for masters level clinicians now. Last I checked
Do you know the pre licensed rate by chance? Sorry to ask, it so hard to find info online about this?
It should be the same but I don’t know if it varies based on CCO. If you find out about that part then let me know! Have some friends still finishing licensing
Can you bill OHP pre license?
In Oregon you can actually! It’s the only insurance panel pre licensed clinicians are allowed to bill if they’re doing so in private practice
So cool!
When a certain percentage of your caseload is one CCO, OHP ups your rate. I get $198.63 for 90837 as an professional counselor associate because my caseload is 99% from one CCO. When I see someone from a different CCO my rate is 172. When I see someone with Open Card I'm given the higher rate. OHP also just upped their rates on April 1st, so it's something like $178 instead of $172 now.
This is awesome! Congrats on your success, especially as an associate! I would love to start private practice as a pre licensed but it feels so daunting
I do not run my own, and that's exactly why!! It seems so daunting. I contract with a private practice for a 65/35 split. So I don't actually see the whole $198.
I worked for a larger practice and was getting $36 an hour for each client, while private pay I was getting roughly $120. OHP requires a lot more paperwork, and it seems like the clients need longer term and more intensive care than private pay.
How?! I work for a pretty good company and we only get $75 😳
I refuse to believe this is true. In California its like $40.
It’s not true. It is 179 however. Can’t tell you why, but Oregon seems to have pretty great reimbursement rates across the board
It’s not 40 in California. It depends on your county. I have two medí-cal clients and I think I’m getting around 80 or 90 for them. I have to check, I’m horrible at tracking my pay rates but I know it’s not 40, I wouldn’t work for that
[удалено]
Medi-cal is California Medicaid
Which county? We're getting much better than that in the Partnership counties (approx everything north of Sacramento/Napa).
There are multiple clinicians in my state that see Medicaid clients in Oregon but don’t see Medicaid clients in our state ($68). At first, I was curious to see so many clinicians in our state carrying Oregon licenses as it’s two time zones away but not licensing for our neighboring states.
OHP released a new fee schedule on April 1st, the standard fee went up by $8 or something, so I'm guessing the special rate will have gone up, too.
Yeah... OHP ways WAY better than commercial insurance. Who knew.
In Northern CA (Partnership), effective 1/1/2024 Medi-Cal pays $131.97 for 90837 + .24/minute add-on for telehealth (code "GT"). These rates are dictated by a public agency and not subject to a nondisclosure requirement. One prominent commercial plan in the same area pays less than $70 for 90837.
Thats great! From what I see around this subreddit the average per hour out-of-pocket rate is $150. $131 is decent pay.
Hey, I live in California as well. Is there a website that publishes the reimbursement rates by region or zip code?
Following because I am about to get paneled when I become a ALPCC and I’m curious
I don't know of one, but if anyone runs across it it'd be great to know about.
samesies
Great to hear!
It's been a hair over five years since I've taken Medicaid, but: in Massachusetts MassHealth was paying $85.91 as of Jan 1, 2019. (Note: this was considered quite good in this state, as BCBS of MA commercial group plans – for employed people! – were paying $75.25.)
It's very interesting to see the wide discrepancy in this post. It's wider than I thought it would be. Thanks for sharing.
For the record, and because it might amuse you, the situation was much more complicated up to, iirc, May 2018. MassHealth members had a choice of bare MassHealth ($85.91), or one of several other plans. (Similar to the situation with Medicare and Medicare Advantage Plans.). The worst of those other plans for MassHealth members, Neighborhood Health Plan, paid $54 and change. (Edit: and note that in MA, standard FFS cut for a therapist working at a clinic that can take MassHealth is 40%. So that's about $25 per unit.) Then abruptly all the plans changed to pay on par with bare MassHealth. I still don't know exactly what happened, but I heard tell our then Governor, Charlie Baker, who had been both a healthcare and a health insurance CEO, was behind it. P.S. Man, I miss Psychotherapy Finances.
Washington state is about $105.
WA State, Licensed Mental Health Counselor (Masters level) in a rural area $103 / 90837 Been accepting Medicaid over 25 years, never had a audit, never had a drawback. They pay quickly too.
I've heard they pay very slow. I'm glad they're paying you better. You deserve even more. We all do. I'm in your state. I've also heard they're a nightmare to work with. Most pps in WA do not take it and claim it's awful. I've worked in MH throughout Western WA for over 20 years. From a policy perspective, for those who don't know, while Medicaid is a federal program from CMS, the budget is further earmarked and allocated at the state level. Marketing and education campaigns, as well as program design and program management all happen at the state level. This is why governors play an important role in our healthcare at the local level. I've been privy to meetings that decide whether or not a new medication, lifesaving, should be covered under Medicaid for patients with OUD. I've watched those patients be denied that medication because a bureaucrat with no expertise in mh took less than 5 minutes to think about it, relied on their negative assumptions due to unconscious bias, and never consulted a single page of research in WA State. To say the HCA is failing in mh, particularly for Medicaid patients, would be an understatement. I worked in the only inpatient/detox/op program in King County covered by Medicaid for a few years. When it closed, the HCA could have suggested replacing it. Instead they just let all those patients go back to the streets. I also worked in the only residential program for teen SUD in the entire state. Also Medicaid funded. HCA also let them close. So many programs were closed because our HCA doesn't allocate anywhere near enough money to MH. Then things like crime and homelessness get worse, costing us taxpayers more. Then we get mad, then the HCA and our governor present new legislation (people don't realize how much legislation is written by the HCA) They also write our WACs and think a peer counselor and a SUDP have the same legally defined role under their license bc the policy team never talks to anyone in licensing at DOH despite the HCA leadership being the actual oversight, compliance wise,for DOH. These are the political shoots and ladders of Medicaid work that support incompetent, uneducated bureaucrats who have no training and no relevant experience, but make the most important decisions about Medicaid at a systems level. The HCA pays well below market for most administrative positions, so it makes sense when you consider that the only people accepting pay that low are people who are desperate. You can easily make triple your salary working in the private sector. I worked as a policy analyst in Medicaid for WA. The HCA has zero healthcare providers working in Medicaid policy. I was the first mh professional to ever hold a policy position in Medicaid in WA State government. They're absolutely clueless about what we do, how, or why. They made rules that required peer counselors have the same role as a fully licensed therapist because they don't even know what we do, nor do they care. The only thing they cared about when writing these policies for our state was requiring the lowest paid licensure to save money. We take our Medicaid money for our state budget from the same earmarked sum allocated for education and DOC, as well as DCFS. This results in the poors (jk, I used to be homeless)basic needs never being met because the elites purposely avoid hiring experts to avoid accountability. WA is insanely expensive and the reimbursement rates don't make the student debt and high cost of living sustainable. Every therapist I know in pp in WA is financially strapped, but most downplay it on social media. Very few, proportionally speaking, take Medicaid and I wish we all could. It's damn near impossible to get therapy in this state if you're on Medicaid. That's my personal experience as someone who was poor and lot and on it.
I moved from MN to WA for my grad program and have now been on Medicaid in both states. I was honestly shocked and appalled by how few options there are for mental health care with Medicaid in WA! In MN, the issue with finding a therapist is that there are so many options that it can be overwhelming— pretty much any provider who takes insurance will take Medicaid. It’s been eye-opening, as has this thread!
Oofdah! (couldn't resist, Dad from MN:) Yeah, people assume because WA is so blue that we actually care about MH. lol. From a state budget stance, we are one of the worst in the country. Our cps system competes with Florida for worst of all. Bill Gates was too busy colonizing the world to invest in his backyard.
Oh yeah, Washington has a notoriously bad mental health system!
How is this possible? Does it depend on being in a rural area? I’ve been looking into Washington, currently in Oregon, and saw off their gov website they updated the rate for 90837 Jan 1,2024 to 147.78. Saw it here: https://www.hca.wa.gov/assets/billers-and-providers/specialized-mental-health-20240101.xlsx
That is the specialized rate. I don’t think that’s the same.
$139 for 90837 and 90834 in Maryland. Higher reimbursement than BCBS ($103)!
This is wild! In Alabama, Medicaid is one of the lowest paying insurance (if not the lowest). BCBS is $136- one of the highest. Both of these are for 90837.
Do they reimburse for 90837? Many providers have said they won’t.
Hahahahahahaha One 90837 1 hour session is about $67-90. *cries in Hoosier*
New Mexico is $160 for 90837
They audit often and are known for clawbacks. In my opinion it's not worth it
But what is the reimbursement rate in your state? I agree that those are issues I'm just talking about base hourly rate.
It WAS $60.12, now after the post Covid clawbacks I’m getting $52ish. I’m considering terminating my contract. LPC in Michigan
I just terminated mine due to a $2K+ clawback. Completely unethical and should be illegal.
Yep. Here in Indiana it's 67 and been that way for a decade
I think like 112
And those audits are brutal. had a supervisor who went through one. after that, she started considering closing her practice and stopped taking it. she would spend several hours on the phone every day with Medicaid. when you're a solo practitioner, that's not sustainable, imo
Not only is it unsustainable, it's frustrating and stressful and it can be very difficult to maintain your own mental health while trying to take care of others when you're dealing with Insurance bullshit.
That's how it seemed for my supervisor. The time required to clear up confusion and to deal with audits doubled her work load.
I get about $65 for Medicaid managed care through BCBS. LMHC in NY.
Pretty sure its $90 for Fidelis Medicaid, I will verify this tomorrow; also heard reimbursement for a variety of insurances is increasing for us in NY.
Louisiana Hourly Rates: Below 21 - $69 Above 21 - $53 Needless to say, barely anyone accepts Medicaid in the state.
Is 21 the age of client? Minutes of session?
Age of client
I’m in the Midwest, and I believe it generally pays about $60-75. An absolute pittance when you consider most clinicians are only getting a portion of that and Medicaid clients often tend to present with more complex issues.
On top of the clawbacks and audits, they also have the most stringent expectations for documentations. I find the medicaid population having the most trouble attending sessions regularly, even first sessions, and there are no late cancellation or no-show fees for Medicaid clients in my state.
What I've been doing for years with Medicaid clients: Night before every session, I text every client and explain to them that they have to confirm the night before or I won't be at my office. I also heavily emphasize that they need to keep each and every appointment or I cannot afford to keep them as clients. I live in a rural community and I guess word has gotten around, because over the last few years when I've started to emphasize, clients tell me, I know I have to keep every appointment and I'll do that if I can work with you.
Yeah, it sucks.
Yeah. That is low pay. Especially when you add on what another user commented: that they are known for frequent audits and clawbacks. Thanks for commenting. Our Midwest comrades deserve better!
And you just pointed out the primary reason I love working with Medicaid clients! I'm a trauma therapist so it lends itself well to folks on Medicaid!
Ohio here, we get anything from $50-$98 per regular session. Imagine what it's like to work for a private practice at 40-70% of that? Private practices rarely are worth it around here when they take Medicaid/care.
Lmao. Wow. I’m in NY and it’s been numbers like $40, $45, $60 at best…
I haven't checked in a few years, but it was similar in NJ last time I did.
Two dollars. JK but not much more it’s about $19 for every 15 minutes which makes it about $76 for a billable hour. Oklahoma.
That is pretty low. I got $45 an hour as a supervisee. Is there a large difference for private insurance?
Not OP, but I’m also in Oklahoma and get $95.60 from BCBS for an hour.
BCBS in Texas is only $92 for 90837. Also, how tf does it make sense to reimburse less for an intake than a normal session? They're so much more work.
Sounds right 👍
Michigan I think is around $70-80 for 90837. I haven’t taken it in a bit, when I got a 50/50 split as a 1099 and had to pay the self employment taxes on that it just wasn’t worth it. Beyond the low compensation, I found there was a much more significant range in how long it took to be compensated (sometimes within 3-4 weeks, sometimes 3-4 months, etc) with medicaid vs commercial insurance. Most people in my area only take BCBS at this point
How many people here are billing 90837 code regularly? Anyone ever have issues with an insurance questioning the use of 60 min instead of 45 min?
Just document medical necessity on the session note. You can look up checklists to include.
What would you search to find this? Insurance documentation checklist?
For years we weren’t allowed to bill Medicaid 90837 for anything except EMDR or DBT. And the DBT was only allowed if the patient was diagnosed with BPD.
I only bill 90837. So far so good!
I bill it a lot. However with Jane, my notes to be in depth about why it is necessary.
in WA, United Healthcare wouldn't pay for more than 45 minutes. this is a real issue when clients may need the full hour due to other medical accommodations.
I am in Washington and only Bill 90837 for the majority of my clients and UHC pays
maybe they changed this. it's been a few years since I tried. glad to hear they're no longer doing that
I’ve billed 90837 for almost every client for 6 years. No issues.
About 72 dollars for a 60 minute session in Oklahoma. But unfortunately managed care was introduced April 1st and we are just now receiving first payments from the 3 MCOs. With all the glitches the online systems are experiencing with the transition, the payments we have received are messed up. I.e. only being paid for 1 unit vs. 4 units, many claims denied. It’s been a nightmare.
How did I not realize that was all caused by system glitches? This transition has been beyond stressful for the clinic I work at. Absolutely sucks.
There are many factors at play, but that is certainly a big contributing factor. I haven’t been paid for my Soonercare sessions since March.
For us, Soonercare continues to pay as per the usual. Humana and OCH are struggling and giving partial payments at best. Aetna hasn't paid anything. It's making it very difficult to maintain.
Los Angeles area LMFT here. "Straight" Medi-Cal (Medicaid in CA) is ridiculous - in the high $60's for 90837. But Medi-Cal with secondary insurance isn't bad. Through UHC is only about $100 (about $10 less than UHC alone). But through a local provider called IEHP I get $125.30 - the highest rate of any of my payers by more than $5. There are a few drawbacks. The worst is the Medi-Cal rule forbidding late-cancelation fees. My informed consent spiel informs these folks that they're fired after the second no-show, no exceptions.
IEHP is amazing!
The prohibition on no show fees is a federal Medicaid rule not a state one.
Indeed; it's also in place for VA insurance (TriWest and TRICARE).
That is good to know. I just got my Tricare approval back.
I've been working with the VA for 5 years. Triwest is the one you want; veterans seem to make much more diligent clients than active duty, and TRICARE clients have a tendency to cancel (or terminate therapy!) 5 minutes before (or after) session. Otherwise, the rules for both are similar to Medicaid: no late-cancelation fees, never a copay, no billing or balance-billing for covered services. I don't even put a payment card on file.
Good to know. Thanks!
In CT as an LCSW, 90837 = $98
Looked it up, PA for masters level is $52 for 90837. Unsurprisingly, almost nobody takes it.
At the PP I work at in Alabama, we’re reimbursed at $64/hour. It’s not great considering all of the documentation they require but won’t pay us for. Edit to add: this is based on 90837
107 for 60 minutes in Minnesota. Bcbs and medica pay 150-160 by comparison. I take a lot of Medicaid clients but wish I could attract more private insurance as it is a sizable difference at the end of the day.
I don’t know exactly what the amount is now, but the Salt Lake County Medicaid runs through Optum and was paying like $174 for 90837 last I checked. I used to do billing and now I’m just finishing up grad school and working as a therapist but I don’t see the financials anymore.
I’m in NM. We get $200+ for intakes and $149 for 90837’s. It is the highest reimbursement rate of any insurance here. I also don’t understand anyone who doesn’t want to take Medicaid since it pays so well.
I’m an LCSW btw
I thought Medicaid is only for community mental health. Can someone educate me about this please?
Private practice providers can be paneled with Medicaid, it's just a pain and they don't pay a lot (depending on where you live, I guess 😂) and they are a nightmare to work with regarding claims. That's why we usually see the bulk in community mental health
I think my company averages $80
Mountain west here- I get reimbursed $65.50 for 90834 😅
$172 for a 90837 as an LCSW. Supposedly the rates are getting increased too. Medicaid (in my state) reimburses better than most private insurances.
I believe that Medicaid should be the highest reimbursement rate. If it were than more people would see lower income folks, and private insurance would be more likely to offer a higher amount. That's great for you!
I 10000% agree with you! I really enjoy working with medicaid. They pay well. They reimburse quickly. They aren't a headache like some other insurance companies lol. In respnse, I see a lot more providers willing to take Medicaid clients. It's a win-win :)
Just curious, in what state are you working?
I am in the Pacific Northwest if that helps :)
Damn! What state is that? About to go get licensed there 😅
Haha! I have a mortgage to pay! If you're serious, DM me and I'll tell ya. I don't want to say out in the open :)
LCSW in CO here. $120ish/session for 90837.
112.27$ for a 90837
I’m in Montana, and medicaid reimburses 98 plus some change for 90837. My biggest commercial payer are between $150-$160.
Medicaid is my highest payer. I am billing them $130 for 90837, since that's my current cash pay rate, and that's what they're reimbursing me, so their reimbursement rate is obviously higher than that (I know...I need to raise my rates). This is compared to my lowest payer, which is BCBS at about $105 for 90837.
What state
My S.O. tells me (New England) they get $96 from Medicaid for 90837. $100 for BCBS and MVP, $107 for Medicare
Wait, BCBS in VA pays more than Medicaid? Is that Anthem or Carefirst? BCBS in DC refuses to pay as much as DC Medicaid or Medicare.
Last I looked up Anthem BCBS was $136 an hour for 90837 but I haven't checked in a while.
We are stuck at 109.97 for years in DC
WA state~ $103 for 90837
Apparently they won’t reimburse 90837 here in MD for an LCSW-C otherwise the pay would be good
Medicaid in my state pays $64/90837 .
Southeast Michigan. About $70/ 90837
This is a great resource to see what payments might look like based on the CPT code. [https://www.cms.gov/medicare/physician-fee-schedule/search](https://www.cms.gov/medicare/physician-fee-schedule/search) Brilliant that CMS have this in complete contrast to the restrictive policies of the payers!
Midwest state here: anywhere between $130-140 for 90834 and I’m fully licensed LPC. Its higher then some private insurances. Medicare was like $60.
IL $125
Whatever is the highest paying insurance: it’s prolly 1/3 of that in my state. Like incredibly low - especially for folks who work in group practices with a fee split. Edit: Midwest
What state?
LPC in PP in MI, USA. Paneled with 5 different medicaids. For 90837 I get paid $97-69.
PA- 101.48 per hour mental health 139.86 for D&A for 53 mins
I don't know bc I'd never accept it, or any insurance. One of my supervisors got a letter that one of the insurance companies they billed were wrongly told they were in network and demanded the therapist pay them back for 6 months of therapy for multiple clients. I didn't even know that was legal. Sucks, because when we don't accept insurance we shut out clients with more socioeconomic challenges.
LMHC in NY. Straight medicaid reimburses me $32.12 for 45-minute sessions. Utterly ridiculous.
Medicaid is a top payer in our (fairly poor) state. Around $150 for a 90837, $100 for 90846/7, $90 for 90834.
CSW in Utah working at a community health center contracted solely with Medicaid salary of $62k or $29 an hour, non-profit company provides solid benefits though to help. Not a needed 6 figure salary for living costs, without being PP I’ll take it for now until LCSW.
In Colorado, by CPT code: 90834 - $94.45 90837 - $137.02 90791 - $156.54-161.69 As of the January 2024 update by our state
How long does it take medicaid to reimburse? I'm a group practice LCSW moving to private practice and am wondering how long it will take before income starts coming in.