Out-of-Network Benefits and “Superbills”

  • Inquiring About Out-of-Network (OON) Benefits

    Please see the script, below, to use when calling your insurance company to check benefits.

    OON Benefits Inquiry Script

    “Hello, I’m calling to ask about my out-of-network mental health benefits for outpatient psychotherapy.”

    • Is [Your Plan Name] a PPO or HMO?

    • Do I have out-of-network benefits for outpatient mental health treatment?

    • What is my deductible for out-of-network care?

    • How much of my deductible has been met this year?

    • After I meet the deductible, what percentage of each session is reimbursed?

    • Is there a maximum number of sessions covered per year?

    • Are there any forms I need to submit along with a superbill from my psychologist?

    • What is the process for submitting claims? Online or by mail?

    • How long does it typically take to receive reimbursement?

    “Thank you for your help. I’m working with a psychologist who will be out-of-network, and I want to make sure I understand what coverage I might have.”

    Please contact us if you have questions about OON benefits.

  • The following are CPT Service Codes typically used by Psychologists. Ask your insurance provider which codes and how many units are covered.

    Common Therapy CPT Codes

    • 90791: Psychiatric diagnostic evaluation (Intake Session)

    • 90834: Individual Psychotherapy, 38-52 minutes (standard therapy session)

    • 90846: Family Psychotherapy without patient present; 50 minutes (Parent session when the identified client is the child and the child is not present during session)

    • 90834 (Individual Psychotherapy; 38-52 mins) + 90785 (Interactive Complexity) (standard for Parent-Child Interaction Therapy [PCIT] session)

    Additional Therapy Codes

    • 90837: Individual Psychotherapy, 53+ minutes (60-minute therapy session)

    • 90847: Family Psychotherapy with patient present (Family therapy session)

    • 90853: Group psychotherapy (Group therapy session)

    Common Psychological Evaluation CPT Codes

    • 90791: Psychiatric diagnostic evaluation (Intake Session)

    • 96136 / 96137: Test administration and scoring by a professional (first 30 minutes and each additional 30 minutes)

    • 96130 / 96131: Psychological testing evaluation services (first hour and each additional hour), covering data integration and report writing

    • 90834 (Individual Psychotherapy; 38-52 mins) (covers feedback session)

    Note: No-Show and Late Cancellation Fees will be charged to the client and are not reimbursable by insurance.

  • OUT-OF-NETWORK SUPERBILLS AND CLAIMS SUBMISSION GUIDE

    Your clinician can provide you with a superbill, which is a detailed receipt that includes required information. You can then submit this to your insurance company for possible reimbursement to you.

    What’s on Your Superbill:

    • Date of session

    • CPT code (procedure code)

    • Diagnosis code (ICD-10)

    • Clinician name, national provider Identifier (NPI), license, and address

    • Session fee and amount paid

    Steps to Submit a Claim:

    1. Log into your insurance provider’s member portal or call their benefits department.

    2. Look for a Claim Submission Form for out-of-network mental health services.

    3. Attach your superbill (or upload it digitally).

    4. Submit by the method your insurer requires (mail, online, or fax).

    5. Track your claim for reimbursement status.

    If you need help, bring your form or portal instructions to session and your provider will walk you through it.