Financial Agreement

Professional Fees and Billing

You (the client or legal guardian of the client) will be expected to pay the full fee at the time of each session. CARE requires a credit card/Health Savings Account (HSA) on file. You are responsible for:

  • Providing current and accurate insurance information to CARE
  • Communicating all changes in your health care insurance to CARE immediately
  • Checking and knowing your benefits – this information can be obtained by calling the member number on the back of your insurance card
  • Keeping an active credit card or HSA on file at CARE
  • Payment is due at the time of service and CARE will charge the card you have on file. You will be charged your set patient responsibility (if known to CARE) or an “estimated amount” of $150 if you have a deductible plan. Please note that you may owe more or less than $150, depending on your insurance. CARE will adjust your account accordingly once the insurance has been processed.

CARE will submit claims to your insurance company. CARE cannot guarantee reimbursement from a third party (i.e., an insurance company). In the unlikely event that you have an unpaid balance, you will be expected to pay that balance within 30 days of receiving the bill. Failure to pay will result in a pause or termination of services and may result in a monthly service charge of 1.5% and/or your account being turned over to a collections agency or small claims court. A direct pay rate, which is a reduced rate, is available for uninsured private pay clients. We have a sliding fee scale available based on family size income and the federal poverty guidelines.

Fee Tables

Psychotherapy Fees:

SERVICE CPT CODE FEE*
Diagnostic Assessment 90791 367.00
Individual Therapy (53+ mins) 90837 $314.00
Individual Therapy (38+ mins) 90834 $213.00
Individual Therapy (16+ mins) 90832 $176.00
Family and Couples Therapy (26+ mins) 90846/47 $266.00
Group Therapy 90853  $80.00
Prolonged Time (30-74+) 99354/55 $314.00
Brief Emotional/Behavioral Assessment per unit 96127  $16.00
Interactive Complexity Add-On 90785  $37.00
Returned Check  $43.00

*All fees are subject to change. Other billing codes may be used. The most common intake billing codes are 90791, 90785, and 96127 (x4). The most common therapy code is 90837 with the add-on 90785. 96127 (x2) is billed quarterly at a minimum.

Medication Management Fees:

SERVICE CPT CODE FEE*
Medication Management first-time Assessment 99203 $490.00
99204 $639.00
99205 $751.00
90792 $678.00
Medication Management Follow Up and Assessment 99213 $298.00
99214 $426.00
99215 $533.00
Psychotherapy Add-On 90833 $234.00
90836 $266.00

*All fees are subject to change. Please see the Psychotherapy Fees above for fees and a list of additional CPT codes that may be used.

Psychological Testing Fees:

SERVICE CPT CODE FEE*
Evaluation Services (first 31-60 minutes) 96130 $314.00
Evaluation Services add-on (each additional 31-60 minutes) 96131 $266.00
Administration/Scoring (first 30 minutes) 96136 $339.00
Administration/Scoring add-on (each additional 16-30 minutes) 96137 $266.00

*All fees are subject to change.

*Roughly six to ten (most commonly eight) of these units are billed to insurance.

*Other commonly billed CPT codes: 90832/34/37, 90785, and 96127.

*A $300 deposit is required to schedule testing.

Cancellation Policy/Fees

Please note, the cancellation fees for any CARE services will not be covered by any insurance company. The cancellation fees will be charged after your missed appointment.

Psychotherapy:

A 24-hour notice is required for a cancellation of a scheduled psychotherapy appointment. The late cancellation or no-show fee is $150. More than two missed appointments could result in a referral to another clinic. REDUCED FEE: $75 – with an active credit card on file or a payment is made within seven days of the missed appointment.

Medication Management:

A 24-hour notice is required for a cancellation of a scheduled medication management appointment. The late cancellation or no-show fee is $300. More than two missed appointments could result in a referral to another clinic. REDUCED FEE: $150 –with an active credit card on file or a payment is made within seven days of the missed appointment.

Psychological Testing:

You must let CARE know by 9 am the business day prior to testing if you need to cancel or reschedule an assessment appointment. This means, if you have a Monday appointment, you must let CARE know by the Friday prior to the appointment by 9am that you are unable to attend. Since this is a four-hour appointment, the cancellation/no-show fee is $300 (deposit paid in advance). This $300 deposit will be applied to the assessment cost or to the missed appointment fee. The $300 deposit must be paid again to reschedule a missed testing appointment. Two missed appointments will result in a referral to another clinic for assessment and possibly therapy.

IQ Testing:

This is not a medical service and is out of pocket. The cancellation timeline is the same as above and the cancellation/no show fee is $200 (paid in advance), and this money will be applied to the assessment cost or to the missed appointment fee. The $200 deposit must be paid again to reschedule a missed testing appointment. Two missed appointments will result in a referral to another clinic for assessment and possibly therapy.

Reduced Fee

Reduced fees are different for Med Mgmt and Therapy, see above.

Court Involvement

CARE believes that therapy should be a safe place to process emotions and experiences and that your private information should not be used in court. By being a client at CARE, you agree to this and will not use therapy as a tool or resource in court. A fee of $314 – $1000 per hour will be charged for your provider’s and CARE’s time in any legal matter. At a minimum, the fee to process a subpoena is $1000 and appearing in court is at a minimum of $5000. These fees may, but are not limited to: court appearances, report preparation, document review, consultation, legal fees and time, and submission of documents. These fees apply both during and following treatment.