Billing Policies and Insurance
Out of Network Provider
Pacific Behavioral Healthcare (“PBH”) is considered an “out of network provider” which means we are not contracted with any insurance companies. PBH does not bill insurance companies for outstanding balances.
Helping Our Clients Obtain Insurance Reimbursement
The PBH front office is happy to provide clients with a Superbill, which is an extended statement containing information required by insurance companies for reimbursement. Clients may use this Superbill statement to request reimbursement from their insurance company directly to them for sessions that they have attended at PBH.
It is not possible for PBH to guarantee if particular clients will receive reimbursement payments from their insurance company for services provided by PBH. If you are curious if your insurance company will provide reimbursement, we recommend that you contact your insurance company prior to obtaining services at PBH to determine what, if any, coverage will be provided.
Information Insurance Companies May Request
Sometimes insurance companies will want to know specific "CPT" and diagnosis codes will be used for services to be able to provide reimbursement information. While we cannot state in advance what all service codes will be used, or what diagnoses will be made, the information below will provide you with a sample of common codes we utilize at our clinic.
Common Services at Pacific Behavioral Healthcare
Below are some of the common CPT service codes at Pacific Behavioral Healthcare; however, the list is far from exhaustive and other services codes not listed here may be used.
Psychotherapy:
90834 – Individual Outpatient therapy (approx 45 minutes)
99354 – Prolonged Service - 30 minutes + face to face
90847 – Family psychotherapy (conjoint psychotherapy) (with patient present) (approx 45 minutes)
90846 – Family psychotherapy (conjoint psychotherapy) (without patient present) (approx 45 minutes)
90853 – Group Therapy
Testing and Evaluation:
96112/13 – Developmental Testing (ADHD, ASD Evaluations)
96130/31 – Psychological Testing (Mental Health Evaluation)
NOTE: a service code specifier of “95” will be added to the service code for all telehealth appointments.
Common Diagnosis Codes at Pacific Behavioral Healthcare
Below is a sample of some of the common diagnosis codes at Pacific Behavioral Healthcare; however, the list is far from exhaustive. Diagnosis codes can change during therapy based on many factors. Please speak to your therapist with any questions or concerns.
Major Depressive Disorder, Unspecified (ICD Code F32.9; DSM-5 Code 296.20)
Generalized Anxiety Disorder (ICD Code F41.1; DSM-5 Code 300.02)
Post-Traumatic Stress Disorder (ICD Code F43.10; DSM-5 Code 309.81)
Adjustment Disorder - Unspecified (ICD Code F43.20; DSM-5 Code 309.9)
Persistent Depressive Disorder (ICD Code F34.1; DSM-5 Code 300.4)
Bipolar II Disorder (ICD Code F31.81; DSM-5 Code 296.89)
Obsessive Compulsive Disorder (ICD Code F42; DSM-5 Code 300.3)
Erectile Disorder (ICD Code F52.21; DSM-5 Code 302.72)
Female Sexual Interest/Arousal Disorder (ICD Code F52.22; DSM-5 Code 302.72)
Genito-Pelvic Pain/Penetration Disorder (ICD Code F52.6; DSM-5 Code 302.76)
Alcohol Use Disorder - Moderate (ICD Code F10.20; DSM-5 Code 303.90)
Relationship Distress with Spouse or Intimate Partner (ICD Code Z63.0; DSM-5 Code V61.10)
Payment Due at Time of Service
Clients are responsible for payment in full for fees charged for services rendered at the time of service. Payment in full for all charges on a client’s account is required at the beginning of each session. PBH reserves the right to reschedule or cancel future appointments if an account balance remains unpaid.