Reimbursement Rates
| Type of service | CPT code | Private insurer reimbursement rate for PMHNP | Private insurer reimbursement rate for physicians | Medicare reimbursement rate for PMHNP | Medicare reimbursement rate for physician |
| Psych diagnosis evaluation w/med services | 90792 | $123.4 | $152.75 | $117 | $ 140.19 |
| Office/outpatient visit new | 99201 | $60 | $74.26 | $35.68 | $46.49 |
| Initial hospital care | 99221 | $99.9 | $123.64 | $66.96 | $ 79.76 |
| Psych treatment w/patient 60 minutes | 90837 | $23.87 | $29.52 | $ 25.25 | $81.59 |
| Group psychotherapy | 90853 | $28.87 | $29.29 | $25.25 | $25.76 |
The recent expansion of federal coverage in healthcare has brought hope that the citizens will access better health services at much lower costs. Notably, the federal government did not provide adequate coverage for behavioral health, and the citizens had to seek the services of private companies. Nonetheless, the Mental Health and Parity and Addiction Equity Act of 2008 mandated private insurers to offer mental health and substance abuse benefits that match those of the surgical and inpatient care (Chapman, Phoenix, Hahn, & Strod, 2018). The bill also enhanced the role of the Psychiatric Mental Health Nurse Practitioners (PMHNPs) to provide adequate solutions to the growing mental health problems in the country. Notably, PMNHPs did not play an integral role before.
Currently, the role of PMNHPs has increased and continues to impact positively even in the rural areas and among people with low incomes (Elder, 2018). Notably, behavioral illnesses include people with anxiety, substance abuse disorders, post-traumatic stress disorders, major depression, bipolar disorder, and schizophrenia. Medicaid has expanded its role to cover behavioral illnesses to provide quality health services to low-income people. Though there is no current pathway to provide guidelines on who qualifies for the Medicaid program, the federal government ensures coverage for people with incomes that are below and equal to the national income averages as well as those in those in states with affordable healthcare acts.
References
Chapman, S. A., Phoenix, B. J., Hahn, T. E., & Strod, D. C. (2018). Utilization and economic contribution of psychiatric mental health nurse practitioners in public behavioral health services. American journal of preventive medicine, 54(6), S243-S249.
Elder, G. (2018). Initiative to facilitate the development of the PMHNP role in an integrated behavioral health and primary care setting (Doctoral dissertation, Oregon Health & Science University,(June).