The Psychiatry Practice
Dr. Haxton is a non-participating provider of insurance plans. This means that Dr. Haxton does not accept payment directly from your insurance company. This helps to protect your privacy and make sure that your care is not determined by anyone other than your doctor. At the end of your session, you will be provided with a detailed financial statement. You can submit this claim to your insurance to be reimbursed according to the parameters of your plan. Your payment to Dr. Haxton is due in full at the time of each session. Payment can be made by check, credit card or cash.
The Psychiatry Practice Insurance Codes (CPT Codes)
The following insurance code will be used for the first visit:
INITIAL EVALUATION: 90792
Subsequent visits will have two codes, and the session fee will be split between them. Your insurance will reimburse you for each of these codes
individually.
MEDICAL MANAGEMENT/PSYCHOPHARMACOLOGY
99213 or 99214
PSYCHOTHERAPY
90836 or 90838
The TMS Neuromodulation Practice
Dr. Haxton is a non-participating provider with insurance companies but will work directly with your insurance provider to facilitate reimbursement for TMS.
You will be seen by Dr. Haxton for an initial visit to determine your eligibility for TMS and to teach you about the procedure and protocol. If this is an appropriate treatment for you, Dr. Haxton will work with you and your insurance company to facilitate coverage. You will be responsible for the agreed upon financial arrangement and will need to make a payment prior to your treatment. A Health Savings Account or medical financing may be helpful options.
Short-term interest-free medical loans are available and can provide a bridge while waiting for insurance reimbursement or allow for a payment over time.
The TMS Practice Insurance Codes (CPT Codes)
INITIAL EVALUATION
90792
TMS/ rTMS
90867 - Initial Treatment planning: cortical (brain) mapping, establishing
motor threshold (cortical neuron excitability)
90868 - Subsequent delivery and management, per session
90869 - Subsequent motor threshold re-determination, per session, weekly
Before the TMS Evaluation
Before the Initial TMS Evaluation it would be helpful for you to obtain this information from your insurance:
PRINTER FRIENDLY INSURANCE WORKSHEET
1. Do I have out-of-network benefits for mental health?
2. Do I have coverage for TMS or rTMS? (see CPT insurance codes above)
3. If I have coverage, what are the criteria for coverage?
4. Do I need Prior Authorization or Prior Approval? If yes, how do I get that?
5. Do I have any deductible, co-pay, out-of-pocket or other expenses that I am responsible for prior to receiving benefits? What exactly are these costs?
6. After my benefits begin, what % is covered?
7. Where and how do I submit claims/bills? Do I need special forms and where do I get them?
It is helpful for follow-up communication with your insurance company to note the date, name of the person you have spoken with, and direct phone number to reach this person back.
Before your Initial TMS Evaluation please obtain and organize the following important information.
PRINTER FRIENDLY MEDICAL HISTORY WORKSHEET
1. Past episodes of depression. (Number of episodes with beginning and ending dates).
2. All medications you have taken to treat your depression (dosages, beginning and ending dates, and reasons for discontinuation- including side effects)
3. Other treatments (such as ECT - with location and dates)
4. Psychiatric hospitalizations (location and dates)
DR. HAXTON DOES NOT UTILIZE ELECTRONIC MEDICAL RECORDS. YOUR RECORDS ARE STRICTLY PRIVATE AND RELEASED ONLY UPON YOUR REQUEST.
