Good Faith Estimate Information Stacy H. Kaplan, LICSW

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A Good Faith Estimate (GFE) is the estimated cost of services provided. At this time, GFEs are required for clients who either don't have insurance or don't plan to submit for insurance reimbursement. Actual charges may differ based on changes in the frequency or duration of treatment or modalities utilized. The client has the right to initiate the patient-provider dispute resolution process if the actual bill substantially exceeds the GFE. The GFE is not a contract and does not obligate the client to obtain the services from the provider identified in the estimate.

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• All clients can plan to attend one 60-minute intake session at a cost of $250 

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Depending on the service you seek, you can expect to pay:

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• $225 for each 45-minute session.  At a frequency of once a week or every other week for 52 weeks, your total will be $11,700-per-year for weekly sessions or $5850-per-year for every other week sessions.  

• $250 for each 60-minute session.  At a frequency of once a week or every other week for 52 weeks, your total will be $13,000-per-year for weekly sessions or $6,500-per-year for every other week sessions.  

• The Current Procedural Terminology (CPT) codes for in office or telehealth sessions are: 

  • ​ 90791, 90791-95/GT: Diagnostic Evaluation

  •  90834, 90834-95/GT: Individual Therapy 37-52 minutes

  •  90837, 90837-95/GT: Individual Therapy 53+ minutes

  •  90846, 90846-95/GT: Family Therapy without Patient 

  •  90847, 90847-95/GT: Family Therapy with Patient

       

• Additional services that may require additional scheduling, which are not covered by insurance and cost a prorated fee of $250 an hour: 

  • ​School consultation in excess of 10 minutes

  • Parent phone consultation in excess of 10 minutes  

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Federal legislation requires a diagnostic code to be included in a GFE. The diagnosis shared in your GFE is based on the initial information you provided. Proper diagnosis requires careful and skilled assessment by Stacy and the diagnosis present in your GFE may change as she learns more about you. Below are commonly used diagnoses with the corresponding diagnostic codes, but this is not a comprehensive list of diagnoses:

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Attention Deficit-Hyperactivity Disorder (ADHD):

F90.2 ADHD, Combined presentation

F90.0 ADHD, Predominantly inattentive presentation

F90.1 ADHD, Predominantly hyperactive/impulsive presentation

F90.8 Other Specified Attention-Deficit/Hyperactivity Disorder

F90.9 Unspecified Attention-Deficit/Hyperactivity Disorder

 

 

Depressive Disorders: 

F32.0 Major Depressive Disorder, Single Episode Mild (.1 Moderate; .2 Severe; .3 with psychotic features; .4 In partial remission; .5 in full remission; .9 unspecified)

F33.0 Major Depressive Disorder, Recurrent Episode Mild (.1 Moderate; .2 Severe; .3 with psychotic features; .4 In partial remission; .5 in full remission; .9 unspecified)

F34.1 Persistent Depressive Episode (Dysthymia)

F32.8  Other Specified Depressive Disorder

F32.9 Unspecified Depressive Disorder

 

 

Anxiety Disorders: 

F93.0 Separation Anxiety Disorder

F40.10Social Anxiety Disorder

F41.0 Panic Disorder

F41.1 Generalized Anxiety Disorder

F41.8 Other Specified Anxiety Disorder

F41.9 Unspecified Anxiety Disorder

 

 

Obsessive Compulsive Disorders (OCD)

F42 Obsessive-Compulsive Disorder 

 

 

Trauma, Stress Related Disorders, & Adjustment Disorders: 

F43.10 Posttraumatic Stress Disorder

F43.0 Acute Stress Disorder

F43.21 Adjustment Disorder with depressed mood (.22 with anxiety; .23 with mixed anxiety and depressed mood; .24 with disturbance of conduct; .25 with mixed disturbance of emotions and conduct; .20 unspecified)

 

 

Relational Problems: 

V61.20 Parent-Child Relational Problem

V61.10 Relationship Distress with Spouse or Intimate Partner

V61.29 Child Affected by Parental Relationship Distress