Good Faith Estimate Information Stacy H. Kaplan, LICSW
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.
All clients can plan to attend one 60-minute intake session at a cost of $250
Depending on the service you seek, you can expect to pay:
$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
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:
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
F40.10 Social 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