Insurance Information - Capital Youth Services

Insurance & Therapy Coverage — Frequently Asked Questions

Are you in-network with insurance companies?

No. We are out-of-network with all insurance plans. Clients are responsible for payment at the time of service and may submit bills to their insurance company for possible reimbursement, depending on their plan.

What does out-of-network mean for me?

If your plan includes out-of-network mental health benefits, your insurance may reimburse a portion of your session cost after you submit a claim. Reimbursement amounts vary widely by plan and carrier.

Do you submit insurance claims for clients?

No. Clients submit their own claims directly to their insurance company.

We provide a superbill (detailed receipt) that includes all required information for insurance submission.

Why should I call my insurance company before starting therapy?

We strongly recommend contacting your insurer to verify:

Whether your plan includes out-of-network mental health benefits
Your deductible and how much has been met
Reimbursement percentages
Any session limits
Whether pre-authorization is required

Insurance policies differ significantly, and your carrier is the best source for accurate benefit details.

Common CPT Codes for Therapy Services

When speaking with your insurance company or submitting claims, you may be asked for CPT codes. Common codes include:

90791 — Intake / Diagnostic Evaluation
90832 — Psychotherapy, 30 minutes
90834 — Psychotherapy, 45 minutes (standard individual session)
90837 — Psychotherapy, 60 minutes
90846 — Family therapy (without patient present)
90847 — Family therapy (with patient present)

What is a deductible and why does it matter?

A deductible is the amount you must pay out-of-pocket each year before insurance begins reimbursing services. Even with out-of-network benefits, you may be responsible for the full cost of sessions until your deductible is met.

What does “customary” or “usual and customary” mean?

Insurance companies often reimburse based on what they consider a “customary” rate for a service in your geographic area. If your provider’s fee is higher than that rate, insurance may only reimburse up to their internal limit, not the full amount paid.

To estimate typical reimbursement ranges in your area, you can use:
https://www.fairhealthconsumer.org

This tool provides regional benchmarks for what insurers often consider customary rates and may be referenced if challenging your insurance company “usual and customary” rate.

What should I ask my insurance company?

When you call, ask:

“Do I have out-of-network mental health benefits?”
“What is my deductible, and how much has been met?”
“What percentage do you reimburse for CPT codes 90791, 90834, 90837?”
“Are there annual session limits?”
“Is pre-authorization required?”
“What is the customary rate in my area for psychotherapy?”

Is there a possibility for higher reimbursement for specialty services?

Yes. Maryland law provides for higher reimbursement for specialty services (DBT, DBT-C, group therapy, SPACE, Prolonged Exposure for Trauma, etc.) if not available in network. More information on this here.

Important reminder

Out-of-network reimbursement is determined solely by your insurance plan. Coverage, reimbursement amounts, and timelines are not guaranteed and vary by carrier and policy.