Fee Disclosure Statement
| CPT CODE | SERVICE | MAXIMUM FEE |
|---|---|---|
| 90801 | Initial Evaluation/Consultation | 36.00 – ¼ hour |
| Interactive Evaluation, non-verbal | N/A | |
| Evaluation of Records | 36.00 – ¼ hour | |
| 96101 | Psychological Testing | 36.00 – ¼ hour |
| 96119 | Neuropsychological Testing | N/A |
| Psychoeducational Testing | N/A | |
| 90887 | Interpretation of Testing Results | 36.00 – ¼ hour |
| 90889 | Preparation of Report | 36.00 – ¼ hour |
| Individual Psychotherapy, time unspecified | 144.00 | |
| 90808 | Individual Psychotherapy, 75-80 minutes | 144.00 |
| 90804 | Individual Psychotherapy, 20-30 minutes | 120.00 |
| 90806 | Individual Psychotherapy, 45-50 minutes | 130.00 |
| 90846 | Family Psychotherapy, (without patient present) | 36.00 – ¼ hour |
| 90847 | Family Psychotherapy, (with patient present) | 36.00 – ¼ hour |
| 90849 | Multiple-family Group Psychotherapy | 10.00 – ¼ hour |
| 90853 | Group Psychotherapy | 120.00 |
| Marital Psychotherapy | 144.00 | |
| 90880 | Hypnotherapy | N/A |
| 90882 | Environmental Intervention/Consultation | N/A |
| Pain Management | N/A | |
| Cognitive Retraining | N/A | |
| Chemical Dependency Evaluation | N/A | |
| Chemical Dependency Treatment | 230.00 – day | |
| CPT CODE | ADDICTION SERVICES | MAXIMUM FEE |
| 90853 | Education Group | 15.00 – hour |
| 90899 | Pre-treatment | 10.00 – ¼ hour |
| 90791 | Substance Abuse Assessment | 144.00 |
| 90791 | DUI Assessment | 144.00 |
| 90899 | Client Drug Screen | 25.00 |
| 90899 | Non-Client Drug Screen | 50.00 |
| 90899 | Zero Tolerance PRI Class | 210.00 |
2026 Sliding Fee Scale
| Household Size | Annual Income at or below 100%-138% Federal Poverty Guidelines | Nominal Charge for Individual & Psychiatric Therapy | Nominal Charge for Group Therapy | Annual Income 139%-200% Federal Poverty Guidelines | Nominal Charge for Individual & Psychiatric Therapy | Nominal Charge for Group Therapy |
|---|---|---|---|---|---|---|
| 1 | $15,960 - $22,025 | $10.00 | $5.00 | $22,184 - $31,920 | $20.00 | $15.00 |
| 2 | $21,640 - $29,863 | $10.00 | $5.00 | $30,080 - $43,280 | $20.00 | $15.00 |
| 3 | $27,320 - $37,702 | $10.00 | $5.00 | $37,975 - $54,640 | $20.00 | $15.00 |
| 4 | $33,000 - $45,540 | $10.00 | $5.00 | $45,870 - $66,000 | $20.00 | $15.00 |
| 5 | $38,680 - $53,378 | $10.00 | $5.00 | $53,765 - $77,360 | $20.00 | $15.00 |
| 6 | $44,360 - $61,217 | $10.00 | $5.00 | $61,660 - $88,720 | $20.00 | $15.00 |
| 7 | $50,040 - $69,055 | $10.00 | $5.00 | $69,556 - $100,080 | $20.00 | $15.00 |
| 8 | $55,720 - $76,894 | $10.00 | $5.00 | $77,451 - $111,440 | $20.00 | $15.00 |
| For each additional person add 5,680 |