June 1, 2018
Subset of Fees for Peter Forster, MD
Note: Some sessions consist of 2 or more CPT codes
| Medical Evaluation & Management | CPT Code | Fee | |
|---|---|---|---|
| Established Patient 10 minutes | 99212 | $145.00 | |
| Established Patient 15 minutes | 99213 | $215.00 | |
| Established Patient 25 minutes | 99214 | $330.00 | |
| New Patient Level IV Complexity | 99204 | $420.00 | |
| New Patient Level V Complexity | 99205 | $540.00 | |
| Psychotherapy | |||
| 30 Minute Psychotherapy Add-on | 90833 | $90.00 | |
| 45 Minute Psychotherapy Add-on | 90836 | $140.00 | |
| Telephone Consultation (20 minutes or less) | 99442 | $130.00 | |
| Telephone Consultation (30 minutes or less) | 99443 | $190.00 | |
| Email/Online Consultation (10-15 minutes) | 99444 | $55.00 | |
| Refill Out of Session that Takes Extra Time | $30.00 |
Subset of Fees for Jasmine Teleki, PsyD
| Psychotherapy | CPT Code | Fee | |
|---|---|---|---|
| Psychotherapy 25 minutes | 90832 | $160.00 | |
| Psychotherapy 45 minutes | 90834 | $220.00 | |
| Psychotherapy 60 minutes | 90837 | $295.00 | |
| New Patient Initial Appointment 1.5 to 2 hours | 90791 | $415.00 | |
| Telephone Consultation (20 minutes or less) | 98967 | $85.00 | |
| Telephone Consultation (30 minutes or less) | 98968 | $130.00 |
Subset of Fees for Alana Kivowitz, LCSW and Chris Restrivo, MFT
| Psychotherapy and Care Management | CPT Code | Fee | |
|---|---|---|---|
| Psychotherapy 25 minutes | 90832 | $110.00 | |
| Psychotherapy 45 minutes | 90834 | $160.00 | |
| Psychotherapy 60 minutes | 90837 | $225.00 | |
| New Patient Initial Appointment 2 hours | 90791 | $415.00 | |
| Telephone Consultation (20 minutes or less) | 98967 | $65.00 | |
| Telephone Consultation (30 minutes or less) | 98968 | $100.00 |
Additional Patient Services
| Staff Assistance | $80.00 per hour |
Includes requesting extensive medical records, compiling medical history, urgent refills and other assistance.