January 5, 2022
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 | $165.00 | |
| Established Patient 15 minutes | 99213 | $250.00 | |
| Established Patient 25 minutes | 99214 | $375.00 | |
| Established Patient 40 minutes | 99215 | $450.00 | |
| New Patient Level IV Complexity | 99204 | $480.00 | |
| New Patient Level V Complexity | 99205 | $615.00 | |
| Psychotherapy | |||
| 30 Minute Psychotherapy Add-on | 90833 | $105.00 | |
| 45 Minute Psychotherapy Add-on | 90836 | $160.00 | |
| Telephone Consultation (20 minutes or less) | 99442 | $150.00 | |
| Telephone Consultation (30 minutes or less) | 99443 | $220.00 | |
| Email/Online Consultation (10-15 minutes) | 99444 | $70.00 | |
| Refill Out of Session that Takes Extra Time | $40.00 |
Subset of Fees for Jasmine Teleki, PsyD
| Psychotherapy | CPT Code | Fee | |
|---|---|---|---|
| Psychotherapy 25 minutes | 90832 | $210.00 | |
| Psychotherapy 45 minutes | 90834 | $320.00 | |
| Psychotherapy 60 minutes | 90837 | $385.00 | |
| New Patient Initial Appointment 1.5 to 2 hours | 90791 | $495.00 | |
| Telephone Consultation (20 minutes or less) | 98967 | $100.00 | |
| Telephone Consultation (30 minutes or less) | 98968 | $150.00 |
Subset of Fees for Andrea Starn, MFT and Alana Kivowitz, LCSW
| Psychotherapy and Care Management | CPT Code | Fee | |
|---|---|---|---|
| Psychotherapy 25 minutes | 90832 | $135.00 | |
| Psychotherapy 45 minutes | 90834 | $210.00 | |
| Psychotherapy 60 minutes | 90837 | $270.00 | |
| New Patient Initial Appointment 2 hours | 90791 | $495.00 | |
| Telephone Consultation (20 minutes or less) | 98967 | $80.00 | |
| Telephone Consultation (30 minutes or less) | 98968 | $120.00 |
Subset of Fees for Naomi Muzac, ACSW
| Psychotherapy and Care Management | CPT Code | Fee | |
|---|---|---|---|
| Psychotherapy 30 minutes | 90832/ACSW | $145.00 | |
| Psychotherapy 45 minutes | 90834/ACSW | $180.00 | |
| Chronic Care Management | 99490/ACSW | $136.00 | |
| New Patient Initial Appointment 2 hours | 90791/ACSW | $340.00 | |
| No show/late cancel for 30 min appt | CXL/ACSW30 | $145.00 | |
| No show/late cancel for 45 min appt | CXL/ACSW45 | $180.00 | |
| Late Fee ACSW | Late_Fee/ACSW | $50.00 |
Additional Patient Services
| Staff Assistance | $120.00 per hour |
Includes requesting extensive medical records, compiling medical history, urgent refills and other assistance.