O.T. BILLING

Occupational therapy at Parker Place is billed on a fee-for-service (private pay) basis only. Please read on for more information on OT pricing and the answers to some frequently asked questions about billing!

OCCUPATIONAL THERAPY PRICING

Initial evaluations (approx. 55 minutes) with documentation of the therapist’s findings: $320

Follow-up therapy sessions (approx. 55 minutes): $160

FREQUENTLY ASKED QUESTIONS

What does fee-for-service/private pay mean?

Because our therapist, Kara, is not in-network with any insurances, occupational therapy at Parker Place cannot be billed to insurance. All services must be paid for out-of-pocket prior to, or upon, check-in.

Are there any limitations on who can receive fee-for-service OT at Parker Place?

Unfortunately, we are unable to accept Medicaid recipients on a self-pay basis, due to Medicaid regulations. If your child has a Medicaid plan, we recommend checking with your MCO’s member services department for information on an occupational therapist who is credentialed with Medicaid.

Can I be reimbursed by insurance?

This depends entirely on your insurance plan and whether it includes out-of-network benefits. We recommend contacting your insurance’s member services department and asking whether your plan includes reimbursement for occupational therapy with an out-of-network provider.

If the answer is yes, we suggest asking the representative the following questions:

  • Is any prior authorization required for an initial evaluation, or for follow-up therapy sessions, if recommended by the therapist?

  • Are there any specific diagnoses or conditions that are required in order to qualify my child for out-of-network OT benefits? Are there any diagnoses or conditions that would disqualify my child from these benefits?

  • Is there any cap on the number of visits my child may receive within a particular time period?

  • Do I have to meet my plan deductible before my out-of-network OT benefits kick in? If so, how much is remaining on my deductible this year?

  • Is there a limit (either dollar amount or length of time) for any particular OT service?

  • What is the reimbursement amount for the following procedure codes: 97167, 97166, 97165, 97530, 92526, 97110, 97112, 97129, 97535.

My insurance includes out-of-network coverage for OT - how do I get reimbursed?

We are happy to provide a superbill documenting your payment, along with your child’s diagnoses and the procedure codes for any services rendered. This can be submitted to your insurance company in accordance with their reimbursement process - please check with your insurance for specific requirements.

My insurance requires a prior authorization for occupational therapy - how do I obtain this?

Our staff can assist you with requesting prior authorization from your insurance company. Please let us know about this requirement when you first inquire with us, and we’ll be happy to help.

What forms of payment do you accept?

Parker Place accepts all major credit cards, personal checks, and cash.

Are there any additional fees?

As is the policy throughout our practice, appointments canceled with less than 24 hours’ notice, including “no-call no-shows,” may incur a $50 missed appointment fee. This fee must be paid before your child’s appointment may be rescheduled.

 Ready to schedule an evaluation for your child? Please complete the inquiry form here, or continue to browse our site!