The Floortime Center is not in-network with any insurance companies, however occupational therapy, speech therapy, and mental health appointments can receive varying amounts of insurance coverage dependent on the provider and your insurance plan’s out-of-network coverage. It is the responsibility of the family to contact their insurance provider for information regarding benefits and coverage prior to submitting claims. It is in the family’s best interest to find this out prior to beginning therapy to be aware of out of pocket costs and possible reimbursement rates.

Prior to starting sessions, many insurance companies will request:

  • A referral from your child’s pediatrician before reimbursing any claims. It is important to visit your pediatrician and request that they provide a referral with the following information listed
  • Pre-Authorization and in the future Re-Authorization
  • Speech or Occupational Therapy Referral for Services
  • Medical Diagnosis Code: this is an ICD-10 code that the doctor provides.
  • The requested start date for therapy: (it can be a tentative date)
  • Duration: for example 90 days, 2x per week

You will need to provide this referral to your insurance company. We will also keep a copy on file for our records. Without this, we cannot add the diagnosis code(s) to your invoices

Evaluations:

In order for most insurance companies to reimburse for OT or ST sessions, we will need to complete an evaluation (OT or ST) if one has not been done within the previous year. This evaluation is proof of medical necessity for insurance providers. Many insurance providers require documentation from a licensed therapist before providing reimbursement that proves treatment is necessary. Your insurance provider may cover this cost, again depending on your benefit plan.

Treatment Sessions:

While we are not in-network with any primary insurers, we will provide invoices with the appropriate coding necessary for you to submit a claim for reimbursement. Invoices will be provided at the time of the appointment. If you wait for more hen 6 months to submit your invoices, any documentation requested from your insurance company will be only be sent with an additional fee of $160 per request.

Common CPT Codes used by OT include:

  • 97110 Therapeutic exercise ( strength, endurance, ROM, flexibility)
  • 97112 Neuromuscular reeducation
  • 97530 Therapeutic activity
  • 92526 Treatment of swallowing dysfunction and/or oral function for feeding

Common CPT Codes used by SLP include:

  • 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder
  • 92526 Treatment of swallowing dysfunction and/or oral function for feeding

We do not work with Medicare, Medicaid or any secondary insurance providers.

Therapist Involvement:

  • If insurance companies request reauthorization they can contact the treating therapist directly or caretakers can request this. Therapists can provide reauthorization documentation when necessary. This is a form of documentation stating that treatment sessions continue to be necessary and why.
  • If your primary insurer needs session notes, please have them contact your therapist directly.

**Please see associated costs for requests for large amounts of documentation requests.