Cost and Insurance Information
The Understanding Pain Program is billed to insurance as Pain Education Groups. Medicare, Medicaid, Workers Compensation, and many, but not all, commercial insurance carriers will cover some or all of the costs associated with this program. Worker’s Compensation requires that we obtain pre-authorization, so if your insurance carrier is Worker’s Compensation be sure and let us know so that we can obtain pre-authorization prior to enrolling you in the Understanding Pain program. For other insurance carriers, we encourage you to contact a representative at your insurance company to determine whether or not the insurance company will pay for some or all of the costs of the program.
What do I say to the insurance company representative?
When you contact your insurance company representative, ask whether your insurance plan will cover "Group Health and Behavior Intervention" appointments (it is very important that you use this exact phrase), and up to 12 physical therapy sessions. If you ask whether they will cover “Understanding Pain,” they are likely to say no because it sounds like a purely educational intervention. Understanding Pain is much more than a mere educational intervention and so we bill for our services using a particular billing code, which is known as a Health and Behavior Intervention code.
Your insurance company representative will need the following information:
- Your chronic pain-related diagnosis. For example: Low back pain, neck pain, complex regional pain syndrome, fibromyalgia, etc.
- The Current Procedural Terminology (CPT) code, which we use on the insurance billing form for Understanding Pain, is: 96153 x4 or x8 units. It is very important to be as clear and accurate as possible when you are seeking payment information from your insurance company. The 96153 CPT code is the billing code for Group Health and Behavior Intervention. This code is billed in 15 minute time increments. Because each meeting is either one or two hours long (60 or 120 minutes) the 96153 code is billed for 4 or 8 units (example: 8 units x 15 minutes = 120 minutes or 2 hours) each time you attend.
- The Physical Therapy Department will bill any visits for their services using standard physical therapy billing codes.
What if I don’t have any kind of insurance?
If you need financial assistance, you may contact our Financial Counselors at (855) 229-6466. If you qualify, the Providence Charity Care program may cover some or all of the costs of your participation in the Understanding Pain program and physical therapy.
What if my insurance does not cover Group Health and Behavior Intervention?
If you think that you might benefit from participating in the Understanding Pain program, but your payment source does not cover Group Health and Behavior Intervention, you might consider working one-on-one with one of our psychologists. Those individual contacts would be billed as either as a Psychotherapy encounter (CPT codes 90832, 90834, or 90837 for 30, 45, or 60 minute encounters respectively) or an Individual Health and Behavior Intervention (CPT code 96152x4 and could be covered by your insurance company even if your insurance company will not pay for the group Understanding Pain program. If you are interested in attending individual pain management focused counseling, please call our office. We can help you work with your insurance company to see if your individual contacts will be covered by your insurance.