We are “in-network” with these insurers:
- Blue Cross Blue Shield of Massachusetts
- Mass General Brigham Health Plan
- Harvard Pilgrim Health Care (see notes below for important exclusions)
- Tufts (see notes below for important exclusions)
- Fallon
For Tufts, we are not in-network with these plans: Tufts public plans.
For Harvard Pilgrim, we are not in-network with these plans: GIC Primary Choice HMO plans, Quality HMO plans.
For Harvard Pilgrim, we are in-network with these plans: GIC Independence Plan, Explorer POS, Access America
Cigna’s directory sometimes reports we are in-network. We are not. We have asked them to remove us, but we are sometimes still there. However, if your insurance card says “Tufts Health Plan administered by Cigna Health and Life Insurance”, then we are in-network.
UnitedHealthcare’s UMR plan sometimes uses the Harvard Pilgrim network. If your card has the Harvard Pilgrim Healthcare name and logo, then we suggest you call your insurance company to verify we are in-network through Harvard Pilgrim.
This list may change, so please check with us if you have questions.
Tufts and Harvard Pilgrim have recently merged to become Point32Health.
Allways recently renamed itself to Mass General Brigham Health Plan.
Our MassHealth panel is currently closed, so we cannot accept new patients whose primary insurance is MassHealth. This includes MassHealth plans administered by Mass General Brigham Health Plan (cards for this plan have a “MassHealth #” in addition to a “Health Plan ID #”).
For insurance companies not on the list above, we are “out-of-network”. If you are an out-of-network patient, then payment in full must be made at the time of your visit. We will provide you with documentation to support submitting an out-of-network claim to your insurance company, but it is your responsibility to file the claim.
We recommend you speak with your insurance company to better understand what they will cover and to determine if referrals or insurance authorizations are needed. You must have a referral if your insurance is an HMO and your child’s pediatrician is outside the Mass General Brigham network. Depending on your insurance, we may also ask you to get a “request for consultation” from your child’s pediatrician. We prefer the pediatrician to use this Request for Consultation form.
When you speak with your insurance company, they may ask you which billing codes we typically use. The following are typical codes for the series of four visits for new patients:
| Service | Notes | Billing code (CPT) |
|---|---|---|
| First visit | | 99205 |
| • Brief emotional / behavioral / developmental assessments | May be multiple units depending on time required | 96127 |
| • Additional time needed either for time spent face to face, time spent consulting therapists or school, document review, or documentation (part of first visit) | If required May be multiple units depending on time required | 99417 |
| Second visit | | 99215 |
| • Brief emotional / behavioral / developmental assessments | May be multiple units depending on time required | 96127 |
| Third visit | | |
| • Developmental / behavioral testing (typically the bulk of third visit) | Base charge plus additional charges, depending on time required (see note below this table) | 96112 + 96113 |
| Fourth visit | | 99215 |
When speaking with your insurance company, it is important that they know we are a medical practice, not a behavioral health practice. They may try to tell you otherwise, but we are definitely medical.
Many health insurance plans have a significant deductible, meaning that you may owe hundreds or even thousands of dollars before your insurance starts to pay. For new patient visits and testing visits in these circumstances, we typically see amounts from $300 to $2500 owed by the patient before insurance starts to pay. When you speak with your insurance company, they will be able to assist you in estimating how much you will owe.
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