INSURANCE & BILLING

Capitol Kids Therapy does not have the ability to process internal billing and collections through individual insurance claims. Many families inquire about reimbursement for their child's evaluation and therapy program. This guide is to offer information that will help you get paid more quickly from your insurance plan. Thank you for visiting this page!

We are very appreciative to the parents of our children for the priority they place on staying current with their payments. Some families find the use of the HSA or flex spending accounts to be the easiest and most effective tool when seeking compensation for their child's speech therapy services. Others have taken the necessary steps to streamline the process of submitting their claims to their insurance company each month so their reimbursement checks arrive on a predictable schedule. These helpful hints are offered to help you get started:

Call your insurance company right away to learn more about your plan's unique benefits. Capitol Kids Therapy, LLC is not a participating provider with any plan and therefore you will need to inquire about "out of network" benefits. Most plans cover a specific number of sessions per year or a specific dollar amount per year. Reimbursement typically begins after a deductible is met. It is important to find out if your deductible is for the entire family or for each individual on your plan.
Ask your insurance company where to find the forms you will need to submit your paid invoices and make sure your agent recognizes that you are paying out of pocket for services, therefore reimbursement checks should be made payable directly to you. These forms can be rather technical, so please ask us to help you with your first form if you need clarification of line items.
Speech-language therapy is an untimed code, therefore sessions less than 1 hour will be counted as one session towards your total number of visits for the year (if your plan "limits" visits). Do not fear! Most plans will allow requests for additional visits, so please alert us if this applies to your plan. If you have a visit-specific plan, please request forms for authorizing additional visits for your child since most therapy plans extend beyond the customary 15-30 visits allowed per year.
Ask your insurance company what your reimbursement rate will be for each unit. If your child's treatment plan includes oral-motor activities, ask your insurance company if your reimbursement rate increases by using two codes per session (this would be: 92507 for individual speech-language therapy and 92526 for oral-motor/feeding therapy).
Ask us for a diagnostic code, referred to as an ICD-10 code, so that you may inquire if the diagnosis is covered under your plan.
Check to see what amounts are allowed for the CPT code we will use on your invoice. The following CPT codes are commonly used on our invoices:

92507 - Individual Speech-Language Therapy

92508 - Group Speech-Language Therapy

92526 - Oral Motor/Feeding Therapy

92521 - Stuttering Evaluation

92522 - Articulation Evaluation

92523- Comprehensive Speech-Language Evaluation

99366 - team conference with interdisciplinary team of health care professionals

Finally, be sure to send your Capitol Kids Therapy, LLC invoices along with copies of your treatment notes to your insurance company as quickly as possible. Also consider checking with your HR person during this time to find out your options for best coverage of out of network speech therapy. Employers typically have an "open season" period in the summer or winter where you can switch plans for coverage that better meets your needs. Confirm that you have filled out the form properly to be directly reimbursed by your insurance company- there is a field on the claim form that indicates who should receive payment (Capitol Kids Therapy, LLC should not be the recipient of reimbursement checks).

One additional resource to help you with your claims is the DC Ombudsman, Paula Johnson, at 202-724-7491.