BoreTide Behavioral Health
Services & Fee Schedule
This is for services provided by Kelly Moore, PMHNP-BC at 4241 B Street, Suite 305, Anchorage, Alaska 99503
BoreTide Behavioral Health is currently in network with:
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Blue Cross Blue Shield/Premera
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Aetna/EBMS
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TriWest
We accept and are able to bill all other private insurance companies but please check with your plan to learn about coverage.
We are not set up or able to take Medicare, Medicaid or Denali Kid Care
Evaluation and Management Services: 99215 (Follow-Up Appointment)
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation.
$482.00
Evaluation and Management Services: 99214 (Follow-Up Appointment)
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation.
$330.00
Evaluation and Management Services: 99213 (Follow-Up Appointment)
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. This time includes chart review, face-to-face time and documentation.
$213.00
Evaluation and Management Services: 99417 or G2212
Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes. This time includes chart review, face-to-face time and documentation.
$140.00
Evaluation and Management Services: 99205 (Intake Assessment)
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter This time includes chart review, face-to-face time and documentation.
677.00
Evaluation and Management Services: 99421 (Online Communication/Correspondence)
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes (Used for email correspondence - not telemedicine) This time includes chart review, face-to-face time and documentation.
$86.00
Evaluation and Management Services: 99422 (Online Communication/Correspondence)
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes (Used for email correspondence - not telemedicine) This time includes chart review, face-to-face time and documentation.
$165.00
Evaluation and Management Services: 99441 (Telephone Communication/Correspondence)
Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion This time includes chart review, face-to-face time and documentation.
$45.00
Evaluation and Management Services: 99442 (Telephone Communication/Correspondence)
Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion. This time includes chart review, face-to-face time and documentation.
$96.00
Medicine Services and Procedures: 90785
Interactive complexity (List separately in addition to the code for primary procedure). This add–on code represents increased work intensity of psychotherapy services that adds difficulty to delivery of service.
$85.00
Medicine Services and Procedures: 90833
Psychotherapy, 30 minutes with patient when performed with an evaluation and management service. In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the same session. The treatment session with the patient typically lasts anywhere between 16 to 37 minutes. $200.00
You will be provided with an estimate of the anticipated charges for your nonemergency care upon request. Please do not hesitate to ask for information.
Hardship pricing is available based on individual situations, please inquire with your provider to see if you are eligible.
The undiscounted price may be higher or lower than the amount an individual actually pays for the health care services described in the list.
Prices are subject to change without notice.
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