Insurance & Billing for Pediatric Therapy

A Private Pay client is responsible for all services received at Extraordinary Kids. Because we are not in-network with your insurance company, we will not receive payment from your insurance company. If you have out-of-network benefits with your plan, those benefits will be reimbursed directly to you, not to Extraordinary Kids.

During the intake process, we will ask for a credit card to be kept on file for co-payments and other applicable charges.

For Out-of-Network or Private Pay clients, payment is due, in full, at the time of service. A superbill will be provided upon the client’s request.

If you would prefer to make your payment using a payment method other than the card of file, please let us know at the time of treatment. We accept cash, check, debit, and all major credit cards for payment.

Every insurance plan is different, so this is a tricky question to answer. The best thing to do is contact your insurance company, and ask them the following questions:

1. 1. My child will be receiving (speech and/or OT) from an out-of-network provider. Does my plan provide any reimbursement for this? (example: 60% of the eligible charge ​is reimbursable, 40% is patient responsibility + amount above the eligible charge​)
   2. Are there any diagnosis/condition limitations that would disqualify my child from receiving benefits, such as no coverage for developmental delays?
   3. Does my child need prior authorization in order to receive the above benefits?
      1. If yes, will the evaluation be eligible for reimbursement or do I have to receive the prior authorization before I can get an evaluation?
      2. If a prior authorization is not needed, is there a cap of how many visits my child can receive in a year, or how many visits can my child receive before a prior authorization is required?
   4. Do I have to meet the plan deductible before I receive any benefits; if so, how high is my deductible and how much of it have I met this year?
   5. Is there a max dollar amount or time amount my plan will pay for a certain service? (example: some plans will only pay for the equivalent of a one-hour OT session, while others will only pay up to a maximum dollar amount (such as $90 for a session)).
   6. What is your Eligible Charge/Fee Schedule​ for the following treatment codes:
   7. 1. Common Speech CPT Codes: 92523 (speech evaluation), 96210 (Feeding Evaluation), 92507 (speech and language treatment untimed), 92609 (only used if your child uses an AAC for communication, untimed), 92625 (feeding therapy, untimed)
      2. Common OT CPT codes: 97167 (OT evaluation), 96125 (Standardized cognitive performance testing per hour, face to face time providing assessment, interpreting test results and preparing the report), 97530 (Therapeutic Activities, 15 minutes), 97112 (Neuromuscular Re-education, 15 minutes) 97110 (Therapeutic Exercises, 15 minutes), 97535 (self-care and activities of daily living training, 15 minutes)

Extraordinary Kids will help apply for a prior authorization with your insurance if needed. Just let us know that your insurance company stated you need one, and we will have our medical biller assist in the request.

For Out-of-network insurance plans, payment is due, in full, at the time of service. A superbill will be provided upon the client’s request which can be submitted to your insurance provider. If you qualify for reimbursement, it will be sent directly to you, not to Extraordinary Kids. Keep in mind, you will be charged directly by Extraordinary Kids for any services rendered, whether or not your insurance reimburses you. Extraordinary Kids is not responsible if your insurance denies the claim. Any disputes regarding reimbursement will be between you and your insurance company, although our medical biller will be happy to give you advice or answer questions you may have.