Is EMDR therapy covered by insurance?
Looking to find out if you can use your insurance benefits for Eye Movement Desensitization and Reprocessing (EMDR)?
The answer is: it depends.
Most insurance companies do not distinguish between EMDR and other forms of talk therapy such as Cognitive Behavioral Therapy (CBT). If your insurance plan has mental health benefits, it most likely covers EMDR as a therapy modality.
That being said, EMDR typically requires longer sessions (60-90 minutes) than other forms of psychotherapy (45-50 minutes) and your insurance company may not pay the additional cost associated with an extended session. The good news is that most insurance companies will cover up to 60 minutes, even if they won’t cover a full 90 minute session.
Because of some of the time restrictions insurance companies place on therapy sessions, it can sometimes be hard to find an in-network provider who provides EMDR. Many clients have out-of-network benefits, however, which can help to cover a large percentage of the cost of treatment.
How can you find out more?
You can find out for sure whether EMDR will be covered by calling your insurance company and specifically asking if your insurance plan will cover both CPT codes 90834 (45 minute psychotherapy session) and 90837 (60+ minute psychotherapy session). While you’re on with them, other helpful information to ask includes:
What’s my In-Network & Out-of-Network Deductible?
What is my co-insurance (AKA percentage I have to pay)?
What is my out-of-pocket max?
What is the Allowed Amount or Usual and Customary Rate (UCR) for the CPT codes 90834 & 90837?
Do I need pre-authorization for mental health services?
The Bottom Line
If you have insurance, it most likely will cover at least some of the cost of EMDR. While it may be hard to find an in-network provider who provides EMDR based on insurance restrictions, you may have out-of-network coverage that can help cover at least some of the costs.
You Don’t Have to Navigate the Insurance Maze Alone
Navigating the insurance reimbursement can be difficult - especially when you’re trying to focus on healing. If you’d like to learn more about how to use your out-of-network benefits for EMDR in NYC, feel free to book a free consult with any of the therapists at Madison Square Psychotherapy where we can speak more about navigating treatment and navigating insurance reimbursement.
