National Alliance for Mental Health


  800-969-6642 External link opens in new tab or windowwww.nmha.org

External link opens in new tab or windowwww.nimh.nih.gov


Depression & Bipolar Support                   

National Alliance for the Mentally Ill

Alliance 800-826-3632                         

   800-950-62 External link opens in new tab or windowwww.nami.org

External link opens in new tab or windowwww.dbsalliance.org   

American Association for Marriage
& Family Therapists

External link opens in new tab or windowwww.AAMFT.org

American Psychological Association
External link opens in new tab or windowwww.apa.org   

Georgia Psychological Association

 External link opens in new tab or windowwww.gapsychology.org 


                                Good Faith Estimate and table of services of and fees


Dear Client,

 In compliance with the No Surprises Act that goes into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing.”

 This Act requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.

 Additionally, we are required to provide you with a Good Faith Estimate of the cost of services (attached). It is difficult to determine the true length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. Therefore, attached you will find a fee schedule for the services typically offered by your therapist, and we will collaborate with you on a regular basis to determine how many sessions you may need


Thank you very much,


   This Good Faith Estimate explains your therapist’s rate for each service provided. Your therapist will collaborate with you throughout your treatment to determine how many sessions and/or services you may need to receive the greatest benefit based on your diagnosis(es)/presenting clinical concerns




.Service code

(CPT Code)



Fee for Service (Number of Sessions Will Be Determined as We Progress)



Initial Diagnostic Evaluation




Psychotherapy, 16-37 minutes

Pro-rated fee



Psychotherapy, 38-52 minutes

            Pro-rated fee

Estimate by number of sessions


Psychotherapy ≥ 53 minutes (This fee is my hourly rate & used for all prorated calculations as indicated)




Psychotherapy for a Crisis (30-74 minutes)

             Pro-rated fee



Psychotherapy for a Crisis

(add on code for each additional 30 mins)

Pro-rated Fee



Family Psychotherapy without Patient Present, 50 minutes




Family Psychotherapy with Patient Present, 50 minutes



       98966-               98968

Telephone Assessment & Management


Prorated based on the amount of time spent at hourly rate


       98970-  90872       

Online Digital Evaluation & Mgt

(Responding to Email & Text Messages)

Prorated based on the amount of time spent at hourly rate


Cancelation Fees

Therapist Requires a 24-Hour Cancelation Fee

You are Responsible for the Fee of the Appointment Missed


Production of Records/Legal             Fees


Prorated rate










*Please Note:


Tele-health services are charged at identical rate