Can You Charge for Calls, Emails, and Paperwork?

Yes, and psychiatrists in cash-pay practice already do it routinely. Prior authorizations, disability forms, calls with a patient's therapist, and anything else that takes real time outside a scheduled visit get billed, typically in blocks of ten minutes at a published rate somewhere between $50 and $100. What separates practices that collect this money cleanly from practices that either eat the cost or fight about it every month is one line: a quick, occasional request is free goodwill, and anything past a couple of minutes is billed work, published with the rest of your fee schedule before the first time it happens.

The seven situations below cover almost everything that comes up between visits, with the rates and scripts psychiatrists in real cash-pay practices actually use.

Do quick refill requests between visits cost anything?

No, the quick, occasional ones stay free. A one-line message asking to refill a stable medication a few days early, or a single "can you send this to a different pharmacy," is the kind of request practices treat as free goodwill, the cost of running a practice patients like. The moment it stops being occasional, the calculus changes. A stimulant patient whose refill requires a pharmacy-stock check, a PDMP lookup, and resending to two or three pharmacies during a shortage costs the practice roughly 15 minutes of real work each time it happens, and psychiatrists who watch stimulant refills eat their week land on either a higher standing fee for stimulant follow-ups or a dedicated monthly admin add-on of $100 or more that explicitly covers the between-visit chasing. What decides the answer is repetition. One favor is free. A pattern is a line item.

Can you bill for forms, letters, and disability paperwork?

Yes, and most practices already have a published rate for it: commonly $75 for a flat form or letter, or the same $75-per-10-minutes rate as everything else in this post, billed in blocks with the first few minutes free. Disability verification, FMLA-adjacent paperwork, and school or accommodation letters run longer than a standard prior auth, often 30 to 60 minutes once you account for reading the request and writing something specific enough to be useful, so they add up fast at any per-block rate. Bill it in the same time blocks you use for everything else in this post rather than inventing a separate fee schedule per document type; patients don't distinguish between a disability form and a prior authorization, and neither should your invoice. Publish the rate in the same intake paperwork where the rest of your office policies already live; a one-off email gets forgotten by the second time you need to enforce it.

This paperwork generally falls outside your patient's out-of-network benefits. A superbill needs a CPT code tied to the service you performed, and admin time doesn't cleanly have one. The two codes that theoretically cover related work, 99358/99359 for prolonged non-face-to-face service and 99446-99449 for interprofessional consultation, come with narrow rules (99446-99449 requires the request to come from another treating clinician) and shaky payment: Medicare stopped paying 99358/99359 entirely as of January 2023, per AAPC's coding reference, and commercial out-of-network payers vary on whether they'll honor it at all. Tell patients plainly that this charge is between you and them, and their insurance is unlikely to reimburse it.

Should you charge for prior authorizations, and how much?

Yes, and the observed range across cash-pay practices is $75 flat for a straightforward prior auth or $75 per 10 minutes for anything that turns into a saga, with a common 30-minute minimum once you've started the clock. A simple form submitted through CoverMyMeds that takes under three minutes generally isn't worth billing; save the fee for the ones that turn into a multi-day back-and-forth or a peer-to-peer call. Require a card on file before you start a prior auth that's likely to run long, and if a routine request turns into a saga mid-stream, tell the patient before you keep going rather than surprising them with the total afterward.

The cheapest prior auth is the one you never file. If the medication has a generic equivalent, redirecting the patient to GoodRx or Cost Plus Drugs avoids the authorization entirely and usually costs the patient less than their copay would have. Practices that publish this fee upfront report something counterintuitive: transparent pricing shrinks the volume of prior-auth requests instead of drawing complaints about the fee.

Do you charge for care-coordination calls with therapists and other providers?

It depends, and both defaults show up in practice with roughly equal frequency: some psychiatrists waive the first coordination call with a given therapist each year and bill any call after that, reasoning that a few free minutes of goodwill each year costs nothing and keeps the relationship warm. Others never charge for these calls at all, on the theory that a therapist who feels valued sends more referrals than any fee could recover. Almost nobody bills a first-time coordination call with a new therapist; treat that first call as relationship-building.

The practical trick that makes billing coordination time feel less awkward, when you do charge for it, is language. Saying "let's reserve some time to talk this through" frames the call as scheduling and sets the billing expectation without a single word about money. An hour-long conference with a patient's therapist becomes an unambiguously billed event under this framing, and a two-minute clarifying question stays free.

Can you charge for patient emails and portal messages?

Only past a threshold, and the practical rule most psychiatrists converge on is symmetry: never spend longer composing your reply than the patient spent writing the message. A vague, open-ended question ("what could be causing my fatigue?") gets one sentence back plus a link to book a visit, letting the patient decide whether the question is worth paying to explore properly. A family member who wants a real conversation about the patient's care gets offered a scheduled slot instead of an open-ended callback, which bounds the time and makes the billing obvious to everyone on the message thread.

The underlying reason this works without resentment: an unstructured phone tag or email thread is an infinite, undocumented obligation, while a scheduled ten or thirty minutes is a bounded, billable, chartable event. Moving the conversation from the inbox to the calendar solves the pricing question and the documentation question at the same time.

Where does FMLA and disability paperwork fit?

The same time-block rate as everything else in this post. FMLA certifications and disability paperwork are simply forms that take longer than average, which is a reason to time them accurately rather than price them on a separate schedule from a school letter or a prior authorization. If a request is going to take real time to complete honestly, tell the patient the estimated block count before you start, the same courtesy you'd extend on a drawn-out prior auth.

What is the monthly admin-fee model, and is it worth setting up?

For patients who generate recurring admin work, month after month, a flat monthly fee is worth it; for everyone else, itemized time-block billing is simpler and fairer. Psychiatrists running cash-pay practices have converged on a hybrid: charge per visit as usual, and add an optional $50 to $100 monthly fee that covers routine between-visit work for that specific patient, refills, quick messages, and the occasional form or lab review, without a line-item invoice for each one. Stimulant patients whose refills require monthly pharmacy-stock hunting are the clearest case for this add-on, since $100 a month approximates the 15 minutes per fill that refill work actually costs.

The tradeoff against itemized billing runs both ways. A flat fee removes the friction of billing every small thing and gives patients cost certainty, but it also means you're sometimes paid the same $75 for a month of silence and a month of three drawn-out phone calls. The itemized version is fairer in the aggregate and worse for goodwill, since patients notice every charge even when the total is smaller. One underrated benefit of the monthly model: a canceled membership becomes a clean signal that the patient has moved on, which removes the ambiguity of a patient who simply stops responding and leaves your discharge paperwork in limbo. Write that equivalence into your office policy explicitly, canceling the membership means the patient is seeking care elsewhere, so you're not guessing later.

One caveat if you take insurance for some patients: this fee generally doesn't apply to them. Out-of-pocket admin charges on top of an insurance-billed visit risk violating your payer contract, and contract terms differ by payer, so confirm your specific agreement before billing a paneled patient directly. The workaround psychiatrists use instead is a brief, insurance-billed monthly visit, even a plain follow-up code, which documents and reimburses the same check-in that a cash patient would pay an admin fee for.

If you're introducing either model to patients who've never been charged for this work before, say so plainly and once: "Starting next month, I'm formalizing something that's been informal until now. Routine paperwork and calls outside our visits, forms, prior authorizations, coordination with your other providers, will be billed at $75 per 10 minutes, waived for anything under a few minutes. This protects the time I can give you in session, and it's the same policy for every patient in my practice." That last sentence, that the rule is universal and not aimed at them, is what keeps the conversation from reading as a shakedown.

Whichever model you pick, the mechanics are easier when the charge doesn't require opening a new invoice thread. A time-block admin fee posts the same way a no-show fee or a copay does, as a charge against the card already on file; Eureka bills these one-off amounts directly against the stored card rather than routing them through a separate billing tool, which is most of what makes the model above practical to actually run.