Good Faith Estimates and Diagnosis Codes: Federal Requirements Apply
Under the No Surprises Act federal regulations effective January 1,2022, psychotherapists must include diagnosis codes in Good Faith Estimates when providing them to uninsured or self-pay patients—this is a federal requirement that applies uniformly across all states, including [STATE]. 1
Federal Regulatory Framework
The Health Insurance Portability and Accountability Act (HIPAA) and subsequent federal regulations establish baseline requirements for healthcare providers, including mental health professionals, regarding disclosure of treatment information. 1
The No Surprises Act mandates that Good Faith Estimates include specific diagnostic information using standard coding systems (ICD-10 codes). This federal requirement supersedes state-level variations. 1
The diagnosis code serves as a required element for cost estimation, as it directly impacts the scope and duration of anticipated treatment services. 1
Clinical and Ethical Context
While federal law requires diagnosis code inclusion, psychotherapists must balance this requirement with ethical obligations around patient privacy and confidentiality:
Confidentiality remains crucial in psychiatric treatment, and therapists should inform patients about what information will be documented and potentially disclosed, even in administrative documents like Good Faith Estimates. 2, 1
Transparency with patients about the diagnosis being used is ethically essential before providing the Good Faith Estimate, as this respects patient autonomy and informed consent principles. 3, 4
The diagnosis included should be clinically accurate and reflect the treatment plan being estimated, not a placeholder or minimized code to protect privacy, as this would violate both clinical integrity and regulatory compliance. 2, 4
Common Pitfalls to Avoid
Do not omit the diagnosis code thinking state privacy laws override federal billing requirements—the No Surprises Act is federal legislation that applies nationwide. 1
Do not use vague or non-specific codes (like "unspecified mental disorder") solely to protect privacy when a more specific diagnosis guides the treatment plan, as this misrepresents the clinical situation. 2, 4
Do not provide the Good Faith Estimate without first discussing the diagnosis with the patient, as this violates ethical standards for transparency and informed consent in psychotherapy. 3, 4
Implementation Approach
When preparing Good Faith Estimates, psychotherapists should:
Complete a diagnostic formulation that integrates biopsychosocial data and uses both DSM diagnostic criteria and psychodynamic understanding of the patient's presentation. 2
Discuss the diagnosis openly with the patient before documenting it in the Good Faith Estimate, explaining how it relates to the treatment plan and cost estimation. 2, 3
Document the ICD-10 code that most accurately reflects the primary condition being treated in the Good Faith Estimate as required by federal regulation. 1
Maintain separate psychotherapy notes with more detailed clinical information, which receive higher privacy protections under HIPAA than the administrative Good Faith Estimate document. 1