Steven D. Graham, PhD, DMin 

Steven D. Graham, PhD, DMin 

Patient’s Name: __________________________________
Date (s) of Service: ________________________________
Diagnosis: ______________________________________

 

Therapeutic Procedure                                                                                           FEE

            1. ____ 90832, Partial Session, 30 minutes                                         _____

            2. ____ 90834, Full Session, 45 minutes                                              _____

            3. ____ 90837, Extended Session, 60 minutes                                   _____

            4. ____ 90845, Psychoanalysis                                                              _____

            5. ____ 90846, Family Therapy without Patient Present                 _____

            6. ____ 90847, Family (Conjoint) Therapy with Patient Present   _____ 

 

Evaluative Procedure

            1. ____ 90801 Diagnostic Interview                                                         _____

            2. ____ 90802 Diagnostic Interview, Interactive                                  _____

            3. ____ 96101 Psychological Testing, Interpretation and Reporting by Psychologist                                                                                                                                                          _____

4. ____ 96102 Psychological Testing by Technician, Interpretation and Reporting by Psychologist                                                                                                                                            _____

5. ____ 96103 Psychological Testing by Computer, Interpretation and Reporting by Psychologist                                                                                                                                           _____

6. ____ 96116 Neurobehavioral Status Exam                                                   _____

7. ____ 96118 Neuropsychological Testing, Interpretation and Reporting by Psychologist                                                                                                                                                          _____

8. ____ 96119 Neuropsychological Testing by Technician, Interpretation and Reporting by Psychologist                                                                                                              _____

9. ____ 96120 Neuropsychological Testing by Computer, Interpretation and Reporting by Psychologist                                                                                                              _____

                                                                                         

Other Procedures

            1. ____ 90889 Auxiliary Services                                                           _____

            2. ____ Telephone Consultation                                                              _____

 

                                                                                    Previous Balance                 _____

                                                                                                Total                          _____

                                                                                    Unpaid Balance                  _____

 

 Thank you!
____________________________________________________________________

Steven D. Graham, Ph.D., D.Min., Clinical Psychologist, Fl License: PY6884
NPI: 1619290020, Taxonomy: 103TC0700X.   www.DrSteveGraham.com