Psychotherapy CPT Codes: Addressing The What, Why, How, And The Most Used Queries
Mental health therapists use psychotherapy CPT (Current Procedural Terminology) for billing purposes and it also includes 90834 and 90837 CPT codes.
Psychotherapy CPT codes are well-known for any behavioral or mental health practitioner who is dealing with insurance or has worked in a clinic. Usually, medical coding can be tedious and challenging but in psychotherapy, mental health clinicians won’t likely use more of them daily.
Let’s address your common doubts and queries about what are CPT codes, why they are essential for clinicians, how to use them correctly, and what are the most commonly used CPT codes in psychotherapy.
What Are CPT Codes?
A CPT (Current Procedural Terminology) code is a universal coding system developed by the American Medical Association (AMA). Since its development, it has encountered many changes.
- A CPT code is normally a 5-digit numeric code.
- Some come in 4-digit and one-letter formats.
- It doesn't have any decimal points.
These codes outline medical procedures like tests, surgeries, evaluations, and others carried out by a patient or a physician. CPT codes are obligatory for receiving reimbursements from health insurance companies.
Example:
Behavioral health CPT codes narrate the extent of a psychotherapy session with a patient or a diagnostic interview.
Why CPT Codes Are Necessary For Clinicians?
- CPT codes decide the compensation for an encounter and a practice’s overall success.
- That is why there are very essential for clinicians and healthcare staff.
- These codes are vital for effective practice management.
- Receiving correct reimbursement rates depends on the accurate entry of CPT codes on insurance claim forms that represent the services provided before submitting the claims to the insurance company.
How To Use CPT Codes Correctly In Psychiatry?
It’s not always that easy to decide whether you have fulfilled the required criteria to code correctly for the maximum reimbursement rate. This is why the CPT code set is complicated. Breaking down the process into steps for new and established patients may help.
1. For new patients:
You may bill two types of psychiatric procedures or services CPT codes and according to the time and situation, it may be okay to bill for both codes.
- E/M codes
- Psychiatric diagnostic evaluation codes
- E/M: Use these codes when assessing a new medical issue. Choose the E/M code based on the total time you spent or the complications of medical-decision making on the patient on the day of the service provided. You must choose a code according to the medical decision-making and not total time if your render E/M services with a psychotherapy add-on code.
- Psychiatric diagnostic evaluation codes: Uses these codes for diagnostic assessments. If it takes more time to finish the first evaluation, you may need to use these more than once.
2. For established patients:
The rules permit you to bill an E/M service with every visit but do not require it for every encounter. Only if you documented and addressed a different medical issue during the visit, bill E/M services.
Example:
You may bill for an E/M visit during an encounter if you address the medication’s side effects, in addition to a psychotherapy session.
- But you can only bill for the psychotherapy session if a patient has been steady and has not changed the medications and made a psychotherapy visit.
- And you cannot bill for E/M since there are no medication or medical concerns conveyed during the visit.
- To bill for E/M, you must prove your management or discussion of a medication or medical issue different from the psychotherapy service in your documentation.
What Are The Most Commonly Used CPT Codes In Psychotherapy
3 standard codes are commonly and frequently used by behavioral health clinicians: 90834, 90837, and 90791. A 2021 survey indicates that CPT® code 90837 was billed the most, followed by 90834 and then 90791.
The American Psychological Association has listed the standard CPT codes used by therapists.
- 90832: individual psychotherapy for 30 minutes
- 90834: individual psychotherapy for 40 minutes
- 90837: individual psychotherapy for 60 minutes
- 90845: Psychoanalysis
- 90846: Family psychotherapy without the client present for 50 minutes
- 90847: Family psychotherapy with the client present for 50 minutes
- 90849: Multiple family group psychotherapy
- 90853: Group psychotherapy
As it is psychotherapy, the therapists can have some flexibility regarding the time even though the codes describe specific times such as 30, 40, or 60 minutes.
Therapists, while selecting a psychotherapy CPT code, must choose the closest one to the time spent in the session. The American Psychological Association (APA) lists psychotherapy session duration as follows;
- 90832: Sessions that happen between 16 and 37 minutes
- 90834: Sessions that are 38 to 52 minutes long
- 90837: Sessions that last for 53 minutes and longer
- 90846 or 90847: Family psychotherapy sessions that last for 26 minutes or more
Psychotherapy Medical Billing Services From Vozo
Staying up to date with medical billing and coding in psychotherapy is very essential to any behavioral health-related clinician. Whether you are a licensed clinical social worker (LCSW), a psychiatrist (MD), or a licensed professional counselor (LPC), CPT codes are how you get paid for your vital work across the country.
Is your practice planning to add an office location or provide teletherapy services? Or do your medical billing and other services allow you to stay HIPAA compliant all along? If not, or want to upgrade your specialty to another level with the most advanced medical billing and coding services?
Vozo will be your perfect companion for providing better quality care with patient-centric measures. Our integrated medical billing system, and smart reporting tools, increase s efficiency and ensure complete transparency for your practice. Our high-end automated billing services make it easier for you to schedule appointments faster, submit claims, pay bills online, manage your practice easier than ever and make your clients’ payment mode easier. Our up-to-date coding services ensure no errors are made and you get your reimbursements without interruptions.
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