Psychotherapy CPT codes (CPT codes for Mental health) commonly used by therapists such as 90837 CPT code, 90834 CPT codes and others will be reviewed in this blog. Any behavioral health practitioner who has ever worked in an institutional setting or dealt with insurance knows about CPT (Current Procedural Terminology) codes. They can be tedious and difficult to learn but mental health clinicians are pretty lucky compared to some providers. Unlike many medical doctors, it is likely you won’t have to use more than a handful in your everyday work. Let’s explore the importance of psychotherapy CPT codes and some tips for getting the best out of them.
What are CPT Codes?
In 1966, the American Medical Association created CPT codes to help standardize billing across different disciplines and work environments. In health settings, these represent what type of services clinicians are providing their clients. The codes may refer to both diagnostic practices and medical procedures. For example, an individual psychotherapy session has a certain code. So does a routine visit to the doctor or an angioplasty.
Why Do We Need CPT Codes?
The primary reason for psychotherapy CPT codes is so insurance companies know what they need to reimburse practitioners for services. So, if you want to be paid what you deserve, you need to ensure you are using the proper codes. Additionally, insurance companies do not like to pay for anything more than they have to. If they suspect you are using codes incorrectly, your services may be subject to an audit. If you depend on insurance for your paycheck you will need to learn the relevant CPT codes.
The Most Popular Psychotherapy CPT Codes for Mental Health
The following are the CPT codes most often used by behavioral health practitioners:
90837 CPT Code-60 minute psychotherapy session (52 minutes or longer)
Although this is usually called a 60 minute session, it is important to note that any session longer than 52 minutes gets billed with this code. Meetings must be face to face to use this code.
90834 CPT Code-45 minute psychotherapy session (38 to 52 minutes)
Similar to above except for a shorter time. This may be the most used code in mental health.
90832 CPT Code-30 minute psychotherapy session (16 to 37 minutes)
The 30 minute session is rarer but has occurred with increasing frequency in the telemedicine age. Note that you can see someone for only 16 minutes and still use this code.
90791 CPT Code – Psychiatric Diagnostic Evaluation
This is how you would code the traditional intake session. For example, assessing the presenting problem and/or providing a mental status examination.
90792 CPT Code– Psychiatric Diagnostic Evaluation with medical services
This is how someone like a psychiatrist would code an intake session. The difference from 90791 is that a psychiatrist is a medical doctor who might assess the need for medical services, such as prescription medication.
90847 CPT Code – Family or couples psychotherapy, with the patient present (50 minutes)
This code is for when you use family therapy techniques in a session with multiple family members or a couple. The identified patient must be present.
90846 CPT Code – Family or couples psychotherapy, without the patient present (50 minutes)
This code is for when you use family therapy techniques in a session with multiple family members without the identified patient. This code is more controversial because the identified patient is not present. If you use this code too often, an insurance company may question why you are not including the identified patient.
90853 CPT Code – Group Psychotherapy (not family)
A treatment group for unrelated people, such as you might find for addiction or dialectical behavior therapy. Not the same as a support group.
90839 CPT Code – Psychotherapy for Crisis, 60 minutes (30-74 minutes).
This code is used in a crisis situation. If a patient is suicidal, for instance, and they require therapy to prevent self-harm and ensure stabilization.
A Note About Telehealth
The pandemic has brought about the broad use of telehealth. The AMA has addressed the use of telemedicine by using modifiers rather than introducing entirely new codes. In behavioral health, the modifier 95 is added to the original code to signify teletherapy. For example, you would add the 95 modifier to 90834 to signify a 45-minute teletherapy session (i.e., 90834-95). To be billed with this modifier, a face-to-face video session needs to have occurred. Texting is not yet recognized as a billable service. Tip here: If you plan on providing teletherapy services to your clients make sure that they sign telehealth consent form.
You will also need to add a place of service modifier. This tells the insurance company where the service occurred. Traditionally, providers may perform their work at a school, office, or hospital and should use the corresponding modifier. If you are performing telehealth, you would use the modifier 02. Keep in mind, that if you are providing a service in a facility (e.g., a hospital or nursing home), you will get paid a bit less than if you perform that same service in an office setting due to a lack of overhead.
Why Do CPT Codes Change and Where Can I Find Them?
The world of medicine and behavioral health is always changing and, as a result, CPT codes are updated yearly to maintain accuracy. That doesn’t mean the ones you normally use are different than before—they probably aren’t—but you need to be aware of any possible changes so you can remain precise. Yearly updates usually come out a few months before the new year. You can look for CPT information and any relevant changes here.
Tips For Practitioners
Here are some tips to avoid any potential CPT coding problems:
Insurance companies keep close track of how you bill services. Do not try to overcode to make more money (e.g., billing a 60-minute session when it was only 45) or undercode to try to reduce patient costs. If you are providing incorrect codes, you may be audited and kicked off an insurance panel, not to mention be charged for fraud.
Don’t Confuse CPT and DSM/ICD Codes
CPT codes relay the type of service provided whereas ICD codes report what condition those services are treating. Although they are different, they are related. Documentation about a patient’s diagnosis needs to reflect the level of care they are receiving. For example, if you give a patient a less severe diagnosis (e.g., persistent depressive disorder) and are then trying to see them for 60-minute sessions five times a week that might raise a red flag.
Billing Department Staff Are Not Mind Readers
If you work in an institution or a large private practice, you likely have staff members who are in charge of insurance billing. They are usually very skilled but they cannot fill in codes when they do not have the proper information. If you don’t fill out all the pertinent codes, the staff will be frustrated and your payment may be delayed. Moral of the story: make sure you fill out all the data they need from you for proper billing.
If you’re looking for an EMR/practice management software for your private practice and you wonder if you could manage your mental health CPT codes electronically- the answer is “yes”. TheraPlatform – Mental Health Software for practice management and EMR allows you to enter your own CPT codes and these will auto-populate to the CMS-1500 (also available on TheraPlatform). As a bonus- TheraPlatform offers integrated telehealth with no additional charge. You can trial TheraPlatform for free for 30 days here.