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Cpt code 90837

CPT Code 90837 is a procedure code that describes a 60-minute individual psychotherapy session performed by a licensed mental health provider. It is one of the most common CPT codes used in mental health insurance claims coding and billing. This code represents insight-oriented, behavior-modifying, supportive, and/or interactive psychotherapy services. Medicare requires certain additional services to be included when billing 90837, such as teaching grooming skills, monitoring daily living activities, recreational therapy, and social interaction. The duration of a 90837 session ranges from 53 minutes to longer, and it has higher reimbursement rates compared to other therapy session codes.

Key Takeaways:

  • CPT Code 90837 represents a 60-minute individual psychotherapy session.
  • Medicare requires certain additional services to be included when billing for 90837.
  • The duration of a 90837 session ranges from 53 minutes to longer.
  • 90837 has higher reimbursement rates compared to other therapy session codes.
  • Therapists should accurately document the length of each session to ensure correct billing.

CPT Code 90837 Description

CPT Code 90837 represents a 60-minute individual outpatient psychotherapy session. During this session, licensed mental health providers deliver therapy services to their patients or their family members. This code is commonly used to bill for insight-oriented, behavior-modifying, supportive, and interactive psychotherapy. It is essential to ensure that the services provided during the session align with the requirements set forth by the Centers for Medicare and other payers.

Procedures included in CPT Code 90837

To accurately bill using CPT Code 90837, mental health providers must ensure that the therapy session includes the following procedures:

  • Insight-oriented therapy
  • Behavior-modifying therapy
  • Supportive therapy
  • Interactive therapy

Conditions for CPT Code 90837

CPT Code 90837 is appropriate for individual outpatient psychotherapy sessions that span a duration of 60 minutes. It is crucial to adhere to the recommended time frame and provide the necessary therapy services to warrant billing with this code. Pay close attention to the specific guidelines outlined by Medicare and other insurance payers to ensure accurate coding and billing.

Qualifying for CPT Code 90837

To qualify for billing with CPT Code 90837, therapists must meet the following criteria:

  1. Hold a valid and relevant license as a mental health provider.
  2. Conduct individual outpatient psychotherapy sessions.

Therapists must also be aware of any additional requirements or limitations imposed by individual insurance companies for proper reimbursement.

Benefits of CPT Code 90837

Choosing to bill with CPT Code 90837 for individual outpatient psychotherapy sessions offers several advantages, including:

  • Higher reimbursement rates compared to shorter therapy session codes.
  • Accuracy in capturing the session’s true duration, allowing appropriate billing for longer therapy sessions.
  • Validating the use of insight-oriented, behavior-modifying, supportive, and interactive therapy techniques.

By utilizing CPT Code 90837, mental health providers can ensure proper coding and reimbursement for their comprehensive therapy services.

Reimbursement Rates for CPT Code 90837

The reimbursement rates for CPT Code 90837 can vary depending on the year and the payer. To provide you with an idea of the reimbursement rates, here are some examples:

Year Reimbursement Rate
2023 $147.07
2022 $164.84
2021 $152.48

These figures can give you a general idea, but it’s crucial to consult with individual insurance companies to determine their specific reimbursement rates for CPT Code 90837. Keep in mind that in general, CPT Code 90837 tends to have higher reimbursement rates compared to shorter therapy session codes, which can result in an average increase of $9-20 per session.

It’s important to stay updated on any changes to reimbursement rates and to work closely with insurance companies to ensure proper billing and reimbursement for your services.

Time Length for CPT Code 90837

CPT Code 90837 represents a 60-minute therapy session. However, the actual duration of the session can range from 53 minutes to longer. It is important to accurately document the length of each session to ensure correct billing using this code. Therapists should be mindful of the time spent on administrative tasks and focus on providing clinical therapy during the designated session time.

Session Duration Billing Code
53-60 minutes CPT Code 90837
38-52 minutes CPT Code 90834
Less than 38 minutes Other appropriate therapy codes

Accurate documentation of session length is crucial for appropriate billing. Therapists should ensure that the duration recorded aligns with the actual time spent in therapy, excluding any non-therapeutic discussions or administrative tasks. By carefully tracking and documenting session lengths, therapists can ensure proper billing using CPT Code 90837.

When to Use CPT Code 90837 vs. 90834

Choosing the correct CPT code for therapy sessions is crucial to ensure accurate billing and reimbursement. When determining whether to use CPT Code 90837 or 90834, therapists should consider the duration of the session.

CPT Code 90837 is appropriate for therapy sessions that are 53 minutes or longer. This code covers sessions that exceed the time range of CPT Code 90834, which is used for therapy sessions between 38 and 52 minutes. Accurate tracking and documentation of the session duration are essential to determine the appropriate code for billing.

It’s important to remember that CPT codes should only capture the face-to-face time spent on therapy. Administrative tasks and non-therapeutic discussions should be excluded from the documented time.

Session Duration Appropriate CPT Code
53 minutes or longer CPT Code 90837
38 to 52 minutes CPT Code 90834

By correctly selecting the appropriate CPT code based on the session duration, therapists can ensure accurate billing and maximize reimbursement for their therapy services.

Therapy session coding

How to Bill Extended Sessions for Psychotherapy Over 60 Minutes

When it comes to billing extended therapy sessions that exceed 60 minutes using CPT Code 90837, there are specific guidelines and alternative options to consider. As of 2023, billing for extended sessions using CPT Code 90837 is no longer possible. However, for claims with dates of service from 2022 and earlier, therapists could utilize Add-on CPT Code 99354 for an additional 30-74 minutes of therapy.

Add-on CPT Code 99354 is designed to be used alongside CPT Code 90837 or 90847, allowing therapists to bill for extended therapy sessions. It is important to review the specific guidelines and requirements set forth by insurance companies to ensure proper billing for extended sessions.

Here is an overview of the steps to bill extended therapy sessions:

  1. Determine the duration of the therapy session based on the total time spent with the patient.
  2. If the session duration exceeds 60 minutes but falls within the range of 30-74 additional minutes, you can use Add-on CPT Code 99354.
  3. Submit the claim with both the primary CPT code (90837 or 90847) and the Add-on CPT code (99354).
  4. Ensure accurate documentation of the therapy session, including the time spent, services provided, and medical necessity for the extended duration.
  5. Review the reimbursement rates and guidelines provided by each insurance payer to ensure proper reimbursement for the extended session.

By following these steps and staying aware of the specific requirements set by insurance companies, therapists can successfully bill for extended therapy sessions using the appropriate CPT codes.

Example of Billing Extended Therapy Session:

CPT Code Session Duration Reimbursement Rate
90837 60 minutes $147.07
99354 (Add-on) 30-74 additional minutes Variable

Insurance Scrutiny of CPT Code 90837

Some insurance payers have been closely examining the use of CPT Code 90837 in therapy billing. Providers who frequently utilize this code, such as Highmark BCBS and Anthem, have received warning letters from these insurance companies. The purpose of these letters is to provide educational reminders but has caused some concerns among therapists about the future use of CPT Code 90837.

The American Psychological Association Practice Organization (APAPO) and Pennsylvania Psychological Association (PPA) have stepped in to advocate for affected psychologists. They are working to ensure that CPT Code 90837 is being appropriately utilized and that therapists are aware of the specific requirements and guidelines set by each insurance payer.

Understanding the scrutiny surrounding the use of CPT Code 90837 is crucial for therapists when it comes to insurance reimbursement for therapy sessions. Staying informed of payer policies and guidelines can help therapists navigate the billing process effectively while ensuring proper reimbursement for their services.

Limitations of CPT Code 90837

CPT Code 90837, while widely used in therapy session coding, has certain limitations that therapists should be aware of. Understanding these limitations is crucial for accurate billing and reimbursement. Here are some key limitations to consider:

  1. Face-to-face therapy time only: CPT Code 90837 is designed to capture only the face-to-face time spent on therapy. This means that any time spent on administrative tasks or non-clinical discussions should not be included in the billed session. It’s important to accurately track and document the actual therapy time to ensure proper billing.
  2. Potential reimbursement discrepancies: While CPT Code 90837 may have higher reimbursement rates compared to shorter therapy session codes, it is important to note that some payers may not reimburse 90837 at a higher rate. Before billing, therapists should review the reimbursement policies of individual insurance companies to determine the specific rates for this code.
  3. Preauthorization requirements: Some insurance providers may require preauthorization for therapy sessions billed under CPT Code 90837. This is especially true for certain clients or specific treatment approaches. Therapists should familiarize themselves with the preauthorization guidelines of each insurance company to ensure compliance with their requirements.

By being aware of these limitations, therapists can navigate the coding and billing process more effectively, ensuring proper documentation and reimbursement for their therapy sessions.

How to Ensure Reimbursement for CPT Code 90837

Ensuring proper reimbursement for CPT Code 90837 requires attention to detail and effective communication with insurance payers. To navigate this process successfully, therapists should follow these essential steps:

  1. Verify coverage: Before providing therapy services using CPT Code 90837, therapists must verify the insurance payer’s coverage for this specific code. Confirming coverage ensures that the therapy session will be eligible for reimbursement.
  2. Check client eligibility: In addition to verifying coverage, therapists should check the client’s eligibility for CPT Code 90837. Each insurance plan and client may have specific requirements and limitations that need to be considered.
  3. Accurate documentation: Proper documentation is crucial to support the medical necessity and duration of therapy sessions billed under CPT Code 90837. Therapists should accurately record the time spent in therapy, the services provided, and the specific reasons why longer sessions are medically necessary.
  4. Advocate for reimbursement: If a claim using CPT Code 90837 is denied, therapists can contact the insurance provider representative for clarification. They can also involve their client in advocating for proper reimbursement by reaching out to the member services representative of their insurance company.

To optimize reimbursement for CPT Code 90837, it is important for therapists to communicate openly with insurance companies, follow proper documentation practices, and advocate for their services. By ensuring compliance with reimbursement guidelines and providing thorough documentation, therapists can increase the likelihood of receiving appropriate reimbursement for their therapy sessions.

License Level Requirements for CPT Code 90837

When it comes to providing and billing for therapy sessions using CPT Code 90837, it is important to meet the necessary license level requirements. Licensed mental health providers who are eligible to use this code include:

  • Licensed Clinical Social Workers (LCSW)
  • Licensed Professional Counselors (LPC)
  • Licensed Marriage Family Therapists (LMFT)
  • Clinical Psychologists (PsyD or PhD)
  • Psychiatrists (MD)

Each state may have specific licensing requirements for these mental health professions. As therapists, we must ensure that we hold the appropriate license and qualifications before utilizing CPT Code 90837 for therapy sessions.

License level requirements for therapy sessions

License Abbreviation
Licensed Clinical Social Worker LCSW
Licensed Professional Counselor LPC
Licensed Marriage Family Therapist LMFT
Clinical Psychologist PsyD or PhD
Psychiatrist MD

Authorization Requirements for Optum/United Healthcare Claims

When it comes to billing CPT Code 90837 for Optum/United Healthcare claims, authorization is typically not required. However, there was a time when United Healthcare did impose a prior authorization requirement for this code, which posed challenges for providers. Fortunately, as of 2019, United Healthcare has reversed this requirement and now accepts CPT Code 90837 without prior authorization.

Despite this change, it is still advisable to verify with insurance companies, such as Optum and United Healthcare, their specific authorization requirements and coverage policies for CPT Code 90837. By staying informed and understanding the insurance guidelines, therapists can ensure smooth billing processes and maximize reimbursement for their services.

It’s important to remember that insurance companies may have different requirements and policies, so it’s always a good idea to stay up to date and communicate with them directly to avoid any potential reimbursement issues. Understanding the specific authorization requirements for CPT Code 90837 can help therapists navigate the billing process more effectively, ensuring that they receive proper compensation for their therapy sessions.

Additional Add-On Codes for Extended Therapy Sessions

In addition to Add-on CPT Code 99354 for extended therapy sessions, therapists can also utilize Add-on Code 99355 for sessions that exceed 134 minutes. This additional code allows therapists to bill for sessions longer than 194 minutes. Here is a breakdown of how to use these add-on codes:

  1. Start with CPT Code 90837 for a 60-minute individual psychotherapy session.
  2. If the session extends beyond 60 minutes but is still within the 134-minute range, use Add-on Code 99354.
  3. If the session exceeds 134 minutes, add Add-on Code 99355 for each additional 30-minute increment beyond 134 minutes.

It is important to follow the proper sequencing and documentation guidelines when using these add-on codes to ensure accurate billing and reimbursement.

Add-On Code Description Time Range
Add-on Code 99354 Additional 30-74 minutes of therapy 60-134 minutes
Add-on Code 99355 Each additional 30 minutes of therapy 135+ minutes

Conclusion

Understanding the ins and outs of therapy session coding, specifically CPT Code 90837, is crucial for mental health professionals seeking accurate billing and reimbursement. This code represents a 60-minute individual psychotherapy session, and it comes with specific requirements for proper documentation and billing.

Reimbursement rates for CPT Code 90837 tend to be higher compared to shorter therapy codes, but it is essential for therapists to check with each insurance payer for their specific reimbursement guidelines. Staying up to date with the latest reimbursement rates ensures that providers are adequately compensated for their services.

By following the proper therapy session coding and documentation practices, mental health professionals can navigate the complexities of billing and reimbursement more effectively. It is important to accurately document the duration of each session, ensuring that only the face-to-face time spent on therapy is included in the billing.

Ultimately, understanding and adhering to the reimbursement guidelines for CPT Code 90837 empowers mental health professionals to provide quality care to their clients while maintaining proper financial compensation for their services.

FAQ

What is CPT Code 90837?

CPT Code 90837 is a procedure code that represents a 60-minute individual psychotherapy session.

What services does CPT Code 90837 cover?

CPT Code 90837 covers insight-oriented, behavior-modifying, supportive, and interactive psychotherapy services.

What are the reimbursement rates for CPT Code 90837?

Reimbursement rates for CPT Code 90837 vary depending on the year and payer. It is important to check with individual insurance companies for their specific reimbursement rates.

What is the time length for CPT Code 90837?

The duration of a 90837 session ranges from 53 minutes to longer, as it represents a 60-minute therapy session.

When should I use CPT Code 90837 vs. CPT Code 90834?

CPT Code 90837 should be used for therapy sessions that are 53 minutes or longer, while CPT Code 90834 covers sessions between 38 and 52 minutes.

How do I bill extended therapy sessions over 60 minutes?

As of 2023, billing for extended therapy sessions beyond 60 minutes using CPT Code 90837 is no longer possible. However, for claims with dates of service from 2022 and earlier, therapists could use Add-on CPT Code 99354 for additional time.

How are insurance companies scrutinizing the use of CPT Code 90837?

Some insurance payers have sent warning letters to providers who frequently use CPT Code 90837, which has raised concerns among therapists. The American Psychological Association Practice Organization and Pennsylvania Psychological Association have intervened on behalf of affected psychologists.

What are the limitations of CPT Code 90837?

CPT Code 90837 has limitations, including capturing only the face-to-face time spent on therapy and the potential for different reimbursement rates among payers.

How can I ensure reimbursement for CPT Code 90837?

To ensure reimbursement, therapists should verify coverage with the insurance payer, accurately document the time spent in therapy, and demonstrate medical necessity for longer sessions.

Which licensed mental health providers can use CPT Code 90837?

Licensed mental health providers, such as LCSWs, LPCs, LMFTs, PsyD or PhD psychologists, and psychiatrists, are eligible to provide and bill for therapy sessions using CPT Code 90837.

Are there authorization requirements for Optum/United Healthcare Claims?

Typically, authorization is not required for billing CPT Code 90837 for Optum/United Healthcare claims. However, therapists should verify with insurance companies for their specific requirements.

Are there additional add-on codes for extended therapy sessions?

Yes, therapists can utilize Add-on Codes 99354 and 99355 for extended therapy sessions beyond the 60-minute duration of CPT Code 90837.

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