Have you ever found yourself wondering if you’re using the correct Current Procedural Terminology (CPT®) codes? Knowing the proper codes is vital to getting paid in full and avoiding insurance audits—specifically for therapists that are on panels or provide superbills to clients. Here are some fast facts about the top psychotherapy CPT® codes billed by SimplePractice customers in 2021.
What is a CPT® Code?
CPT® codes are developed by the American Medical Association (AMA), and are a standardized coding system for medical services. Put simply, they refer to the actions a health care provider took during an interaction with or on behalf of their client or patient. CPT® codes are updated annually, and are used by both federal healthcare programs like Medicaid and Medicare, as well as private insurers, to describe services, track healthcare utilization, and identify services to determine payment amounts.
There are a couple different types of CPT® codes. Most healthcare providers use the five-digit CPT® codes in Category I. Because these codes identify specific, well-established procedures, this category of codes is used the most often. With a few exceptions, US insurers generally must pay for Category I procedures, as long as they’re performed by a qualified health professional when they’re medically necessary to treat a clients’ condition.
Category II codes are used to gather information about quality of care and performance measurement, and they’re not required for billing purposes. Category III codes are used for newer procedures and technologies and were created for data collection and assessment, and in some cases, for payment of new services that don’t meet the criteria for Category I codes.
Top 10 CPT® Codes Used in 2021
To learn more about the trends in the behavioral health industry over the last year, we looked at the ten most commonly used CPT® codes by SimplePractice customers in 2021.
Psychotherapy, 60 mins with patient
Psychotherapy, 45 mins with patient
Psychiatric diagnostic evaluation
Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
Pyschotherapy 45 min, telehealth
Group psychotherapy (other than of a multiple-family group)
Psychotherapy, 30 minutes with patient
Psychotherapy, 60 mins, telehealth modifier
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
The CPT® Time Rule for Psychotherapy Codes
The following three codes are time-based codes:
90832 (30 mins)
90834 (45 mins)
90837 (60 mins)
The time for each of these psychotherapy codes is described as time spent with the client and/or their family. Although the code is time-specific, you do have some flexibility. For instance, even though 90832 is for a 30 minute session, you can bill that code for sessions that have a total duration of 16-37 minutes. If you are billing time-based codes, you should always make sure you confirm the total duration each code is billable for.
Changes to CPT® Codes in 2022
New CPT® codes are released each year to keep up with new developments in health care services. The annual update for 2022 includes a number of changes to adapt to the COVID-19 pandemic. Part of the update is a series of 15 vaccine-specific codes meant to efficiently report and track immunizations and administrative services during the pandemic. There are 249 new codes, 63 deletions, and 93 revisions to the 2022 CPT® code set related to COVID-19 reporting.
Aside from these updates, there were additional changes made to respond to the fast pace of digital healthcare services as that industry continues to evolve. Specifically, 5 new CPT® codes were created (98975, 98976, 98977, 98980, and 98981) to report therapeutic remote monitoring. You can visit the AMA’s website to learn more about the updating process and changes being made in 2022.
Since CPT® codes are used across the entire healthcare system, there will likely be codes and updates that don’t apply to you as a mental health provider. Still, it’s a good idea to review the updates as they are released, to make sure you’re using the most accurate code for your service or that you’re not trying to bill a deleted code.
Pollen Magazine examines the health and wellness industry through the lens of the professionals that are redefining private practice. Find inspiration, learn from others, and discover insights on how to build the best version of your practice.
Get the latest stories from your peers right to your inbox.