Top Psychotherapy CPT Codes Billed in 2019

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 2019. 

Facts About CPT codes

  • Developed by the American Medical Association (AMA)
  • A standardized coding system for medical services
  • The preferred system for describing and coding healthcare services throughout the United States
  • Over 8,000 codes that are updated annually
  • Used by both federal healthcare programs (Medicaid and Medicare) and private insurers to describe services, track healthcare utilization, and identify services to determine payment amounts
  • Used to monitor and track overall healthcare trends

Top 10 CPT Codes Used by SimplePractice Customers in 2019

  1. 90837 – Psychotherapy, 60 minutes
  2. 90834 – Psychotherapy, 45 minutes
  3. 90791 – Psychiatric diagnostic evaluation without medical services
  4. 90847 – Family psychotherapy (with client present), 50 minutes
  5. 90853 – Group psychotherapy (other than of a multiple-family group)
  6. 90846 – Family psychotherapy (without the client present), 50 minutes
  7. 90875 – Under other psychiatric services or procedures
  8. 90832 – Psychotherapy, 30 minutes
  9. 90838 – Psychotherapy, 60 minutes, with E/M service
  10. 99404 – Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)

The CPT Time Rule for Psychotherapy Codes

 The following three individual psychotherapy codes are time based code: 

  • 90832 (30 mins)
  • 90834 (45 minutes)
  • 90837 (60 mins)

In order to accurately report the service you provide, you need to meet the threshold of more than half of the time in the code description. In other words, if descriptions say 30 minutes, the clinician must perform that service for at least 16 minutes to report the service.

As shown below, all three time-based codes made it onto our top ten list of most billed CPT codes, with 90837 being the most frequently used code by SimplePractice customers.

Table 1. Three time-based psychotherapy codes

[supsystic-tables id=10]

To learn more about the top CPT codes used by SimplePractice customers, see the psychotherapy code descriptions below, including a printable one-page cheat sheet.

thumbnail of the downloadable cheat sheet that has the most common CPT codes used in SimplePractice in 2019
To learn more about the top psychotherapy CPT codes used by SimplePractice customers, click to download the a printable one-page cheat sheet.

1. 90837 – Psychotherapy, 60 minutes 

Description: Individual psychotherapy, 60 minutes, with client and/or family member.

Time: 60 minutes (between 53 and 60 minutes)


2. 90834 – Psychotherapy, 45 minutes

Description: Individual psychotherapy, 45 minutes, with client and/or family member.

Time: 45 minutes (between 38 and 52 minutes)


3. 90791 – Psychiatric diagnostic evaluation without medical services

Description: This code is used for an initial diagnostic interview exam that does not include any medical services. It includes a chief complaint, history of present illness, family and psychosocial history, and complete mental status examination. In the past, most insurers would reimburse for one 90791 per episode of illness. The guidelines now allow for billing this on subsequent days when there is medical necessity for an extended evaluation. (Use code 90792 for an initial evaluation with medical services.)

Time: There is no time range for this code.

Note: Medicare will pay for only one 90791 per year for institutionalized clients unless medical necessity can be established for others.


4. 90847 – Family psychotherapy (with client present), 50 minutes

Description: Family psychotherapy (conjoint psychotherapy) (with client present). This code is used when the therapy includes the client and family members. It can also be used for couples therapy.

Time: 50 minutes

Notes: According to the American Psychological Association (APA), it’s covered by most insurance plans, and is challenged less often than 90846 because the client is present

The other family psychotherapy codes are:

  • Family psychotherapy, without patient, 50 minutes – 90846
  • Family psychotherapy, multiple-family group  – 90849

5. 90853 – Group psychotherapy (other than of a multiple-family group)

Description: Group psychotherapy (other than of a multiple-family group). This code relies on the use of interactions of group members to examine the pathology of each individual within the group. In addition, the dynamics of the entire group are noted and used to modify behaviors and attitudes of the client members. The size of the group may vary depending on the therapeutic goals of the group and/or the type of therapeutic interactions used by the therapist. The code is used to report per-session services for each group member.

Note: Most insurance plans cover this procedure.


6. 90846 – Family psychotherapy (without the client present), 50 minutes

Description: This code is used when the clinician provides therapy for the family of a client without the client being present

Time: 50 minutes

Notes: Under Medicare rules, 90846 is only covered if the therapy is specifically intended to treat the client, not to treat the family members who may have issues because of the client’s illness. Some insurance payers do not cover sessions if the client is not present, however many will reimburse for this code. 


7. 90875 – Under other psychiatric services or procedures

Description: Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the client), with psychotherapy (e.g., insight-oriented, behavior modifying, or supportive psychotherapy).

Time: approximately 20-30 minutes

Note: Medicare will not reimburse for this code.


8. 90832 – Psychotherapy, 30 minutes

Description: This is one of the three timed psychotherapy codes. This code is less commonly used than the other two codes. 

Time: 30 minutes (between 16 – 37 mins)


9. 90838 – Psychotherapy, 60 minutes, with E/M service

Description: Individual psychotherapy, 60 minutes with client and/or family member when performed with an evaluation and management (E/M) service.

Time: 60 minutes (between 53 and 60 minutes)


10. 99404 – Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)

Time: 60 minutes (between 53 and 60 minutes)


Sources

American Psychology Association 

CPT® (Current Procedural Terminology), American Medical Association.

Good Therapy. (2019, December 9). Commonly Used Codes for Mental Health Professionals. Retrieved February 14, 2020, from https://www.goodtherapy.org/for-professionals/business-management/insurance/article/cpt-codes-for-mental-health-professionals

OSI. (2018, November 14). Most Frequently Used CPT Codes in Psychiatry and Upcoming Changes. Retrieved February 14, 2020, from https://www.outsourcestrategies.com/resources/frequently-used-cpt-codes-in-psychiatry-upcoming-changes.html

 

Popular Articles