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.
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
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.
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.
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)
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