When CPT codes for psychotherapy were revised in 2017, it became possible to bill for longer therapy sessions. The one being addressed in this blog is CPT Code 90837, which is 53 minutes or more. Many of us spend 55 to 60 minutes with clients anyway because, for many clients, the additional 10 -15 minutes makes a huge difference in what clients get out of their sessions. Now it’s possible to get paid for that time.
In 2013 the American Medical Association restructured much of the Current Procedural Terminology (CPT) code lists, retiring the CPT codes that were available for mental health providers performing longer services. Under the new protocols, there were only three codes available for individual psychotherapy. Each of these codes are timed and are well-known to many therapists, as they represent the majority of regularly billed codes, which are the CPT Codes 90832, 90834, and 90837. These, respectively, are described as providing individual psychotherapy for 30 minutes, 45 minutes, or 60 minutes.
The Limiting Nature of CPT Code 90837
The limitation of psychotherapy codes to only three codes with a cap at 60 minutes encapsulates the problem facing therapists today when coding their claims; the AMA defines these CPT codes based on the length of session, with the CPT Code 90837 being used for any session over 53 minutes, with no way to account for sessions longer than an hour, which frequently can occur when conducting psychotherapy.
While some therapists are inclined to use the 90837 for any session over 45 minutes, the AMA has defined these codes using standard rounding practices, rounding down to the CPT Code 90834 for a 52 minute session, and rounding up to a CPT Code 90837 for a 53 minute session.
Similarly, the 90834 code should be used when you spend an between 38 and 52 minutes in therapy; not for any session over 30 minutes. Additionally, some payers reimburse 60 minute sessions (90837) at the same rate as a 45 minute session (90834) even though the session is a different length of time, while other payers require pre-authorization for billing a 90837 or do not include the 90837 in fee schedules for specific policies.
Reimbursement for CPT Code 90837
If your session extends beyond 53 minutes, don’t shy away from billing for the full session. In order to ensure that your use of the code is justified, first make sure your services are covered. Check your contract with the payer to ensure that CPT Code 90837 is available for reimbursement, and verify that your client is covered for that service. Often, their plan may have limits or require preauthorization for CPT Code 90837.
Next, be sure the diagnosis included on the claim is covered. Plans may indicate that only certain diagnoses meet medical necessity criteria for longer services – some treatment approaches, such as EMDR or Gottman couples therapy, often show increased benefit from longer sessions. Your documentation should reflect both the accurate amount of time spent with the client and the services performed during the full duration of the session.
Above all, if your session fits the criteria for CPT code 90837 and you have properly documented the services rendered, then bill 90837! As long as your claim and documentation are accurate, you should be paid justly for your services. If you are denied the ability to bill CPT Code 90837, talk to your insurance provider representative or have your client call their member services representative. If you cannot get insurance approval, talk with your client about how to best utilize the time you do have available.
Insurance companies have been reluctant to pay for CPT Code 90837 and slow to get on board so it is best to check with the company. But BCBS does honor this code and so do many other insurance companies. According to Care Paths, the denial rate for BCBS in 2017 was 1.29%, which is a down from 3 to 4% in 2013 and 2015. Denial rates for Medicare and Medicaid are higher but have also come down. Current CPT Code 90837 denial rates for Medicaid is 5.9% and for Medicare it’s 4.12%.
When To Code Therapy Sessions with CPT Code 90837
With all three of the individual psychotherapy codes; 90832, 90834, and 90837, the intention of the AMA is capture only the face-to-face time spent on clinical discussion and therapy, not any administrative discussions, including scheduling questions, collecting fees, or time spent before or after the session for capturing documentation. While therapists may block off a straight hour for the session on their calendars, only the time spent on therapy can be billed for reimbursement.
Therapists who conduct a traditional 50-minute therapy session should be aware that these should generally be billed as a CPT Code 90834, as less than 53 minutes are spent in clinical discussion and therapy.
Will the use of CPT Code 90837 trigger an audit?
It should not. But again, to be on the safe side double-check with your client’s insurance company for their policy or discuss it with your biller, if you use one. This person should know.
Can I use CPT Code 90837 for all my sessions?
Theoretically, yes. But practically, no. The CPT code is based on face-to-face time, meaning you can only bill for the time actually spent with the client. If the client is late, you need to bill at 90834 (38 – 52 minutes). Otherwise, you risk insurance fraud.
According to BCBS, using 90837 “cannot be for the convenience of the provider.” This means, though specific documentation is not required, play it safe by including justification on your progress note. For example, let’s say:
- Your client has an Adjustment D.O: “90837 is medically necessary to sort through complicated issues related to (what client is adjusting to) and clinical presentation.”
- Your client may have a trauma history: “90837 is medically necessary because significant trauma hx necessitates taking time to create safe space for disclosure and then containment.”
- Or: “90837 is medically necessary to address complicated diagnosis and clinical presentation.”
- One of my Medicare clients is a lovely and highly intelligent and high functioning 72 year old gentleman who has few contacts outside his family and a LOT to process as he is makes sense of his life’s decisions, which, according to developmental theory, is exactly what he’s supposed to be doing at this stage of his life. For him, “90837 is medically necessary because client has no friends with which to sort through complicated life issues. Having more social contacts is one of the goals but is taking a long time to achieve.”
Once you start thinking this way, you will be able to come up with the rationale that fits your client. For accurate Mental/Behavioral Health medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com