Clinical social workers who seek independent reimbursement use CPT codes to identify procedures they perform when providing psychotherapy services. The Health Insurance Portability and Accountability Act (HIPAA) has designated CPT as the national coding standard for reporting procedures for health care professionals such as clinical social workers. CPT provides a uniform language to describe psychotherapy and other health services.
Since 1994, NASW has provided two representatives to the American Medical Association, Current Procedural Terminology Editorial Panel, Health Care Professional Advisory Committee (AMA/CPT/HCPAC) where codes are developed, maintained, and revised. The two representatives provide a national voice for clinical social workers in the creation, revision, and maintenance of the CPT codes.
Health insurance companies can individually decide which CPT codes they will reimburse clinical social workers for. Thus, clinical social workers should acquire a list of the CPT codes that they will be reimbursed for from each health insurance company in which they have a contractual agreement. Doing so may prevent claim denials and overpayment requests. Since 2013, clinical social workers have used the following CPT codes most frequently to report psychotherapy services rendered to an individual, family, or group.
CPT Codes for Clinical Social Workers
The psychiatric diagnostic evaluation is an integrated biopsychosocial assessment that includes history, mental status, and a recommendation. It may include communication with family and other sources who are considered informants. CPT 90791 does not include psychotherapeutic services and can only be reported once per day per patient. This code may be used for a reassessment or it can be used more than once for an initial assessment if more time is required. There is no time range for this code.
CPT 90832, CPT 90834, and CPT 90837
CPT 90832, CPT 90834, and CPT 90837 describe individual psychotherapy services for the patient and may include an informant. The patient is required to be present for all or most of the service. The codes include an ongoing assessment and adjustment of treatment interventions. The times for these codes are:
- CPT 90832 – Psychotherapy 30 minutes. Time range: 16 to 37 minutes
- CPT 90834 – Psychotherapy 45 minutes. Time range: 38 to 52 minutes
- CPT 90837 – Psychotherapy 60 minutes. Time range: 53 minutes or more
Some health insurance companies may consider CPT 90834 as the standard psychotherapy session. In such cases when reporting CPT 90837, it would be beneficial to document in the clinical record why the longer service was warranted rather than the shorter service.
90785 is an add-on code used to report interactive complexity services. It is reported in conjunction with CPT 90791, CPT 90832, CPT 90834, and CPT 90837. Interactive complexity is a special communication factor that complicates the delivery of psychotherapy services. It is commonly used when delivering services to children and verbally undeveloped or impaired patients. These patients usually have third parties such as parents, guardians, interpreters, schools, and court officers.
CPT 90839 and CPT 90840
CPT 90839 and CPT 90840 are codes used to report psychotherapy for crises. These codes report an urgent assessment which includes a history of a crisis state, a mental status exam, and a disposition. Treatment includes:
- Mobilization of resources to defuse the crisis and restore safety
- Provision of psychotherapeutic intervention to minimize emotional trauma
For CPT 90839 and CPT 90840, the presenting problem is life-threatening or complex and requires immediate attention to a patient in high distress. Clinical social workers must devote their full attention to the patient, and cannot provide services to another patient during the same time period. The times for these codes are:
- CPT 90839 – Psychotherapy for the crisis, the first 60 minutes. The time range is 30-74 minutes.
- CPT 90840 – Psychotherapy for the crisis, each additional 30 minutes. Report additional blocks of time up to 30 minutes each beyond 74 minutes.
CPT 90845 is used to identify psychoanalysis services. There is no time range for this code.
CPT 90846 identifies family psychotherapy services without the patient present. This code may be used on the same day as an individual psychotherapy service is provided when the services are separate and distinct for the patient. The session is for 50 minutes and the time range is 26 minutes or more.
CPT 90847 is family psychotherapy with the patient present. This is also referred to as conjoint psychotherapy. This code may also be used on the same day as an individual psychotherapy service is provided as long as the services are separate and distinct for the patient. The time is a 50-minute session and the time range is 26 minutes or more.
CPT 90853 is for group psychotherapy. When appropriate, the add-on code for interactive complexity, CPT 90785, may be used with this code. There is no time specification for this code.
When submitting a claim, a CPT code must be used in order to receive payment. The code is listed on line 24 D, under CPT/HCPCS. An add-on code is also listed under this heading, but on the line following the listing of the primary CPT code.
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