As of January 1, 2013 we psychotherapists, counselors, LMFTs, LCSWs, psychiatrists and other mental health providers will need to use different CPT codes when billing services to insurance companies or Medicaid.
No need to panic.
The CPT changes are fairly simple and straightforward.
In order to help you be prepared, we are sending you a synopsis of some of the proposed changes plus helpful downloadable resources.
While the final changes to CPT Codes will be published next month, here is a heads-up about the basic facts:
The following is not a complete list of the changes, just the most important ones.
- The most common psychotherapy codes are simply being discontinued and replaced by new codes.
- Most insurance companies, starting Ap. 1st, 2014, will expect that you use the new CMS-1500 (2/12) claim form when submitting a bill. Obtain new form
- According to the upcoming 2013 CPT manual, psychotherapy times are for face-to-face services with the patient, and/or family member, with the patient present for some or all of the service.
- The most obvious changes are the replacement of codes specifying durations of psychotherapy sessions:
- 90804 is deleted and replaced with 90832:
- Psychotherapy, 30 minutes with patient and/or family member.
- 90806 is deleted and replaced with 90834:
- Psychotherapy, 45 minutes with patient and/or family member.
- 90808 is deleted and replaced with 90837:
- Psychotherapy, 60 minutes with patient and/or family member.
- While the codes cite specific durations, there is some flexibility. When reporting a psychotherapy service, the provider should choose the code closest to the actual time of the session. The examples given in the manual are:
- Code 90832 for 16-37 minutes.
- Code 90834 for 38-52 minutes.
- Code 90837 for 53 minutes.
- Effective January 1, 2013, therapists should use Code 90837 (instead of 90808 which will be deleted) for sessions lasting 75 to 80 minutes.
- Therapists are not likely to see an increase in payment for the additional time beyond 60 minutes.
- Reimbursement will most likely be limited to whatever payment amount is applied to Code 90837 by Medicare or by a private insurance carrier.
- Regarding codes used for a psychiatric diagnostic interview:
- 90801 is deleted and replaced by two separate codes:
- Code 90791 will be used for a diagnostic evaluation.
- Code 90792 will be used for a diagnostic evaluation with medical services such as a physical examination.
- It is generally acceptable to use 90791 for first sessions with clients since it commonly involves history taking and diagnostic assessment. Generally, most insurance companies will pay for only one Initial Evaluation, however sometimes one can get special permission to use multiple 90791s. If you are audited, you may be required to show a complete diagnostic assessment for this first session.
- Some of the other changes include:
- Removal of evaluation and management (E&M) plus psychotherapy combination codes from the psychiatry section (90805, 90807)
- Deletion of the code for pharmacologic management (providers to use appropriate E&M code)
- Addition of code 90785 for interactive complexity
- New code for psychotherapy for a patient in crisis
- New Code of Crisis Psychotherapy:
- There is a new code for a crisis psychotherapy session requiring urgent assessment and history of the crisis state and mental status exam.
- This new add-on code applies to crisis psychotherapy sessions lasting longer than 60 minutes.
- In order for the new codes to apply correctly, the presenting problem must typically be life threatening or require immediate attention to a client in high distress.
- Code 90839 will be billed for the first 60 minutes of psychotherapy for a patient in crisis, and add-on code 90840 will be billed for each additional 30 minutes of crisis psychotherapy.
- Interactive Complexity – Add-On Codes:
- The new CPT codes include an add on code for interactive complexity which may be used when the patient’s care involve people other than the patient. They can be used with the psychotherapy codes and with the non-family group psychotherapy code (90853).
- There will be new “add-on” codes for specific services that can be provided only in combination with other diagnostic evaluation, psychotherapy and group psychotherapy services.
- Add-on codes identify a treatment above and beyond the principle service.
- Both the principal service code and add-on code should be listed on the billing form.
- The codes for interactive psychotherapy are being eliminated and replaced with an add-on code to capture “interactive complexity.”
- Interactive complexity, new add-on code 90785, refers to factors that make the delivery of a mental health services more complex or complicated. Such factors include difficult communication with disagreeing family members or engagement of verbally undeveloped children. These factors are usually found with patients who request family members or others to be present during the visit, or require the presence of help of third parties such as schools counselors or probation officers.
Here are a few simple, clear and straightforward charts regarding the changes:
- American Psychiatric Association: Current Procedural Terminology (CPT) Code Changes for 2013
- American Psychological Association (APA) Chart
- AMA Chart
- An explanation summarizing the code changes put out by the American Psychiatric Association and the American Academy of Child & Adolescent Psychiatry
- Important Changes to Billing Codes By Barbara Griswold, LMFT
For more background information:
- 2013 Psychotherapy CPT Codes for Psychotherapists, CAMFT
- For comprehensive resources on insurance billing, forms, and updates: Navigating the Insurance Maze
- APA on CPT-2013
- APA- FAQ on New CPT Codes
- The manual, with the revised codes that take effect on January 1, 2013 for Medicare and fall insurance carriers, is owned by the American Medical Association (AMA). Copies of the 2013 manual may be ordered from the AMA online or by calling toll-free at (800) 621-8335.
Reimbursement for the new 2013 codes: