90837 CPT Code: Understanding Its Usage & Billing (2024)

CPT Code 90837 is a widely used procedure code in mental health insurance claims coding and billing. It describes a 60-minute individual psychotherapy session conducted by a licensed mental health provider. In this article, we will explore the description of CPT Code 90837, reimbursem*nt rates, and documentation requirements for billing.

Key Takeaways:

• CPT Code 90837 represents a 60-minute individual psychotherapy session.
• It is essential to accurately track and document the length of each session for proper billing.
• The reimbursem*nt rates for CPT Code 90837 vary depending on the year and insurance provider.
• Make sure to check the specific guidelines and requirements of each insurance provider.
• Accurate and thorough documentation is essential to support the medical necessity of the extended session.

CPT Code 90837 Description

CPT Code 90837 is defined as a 60-minute individual outpatient psychotherapy session. During this session, a licensed mental health provider engages in insight-oriented, behavior-modifying, supportive, and/or interactive psychotherapy with the patient and/or family member. The services can include teaching grooming skills, monitoring daily living activities, recreational therapy, and social interaction. It is important to note that for clients with intellectual disabilities or severe dementia, other CPT codes may be more appropriate.

Key Points: CPT Code 90837 Description

• CPT Code: 90837
• Session Length: 60 minutes
• Type of Session: Individual outpatient psychotherapy
• Therapeutic Approaches: Insight-oriented, behavior-modifying, supportive, and/or interactive psychotherapy
• Additional Services: Teaching grooming skills, monitoring daily living activities, recreational therapy, social interaction

Reimbursem*nt Rates

The reimbursem*nt rates for CPT Code 90837 vary depending on the year and insurance provider. As of 2023, the Medicare reimbursem*nt rate for a 60-minute individual therapy session is $147.07. In previous years, the rates were $164.84 (2022), $152.48 (2021), and $141.47 (2020). It is important to check with insurance providers to determine the specific reimbursem*nt rates for CPT Code 90837.

Here is a breakdown of the reimbursem*nt rates for CPT Code 90837:

Medicare Reimbursem*nt Rates for CPT Code 90837

The Medicare reimbursem*nt rates for CPT Code 90837 have seen fluctuations over the years. It is important for mental health providers to stay updated on the current rates to ensure accurate billing and maximize reimbursem*nt.

For the year 2023, the Medicare reimbursem*nt rate for a 60-minute individual therapy session using CPT Code 90837 is $147.07. This rate reflects the amount that Medicare will reimburse the provider for each session.

Prior to 2023, the reimbursem*nt rates were higher. In 2022, the rate was $164.84, in 2021 it was $152.48, and in 2020 it was $141.47. These rates are subject to change, so it is always advisable to check with insurance providers or Medicare for the most up-to-date information.

Keep in mind that these rates may vary depending on the insurance provider. Different insurance companies may have their own reimbursem*nt policies and rates for CPT Code 90837. It is important to verify the specific reimbursem*nt rates with each insurance provider to ensure accurate billing and reimbursem*nt.

Time Length

CPT Code 90837 represents a 60-minute therapy session. This session allows for a comprehensive exploration of the client’s concerns and the implementation of appropriate therapeutic interventions. The 90837 session length provides sufficient time for the therapist to establish a therapeutic relationship, conduct assessments, and develop personalized treatment plans.

While the standard session length is 60 minutes, it’s important to note that the actual session duration can range from 53 minutes to longer, providing flexibility for both the provider and the client. This flexibility allows therapists to tailor the session to meet the unique needs of each individual.

Accurate tracking and documentation of the session length are crucial for proper billing and reimbursem*nt. It is imperative to record the start and end times of each session, ensuring that the duration falls within the allotted time frame for CPT Code 90837. This not only helps in accurate billing but also aids in demonstrating the medical necessity of the extended session if required by the insurance provider.

Using CPT Code 90837 in Medical Billing Services

When it comes to medical billing services for mental health providers, accuracy and expertise are crucial. At Medical Bill Gurus, we specialize in healthcare services and offer comprehensive support for insurance billing, including the correct usage of CPT Code 90837. Our team of experienced professionals understands the complexities of medical billing and is dedicated to maximizing reimbursem*nt for mental health services.

With our in-depth knowledge of insurance payers, including Medicare, we ensure accurate coding and timely submission of claims. By partnering with Medical Bill Gurus, you can streamline your billing process and focus on providing quality care to your patients.

Our services include:

• Insurance billing for licensed mental health providers
• Expertise in CPT Code 90837 and other relevant codes
• Thorough review of documentation for proper coding
• Timely submission of claims to insurance companies
• Maximization of reimbursem*nt for mental health services

With Medical Bill Gurus, you can trust that your billing needs are in capable hands. We are committed to helping mental health providers navigate the complexities of medical billing, ensuring accurate and efficient reimbursem*nt.

Difference Between 90834 vs 90837

CPT Code 90834 is another commonly used code for psychotherapy sessions. The primary difference between 90834 and 90837 is the time length of the session. 90834 is defined as a 45-minute psychotherapy session, while 90837 is defined as a 60-minute session. It is important to accurately select the appropriate code based on the actual duration of the therapy session.

Billing Extended Sessions for Psychotherapy Over 60 Minutes

Prior to 2023, providers had the option to bill extended sessions for CPT Code 90837 using the add-on code 99354. This allowed for an additional 30-74 minutes of therapy beyond the standard 60-minute session. However, starting in 2023, extended session billing for CPT Code 90837 is no longer available. It is crucial for mental health providers to review the specific billing guidelines for each year and ensure compliance with the current regulations.

Overview of Extended Session Billing

Extended session billing refers to the practice of billing for therapy sessions that exceed the standard time allotted for CPT Code 90837. It provides flexibility for providers and clients who may require a longer duration of psychotherapy to address complex issues or unique circ*mstances. Prior to 2023, this was achieved by using the add-on code 99354 in conjunction with 90837.

However, it is essential to note that as of 2023, extended session billing for CPT Code 90837 is no longer allowed. This means that providers can only bill for the standard 60-minute session using 90837 without any additional time beyond that.

Incorporating the Changes

With the removal of extended session billing for CPT Code 90837, mental health providers must adjust their billing practices accordingly. It is crucial to familiarize oneself with the specific billing guidelines established by insurance providers and ensure compliance with the current regulations.

Providers should carefully track and document the duration of therapy sessions, ensuring that they do not exceed 60 minutes. Accurate documentation is essential for proper billing and reimbursem*nt, as well as for maintaining compliance with insurance requirements.

It is recommended to stay updated on any changes in billing regulations and guidelines to avoid any issues with insurance claims. Engaging with professional medical billing services, such as Medical Bill Gurus, can provide expert support in navigating the complexities of insurance billing and ensuring compliance with the latest regulations.

Reimbursem*nt for 60-Minute Sessions

The reimbursem*nt for 60-minute therapy sessions, billed under CPT Code 90837, varies depending on the insurance plan. While some insurance companies may fully reimburse for these sessions, others may have limitations or require preauthorization. It is recommended to check with the insurance provider to determine the reimbursem*nt policy for 90837 and to keep accurate documentation to support the medical necessity of the longer sessions.

Additional Add-On Codes for Extended Therapy Services

In addition to the now discontinued add-on code 99354, there is another add-on code, 99355, that can be used for even longer therapy sessions. CPT Code 99355 can be billed for each additional 30 minutes beyond 99354. Providers can use a combination of these add-on codes to accurately bill for sessions that exceed the 60-minute mark.

Extended Therapy Services Add-On Codes

To bill for sessions that go beyond the 60-minute duration, providers can use the add-on codes 99354 and 99355. The initial add-on code, 99354, covers extended services of 30-74 minutes, while the add-on code 99355 can be added for each additional 30 minutes beyond 99354. By appropriately using these add-on codes, providers can ensure accurate billing for therapy sessions that require extra time.

Using these add-on codes provides a clear and transparent way to accurately bill for extended therapy sessions, ensuring that providers are appropriately compensated for the additional time and effort invested in the care of their patients.

License Level Requirements for 90837

90837 can only be billed by licensed mental health providers who meet the specific license level requirements. This includes Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Marriage Family Therapist (LMFT), Clinical Psychologists (PsyD or PhD), and Psychiatrists (MD). It is important to ensure that the provider’s license level aligns with the requirements for billing 90837.

Authorization Requirements for Optum/United Healthcare Claims

For Optum/United Healthcare claims, typically no authorization is required for billing CPT Code 90837. However, it is recommended to check the specific requirements of the insurance provider to ensure compliance. In the past, United Healthcare required authorization for 90837, but they have since reversed this policy and now accept the code without prior authorization. It is still advisable to verify with the insurance company if authorization is needed.

Proper authorization and compliance with insurance requirements are essential to avoid claim denials and delays in reimbursem*nt. It is important for mental health providers to stay informed about any changes in the authorization requirements to ensure smooth claims processing.

Here is an example of the billing authorization requirements for Optum/United Healthcare claims:

The Importance of Proper Documentation for 90837 Billing

Accurate and thorough documentation is crucial when billing for CPT Code 90837. Proper documentation not only ensures compliance with billing and coding guidelines but also supports the medical necessity and appropriateness of the services provided. Here, we outline the documentation requirements for 90837 billing and the significance of accurate documentation for CPT code 90837.

When documenting a 90837 session, it is essential to include:

• The actual time spent with the patient, clearly indicating the session’s duration as 60 minutes.
• A detailed account of the services performed during the session, such as insight-oriented therapy, behavior modification, and interactive psychotherapy.
• Documentation of the medical necessity of the extended duration, highlighting the patient’s specific needs that require a full 60-minute session.

Accurate documentation also involves capturing relevant patient information, including:

• Symptoms experienced by the patient
• Feelings and emotions expressed during the session
• Thoughts and cognitions shared by the patient
• Observable behaviors and reactions
• Psychosocial and health stressors impacting the patient

By capturing these vital elements, providers can demonstrate the medical necessity and appropriateness of the extended 90837 session. This comprehensive documentation helps support the coding and billing process, ensuring proper reimbursem*nt for the services rendered.

Why Accurate Documentation Matters

Accurate documentation plays a pivotal role in the billing and reimbursem*nt cycle for 90837 sessions. Here’s why it matters:

• Compliance: Thorough documentation ensures compliance with coding and billing guidelines, reducing the risk of audits or claim denials.
• Reimbursem*nt: Accurate documentation provides evidence of the medical necessity for a 60-minute session, increasing the likelihood of appropriate reimbursem*nt from insurance payers.
• Communication: Detailed documentation enhances communication among healthcare providers, ensuring continuity of care and facilitating collaboration within the treatment team.
• Legal and Ethical Considerations: Proper documentation safeguards the provider by documenting the rationale behind treatment decisions, protecting against potential legal or ethical challenges.

Ultimately, accurate documentation ensures that mental health providers can confidently bill for 90837 sessions, knowing they have the necessary supporting documentation to validate the extended duration of the therapy session.

To illustrate the importance of accurate documentation in 90837 billing, consider the following example:

As demonstrated in these examples, accurate documentation supports the medical necessity and appropriateness of the 90837 sessions, helping mental health providers receive proper reimbursem*nt for their services.

Conclusion

In conclusion, CPT Code 90837 is an essential code for mental health providers conducting 60-minute individual psychotherapy sessions. Understanding the code’s description, reimbursem*nt rates, and proper usage is vital to ensure accurate billing and maximize reimbursem*nt. Staying updated with the latest regulations and guidelines associated with 90837 is crucial for avoiding complications with insurance claims.

If mental health providers require assistance with medical billing services, reputable companies like Medical Bill Gurus can provide expert support in navigating the complexities of insurance billing. These professionals can help ensure that the correct CPT code is applied and that thorough documentation is maintained, leading to successful claims processing and improved revenue for mental health services.

By adhering to the appropriate CPT code and maintaining meticulous documentation, mental health providers can streamline the billing process and enhance their financial outcomes. It is crucial to prioritize accurate billing practices to effectively support the provision of vital mental health services.