Understanding 90837 CPT Code: A Quick Guide (2024)

CPT Code 90837 is a procedure code that describes a 60-minute individual psychotherapy session performed by a licensed mental health provider. It is a routine outpatient CPT code commonly used in mental health insurance claims coding and billing. The Centers for Medicare Services (CMS) defines 90837 as individual outpatient psychotherapy services rendered for 60 minutes. It encompasses insight-oriented, behavior modifying, supportive, and interactive psychotherapy. Medicare guidelines state that certain services such as teaching grooming skills, monitoring daily living activities, recreational therapy, and social interaction should be included when billing for 90837. The time length for a 90837 session is 60 minutes, and it has higher reimbursem*nt rates compared to the 45-minute session (90834). Medicare reimbursem*nt rates for 90837 have varied over the years, with the latest rate in 2023 being $147.07. It is important to differentiate between 90837 and other CPT codes such as 90834 and 90847, which have different time lengths and billing requirements.

Key Takeaways:

• CPT Code 90837 describes a 60-minute individual psychotherapy session
• It is commonly used in mental health insurance claims coding and billing
• Medicare guidelines require inclusion of certain services when billing for 90837
• The reimbursem*nt rates for 90837 are higher compared to the 45-minute session (90834)
• It is important to differentiate 90837 from other CPT codes with different time lengths and billing requirements

At Medical Bill Gurus, we understand the complexities of billing and coding for mental health services. Our team of experts can help ensure accurate coding and billing for CPT Code 90837 and other related codes. Contact us today to learn more about our comprehensive medical billing services.

CPT Code 90837 Description

CPT Code 90837 refers to a 60-minute individual psychotherapy session with a patient and/or family member. This code is used to describe services that involve insight-oriented, behavior modifying, supportive, and interactive psychotherapy. It is specifically designed for outpatient psychotherapy.

It is important to note that CPT Code 90837 is not appropriate for clients with intellectual disabilities or severe dementia, as different codes exist for these populations. When billing for 90837, it is crucial to ensure that the session meets the time requirement of 60 minutes and includes relevant services that may be provided, such as teaching grooming skills, monitoring daily living activities, recreational therapy, and social interaction.

Documentation is a crucial aspect when using CPT Code 90837. It should justify the medical necessity of using this code for each session, taking into account the client’s clinical presentation and specific needs. The documentation should help demonstrate the need for a 60-minute session and the appropriateness of the services provided.

Properly understanding and using CPT Code 90837 can ensure accurate billing and coding for psychotherapy sessions, leading to appropriate reimbursem*nt and compliance with insurance requirements.

CPT Code 90837 Time Frame

CPT Code 90837 represents a session with a time frame of 60 minutes. This includes face-to-face interaction between the therapist and the patient and/or family member. The actual duration can range from 53 minutes to longer, but it should be documented as a 60-minute session. It is important to note that not all therapists adhere strictly to these time intervals for their sessions, but it is necessary to meet the minimum time requirement for billing purposes.

When utilizing CPT Code 90837, it is crucial to accurately record the session’s duration as 60 minutes, regardless of the actual length. This ensures compliance with billing guidelines and facilitates seamless insurance claim processing. Therapists should document the start and end times of each session to support the billed duration. By adhering to the time frame specified by CPT Code 90837, therapists can ensure accurate billing and reimbursem*nt for their services.

Here is an example of how a therapist’s session duration documentation might look:

By consistently documenting session durations as 60 minutes, therapists can ensure accurate billing and maintain compliance with CPT Code 90837. This meticulous approach to documenting session time frames supports proper reimbursem*nt and fosters transparent communication with insurance providers.

CPT Code 90837 Reimbursem*nt Rates

When it comes to reimbursem*nt rates, CPT Code 90837 offers a higher payment compared to its counterpart, the 45-minute session (CPT Code 90834). The exact reimbursem*nt amount can vary based on factors such as professional credentials and geographic location.

On average, 90837 pays around $9-20 more per session than 90834, resulting in a 13-20% increase in reimbursem*nt. It’s important to note that actual payment amounts may differ among insurance companies.

Medicare, the federal health insurance program, publishes their reimbursem*nt rates annually. As of 2023, the reimbursem*nt rate for CPT Code 90837 is $147.07.

To obtain accurate reimbursem*nt information, it’s advisable to contact specific payers and insurance companies to inquire about their reimbursem*nt rates for CPT Code 90837.

Comparison of Reimbursem*nt Rates

Table: Comparison of reimbursem*nt rates between CPT Code 90837 and CPT Code 90834.

What’s the Difference between 90834 vs 90837?

The main difference between CPT Code 90834 and CPT Code 90837 lies in the time frame for which they should be billed. It’s important to select the appropriate code based on the actual duration of the session to ensure accurate billing and reimbursem*nt.

– CPT Code 90834: This code is used for sessions lasting between 38 and 52 minutes.

– CPT Code 90837: This code is appropriate for sessions lasting 53 minutes or longer.

For sessions lasting shorter durations, there are other relevant codes to consider:

• CPT Code 90832: This code is used for sessions lasting between 16 and 37 minutes.
• For sessions shorter than 16 minutes or longer than 89 minutes, different codes or add-on codes may be required.

The key is to accurately document the session time and choose the appropriate code to ensure proper billing and reimbursem*nt.

If you’re not sure about the session duration, here’s a helpful table to guide you:

Understanding these differences will ensure accurate coding and billing for psychotherapy sessions.

How to Bill Extended Sessions for Psychotherapy Over 60 Minutes

Billing extended sessions for psychotherapy exceeding 60 minutes requires careful consideration and adherence to coding guidelines. While the use of CPT Code 90837 alone is no longer possible for sessions lasting over 60 minutes in 2023, there are alternative options available to indicate prolonged services. One such option is the utilization of Add-on CPT Code 99354.

Add-on CPT Code 99354 can be used to signify an additional 30-74 minutes of therapy beyond the initial 60 minutes. This code can be used in conjunction with either CPT Code 90837 or CPT Code 90847, depending on the specific services provided. However, it is important to note that Add-on Codes 99354 and 99355 cannot be used together with CPT Codes 90791 or 90834.

When billing for extended therapy sessions using CPT Code 99354, proper documentation is crucial. It is essential to clearly indicate the start and end times of the session, ensuring that the additional time is accurately accounted for and justified. Additionally, all relevant services provided during the session should be appropriately documented to support the medical necessity of the extended therapy.

Understanding the requirements and restrictions associated with billing extended sessions is essential. Consulting with insurance companies and staying up-to-date with coding guidelines is crucial to ensure compliance and accurate reimbursem*nt.

Below is an example of how the billing for a prolonged therapy session could be coded:

Proper documentation and coding are essential for accurate billing of extended therapy sessions. By following the coding guidelines and consulting with insurance companies, mental health professionals can ensure that their services are appropriately reimbursed, allowing them to continue providing quality care to their patients.

Will 60 Minute Sessions Always be Reimbursed?

The reimbursem*nt for 60-minute sessions, indicated by CPT Code 90837, can vary depending on the insurance plan. While many insurance companies recognize and reimburse for 90837, there may still be cases where reimbursem*nt is not guaranteed. It is advisable to contact the insurance company in advance to inquire about coverage for 60-minute sessions or to check before filing a claim. Some therapists may receive extra reimbursem*nt for 90837, while others may have limitations or restrictions on reimbursem*nt. It is essential to stay informed about the insurance company’s policies and requirements regarding 90837 reimbursem*nt.

If you’re unsure about the reimbursem*nt policies for 90837, we recommend reaching out to your insurance provider for clarification. It’s better to be proactive and well-informed to avoid any potential surprises when it comes to reimbursem*nt for 60-minute sessions. Understanding your insurance coverage helps you plan and budget accordingly, ensuring that you can continue to provide quality care to your clients while navigating the complexities of insurance billing.

While some insurance companies may fully cover 60-minute sessions and reimburse accordingly, others may have different reimbursem*nt rates or require additional documentation. It is crucial to be knowledgeable about the specific requirements of your insurance plan to maximize reimbursem*nt.

Furthermore, it is important to keep in mind that insurance policies can change over time. Reimbursem*nt rates and coverage for 90837 session may vary from year to year. Staying updated on the latest information from your insurance company is essential to ensure accurate billing and reimbursem*nt.

As a mental health provider, your primary focus should be on delivering excellent care to your clients. Understanding the reimbursem*nt processes and requirements is a crucial part of managing your practice effectively and ensuring financial stability. By staying informed, communicating with your insurance company, and staying current on coding guidelines, you can navigate the reimbursem*nt landscape and provide the best possible care to your clients.

90837 Add-On Codes for Extended Therapy Services

When therapy sessions extend beyond the initial 60 minutes covered by CPT Code 90837, there are add-on codes available to ensure proper documentation and billing. By using Add-On CPT Codes 99354 and 99355 in conjunction with 90837, therapists can accurately represent the duration of extended therapy sessions.

Add-On CPT Code 99354 should be used for every additional 30 minutes of therapy beyond the initial 60 minutes. For example, if a session lasts between 90 and 134 minutes, the appropriate billing would be 90837 + 99354. Similarly, for sessions lasting between 135 and 164 minutes, the billing would be 90837 + 99354 + 99355, and so on.

This system allows therapists to effectively track the duration of extended therapy sessions and bill accordingly, ensuring accurate reimbursem*nt. It is important to consult coding guidelines and specific insurance company requirements to ensure compliance and maximize reimbursem*nt.

90837 License Level Requirements

In order to provide 60-minute individual therapy sessions using CPT Code 90837, specific licenses are required. These licenses ensure that the mental health professionals have the necessary qualifications and training to provide psychotherapy services and bill for 90837. The following licenses are accepted:

• Licensed Clinical Social Workers (LCSW)
• Licensed Professional Counselors (LPC)
• Licensed Marriage Family Therapists (LMFT)
• Clinical Psychologists (PsyD or PhD)
• Psychiatrists (MD)

Each of these licensed professionals has expertise in their respective fields and fulfills the requirements set forth by regulatory bodies. It is crucial to maintain and adhere to the proper licensure when utilizing CPT Code 90837 for therapy sessions, ensuring the highest quality of care for clients.

Is Authorization Required for Optum/United Healthcare Claims?

Typically, authorization is not required for Optum/United Healthcare claims when billing for 90837. However, in the past, United Healthcare had a pre-authorization requirement for this code, causing confusion and frustration for providers. This requirement has since been reversed, and as of 2019, United Healthcare accepts 90837 without prior authorization.

It is still recommended to contact insurance companies to verify coverage and confirm any specific requirements or limitations for billing 90837. Communication with insurance companies and understanding their policies is crucial to ensure accurate billing and reimbursem*nt.

Ensuring proper authorization and understanding insurance coverage is an important aspect of the billing process. With Optum/United Healthcare, authorization is generally not required for claims involving 90837. However, it is still advisable to check with the insurance company to confirm their specific requirements and ensure compliance.

By staying informed and up-to-date on insurance policies and procedures, mental health providers can navigate the billing process more effectively and maximize reimbursem*nt for their services.

The Importance of Proper Documentation for 90837

While specific documentation requirements are not mandated for billing 90837, it is important to justify the medical necessity of using this code in the progress notes. Including details about the client’s clinical presentation and specific needs can help establish the need for a 60-minute session. For example, documentation can mention the complexity of issues the client is addressing, the significant trauma history necessitating more time, or the absence of social contacts requiring additional support. By providing justifications for the use of 90837, therapists can ensure that their sessions are accurately documented and supported for billing purposes.

Medical Bill Gurus – Your Partner in Insurance Billing

At Medical Bill Gurus, we specialize in providing comprehensive medical billing services for healthcare providers, including mental health practitioners. Led by our experienced President, Daniel Lynch, our team is dedicated to assisting you with all your insurance billing needs.

We understand the importance of accurate coding and billing in the healthcare industry, and our services are designed to ensure proper reimbursem*nt and coding compliance for mental health billing.

Whether you handle your own billing or prefer to rely on a professional team, we offer a range of services to support your insurance billing requirements. Our services include daily claims filing and submission, claims processing, eligibility and benefits verification, appeals and denials management, and much more.

With our expertise and attention to detail, you can trust us to handle your medical billing efficiently and effectively. We work with all insurance payers, including Medicare and other insurance companies, to maximize your reimbursem*nt and streamline the billing process for your mental health services.

When it comes to accurate coding and billing, Medical Bill Gurus is your trusted partner. Contact us today to learn more about how we can support your insurance billing needs and help you achieve success in your mental health practice.

Conclusion

In conclusion, understanding the 90837 CPT code is essential for mental health professionals involved in billing and coding for psychotherapy sessions. This 60-minute code represents individual outpatient psychotherapy services and has specific requirements and reimbursem*nt rates. It is important to accurately document the session time, justify the medical necessity, and utilize any necessary add-on codes for extended sessions.

Proper documentation and knowledge of insurance company policies can help ensure accurate billing and maximize reimbursem*nt. By staying informed and up-to-date with coding guidelines, mental health practitioners can navigate the complexities of insurance billing more effectively. Whether handling billing independently or seeking assistance from a medical billing company like Medical Bill Gurus, understanding the nuances of the 90837 CPT code is crucial for successful insurance billing in the mental health field.

As professionals in the mental health field, we must prioritize accurate coding and billing to ensure that we are appropriately reimbursed for the services we provide. By understanding the requirements and nuances of the 90837 CPT code, we can confidently navigate the insurance billing process and optimize reimbursem*nt rates. Compliance with documentation guidelines and keeping up with insurance company policies are vital to successful billing. Regardless of whether we choose to handle billing independently or seek assistance from medical billing experts like Medical Bill Gurus, our commitment to staying informed and up-to-date is essential for navigating the insurance landscape effectively.