90837 CPT Code: Guide to 60-Minute Psychotherapy Billing

Introduction

Accurate billing practices are essential in mental health care for both providers and patients. One critical procedure code that health professionals must understand is the 90837 code. This mental health CPT code is used to bill for a 60‑minute individual therapy session and plays a significant role in the billing process for extended psychotherapy sessions.

This comprehensive guide covers everything mental health practitioners need to know about the 90837 code, including its proper use, documentation requirements, and how it differs from other codes. By mastering this code, practitioners can ensure appropriate reimbursement and compliance with insurance policies while providing high‑quality care to patients with various mental health diagnoses.

What Is CPT Code 90837?

Code 90837 is a procedure code established by the American Medical Association (AMA) that allows providers to bill for a 60‑minute individual therapy session. This code is specifically used when a therapy session lasts at least 53 minutes but can extend beyond that. It represents an extended session that often addresses complex mental health diagnoses requiring in‑depth treatment.

Understanding this code is crucial because it directly affects how therapists are compensated for their time and expertise. Extended sessions allow clinicians to delve deeper into a patient's issues, providing a more comprehensive approach to treatment. The ability to bill appropriately for these sessions ensures that therapists can continue offering this level of care without facing financial drawbacks.

CPT Code 90837 vs. Other CPT Codes

Understanding the difference between code 90837 and other CPT codes is vital for accurate billing practices.

Using the correct CPT code ensures proper reimbursement and compliance with insurance requirements. Misclassification can lead to claim denials or reduced payments, which can significantly impact a practice's revenue cycle.

Services Covered Under CPT Code 90837

When billing with code 90837, it's important to know the types of psychotherapy services that are included. This code covers various therapeutic approaches provided during a 60‑minute session, such as:

Insight-Oriented Therapy

This therapy focuses on helping patients gain a deeper understanding of their thoughts, feelings, and behaviors. By exploring underlying motivations and past experiences, therapists assist patients in uncovering patterns that may contribute to their current mental state. This method is particularly effective for individuals dealing with long‑standing psychological issues.

Behavior-Modifying Therapy

Techniques like Cognitive Behavioral Therapy (CBT) aim to change negative thought patterns and behaviors. CBT is structured and goal‑oriented, helping patients develop coping strategies for dealing with specific problems. It's highly effective for treating conditions like anxiety, depression, and phobias by focusing on the here‑and‑now rather than delving into past experiences.

Supportive Therapy

Supportive therapy offers emotional support and encouragement. Therapists provide a safe space for patients to express their feelings and fears, fostering a trusting relationship. This approach is beneficial for individuals going through acute crises or those who need reinforcement to maintain their current level of functioning.

Interactive Therapy

This involves engaging patients through activities and discussions that promote interaction and expression. Techniques may include role‑playing, art therapy, or group discussions. Interactive therapy is especially beneficial for children and adolescents, as it can make the therapeutic process more engaging and less intimidating.

Mental Health Professionals Who Can Use CPT Code 90837

The 90837 CPT code is utilized by various licensed mental health professionals qualified to provide psychotherapy services. Eligible providers include:

• Psychiatrists: Medical doctors specializing in mental health who can prescribe medication.
• Licensed Psychologists: Professionals trained in assessing and treating psychological disorders.
• Licensed Clinical Social Workers (LCSWs): Specialists who provide therapy and support services, often focusing on social and environmental factors.
• Licensed Professional Counselors (LPCs): Therapists who offer guidance on personal, social, or psychological issues.
• Licensed Marriage and Family Therapists (LMFTs): Professionals specializing in relationship dynamics within families and couples.

It's essential for these providers to ensure they meet all licensing and credentialing requirements to use this CPT code appropriately. This includes staying updated with continuing education and adhering to ethical guidelines set forth by their respective licensing boards.

How to Use CPT Code 90837

Proper use of code 90837 involves several critical steps:

Verify Medical Necessity

Ensure that a 60‑minute therapy session is clinically justified based on the patient's condition. Medical necessity must be clearly documented to support the extended time spent during the session. This may involve complex cases where shorter sessions are insufficient to address the patient's needs, such as severe trauma or co‑occurring disorders.

Accurate Documentation

Maintain detailed progress notes in the patient's medical record. Documentation should include:

• Session duration: Clearly state the start and end times to verify that the session meets the minimum time requirement.
• Therapeutic interventions used: Describe the techniques and approaches applied during the session.
• Patient's response to the therapy: Note any progress, setbacks, or significant emotional reactions.
• Alignment with the treatment plan: Explain how the session's activities contribute to the patient's overall therapeutic goals.

Thorough documentation not only supports billing claims but also enhances the continuity of care by providing a comprehensive record of the patient's therapeutic journey.

Use Correct Procedure Codes

Double‑check that you're using the appropriate CPT codes for the services provided. For sessions shorter than 53 minutes, consider using code 90834. Accurate coding prevents billing errors that could lead to claim denials or delays in reimbursement.

Understand Payer Policies

Different insurance companies may have specific guidelines or preauthorization requirements for code 90837. Familiarize yourself with these policies to ensure compliance and proper reimbursement. Some insurers may limit the number of extended sessions covered or require additional documentation to justify their necessity.

Reimbursement Rates for CPT Code 90837

Reimbursement for the 90837 cpt code is generally higher than for shorter sessions due to the extended time and complexity of care provided. However, rates can vary based on geographic location, insurance provider, and negotiated contracts.

Below is a table illustrating sample reimbursement rates for CPT Code 90837 compared to CPT Code 90834:

Note: These rates are illustrative and may not reflect actual reimbursement amounts. Always verify with specific insurers.

Understanding the financial aspects allows practitioners to make informed decisions about scheduling and resource allocation. It also underscores the importance of accurate billing to maintain the financial health of a practice.

How to Ensure Reimbursement for CPT Code 90837

• Submit Accurate Claims: Use the correct code and ensure all information is complete. Double-check patient details, dates, and codes before submission.
• Follow Payer Guidelines: Be aware of any specific requirements from insurance companies. This may include prior authorizations or limitations on the number of sessions.
• Maintain Thorough Documentation: Detailed progress notes support the justification of the extended session. They serve as evidence in case of audits or disputes with insurers.

By adhering to these steps, practitioners can minimize the risk of claim denials and ensure timely payment for their services.

Time Length for CPT Code 90837

The session must last at least 53 minutes to qualify for CPT Code 90837. Sessions shorter than this should be billed using alternative codes:

• 90834: For sessions lasting 38-52 minutes.
• 90832: For sessions lasting 16-37 minutes.

Accurate timing is essential to comply with billing requirements and avoid potential audits. Therapists should document the exact start and end times of each session. Utilizing scheduling software or time‑tracking tools can help ensure precision.

Conditions for CPT Code 90837

Understanding when to use code 90837 is crucial. The code should be used in cases where the patient's condition necessitates an extended session.

Qualifying Conditions

Below is a table outlining conditions that may qualify for code 90837:

Note: The clinical justification must be documented in the patient's medical record for each case.

By accurately identifying and documenting these conditions, therapists can ensure that the use of code 90837 is appropriate and justified.

Benefits of CPT Code 90837

Using CPT Code 90837 offers several advantages for providers and their patients:

• Adequate Time for Treatment: Allows for comprehensive assessment and intervention, which can lead to more effective outcomes.
• Higher Reimbursement Rates: Reflects the extended time and resources dedicated to the patient, supporting the financial viability of offering longer sessions.
• Improved Patient Outcomes: Extended sessions provide the opportunity to address complex issues more thoroughly, potentially reducing the total number of sessions required over time.

These benefits highlight the value of extended therapy sessions for both clinical effectiveness and practice sustainability.

Limitations of CPT Code 90837

Despite its benefits, there are limitations to consider:

• Insurance Scrutiny: Higher reimbursement rates may attract closer examination from insurers, leading to more frequent audits.
• Preauthorization Requirements: Some insurance companies may require preapproval before covering extended sessions, adding administrative tasks.
• Documentation Demands: Requires detailed progress notes, increasing administrative workload and time spent on non-clinical tasks.

Being aware of these limitations allows practitioners to plan accordingly and allocate resources effectively.

What Mistakes to Avoid with CPT Codes

To ensure compliance and proper reimbursement, avoid these common mistakes:

Inadequate Documentation

Failing to provide thorough progress notes in the patient's medical record can result in claim denials. Always document:

• Session Length: Exact start and end times.
• Therapeutic Interventions: Specific techniques and approaches used.
• Patient Progress: Observations on the patient's response and any changes in condition.

Comprehensive documentation not only supports billing but also enhances patient care by providing a detailed treatment history.

Improper Use of Procedure Codes

Using 90837 for sessions less than 53 minutes is inappropriate. This can lead to audits and potential penalties. Always ensure you're using the correct procedure codes for the session duration to maintain compliance and avoid financial repercussions.

Ignoring Payer Policies

Not adhering to insurance guidelines can complicate the billing process and result in denied claims. Stay informed about each payer's specific requirements, including any updates or changes in policy, to ensure smooth billing operations.

Billing Extended Psychotherapy Sessions Over 60 Minutes: Example

For psychotherapy sessions exceeding 60 minutes, additional billing codes may be necessary.

Additional Add-On Codes for Extended Therapy Sessions

Below is a table of add‑on codes that can be used for extended sessions:

Example:

• Session Duration: 90 minutes
• Billing Codes:
  • 90837: Covers the first 60 minutes
  • 99354: Covers the additional 30 minutes

In cases where psychotherapy sessions extend to 120 minutes, additional codes like 99355 may be added to cover the extended time. Ensure the necessity is documented appropriately, including why such an extended session was clinically required.

Understanding how to bill for extended sessions ensures that practitioners are adequately compensated for their time and that patients receive uninterrupted care without administrative hiccups.

Emergency Sessions and Insurance Scrutiny of CPT Code 90837

Due to the higher costs associated with code 90837, insurance companies may scrutinize its usage, especially for frequent or emergency sessions. To mitigate this:

• Verify Coverage: Before providing services, check the patient's insurance policy for any preauthorization requirements or limitations on extended sessions.
• Provide Detailed Documentation: Maintain comprehensive progress notes that justify the extended session, particularly in emergency situations.
• Stay Informed: Keep up-to-date with changes in insurance policies and billing requirements to avoid unexpected claim denials.

By proactively managing these aspects, practitioners can reduce the likelihood of disputes with insurers and ensure continuous care for their patients.

Understanding and properly utilizing the 90837 CPT code is essential for providers offering extended psychotherapy sessions. Accurate use of this procedure code ensures compliance with billing requirements, appropriate reimbursement, and the ability to offer comprehensive care to patients with complex mental health conditions.

By adhering to best practices, maintaining thorough progress notes in the patient's record, and staying informed about insurance policies, providers can navigate billing effectively and focus on delivering quality care.

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Disclaimer: This article is for informational purposes only and does not constitute legal or medical advice. Always consult professional guidelines and regulatory bodies for specific compliance requirements.