Psychotherapy Codes Guide – 90834 & 90837 CPT Code

90837 CPT Code is used for Outpatient Psychotherapy Sessions.  The American Medical Association gives this code. It is a Sixty-minute therapy session. A licensed Mental Health Specialist conducts it. During the session, the provider engages with the patient, family members, and couples as per requirement. The session may include:

• Insight-oriented therapy
• Behavior-modifying therapy
• Supportive therapy
• Interactive psychotherapy
• Teaching grooming skills
• Monitoring daily living activities
• Recreational therapy
• Social interaction

Understanding CPT Code 90837

The CPT Code 90837 is a standard code for one-hour treatment sessions with licensed providers in mental health billing. This code applies to Outpatient Psychotherapy Sessions. Here are the details about this code;

Comprehensive Outline of CPT Code 90837

1. CPT Code 90837 Time Range: The code specifically indicates a 1-hour session. The duration of the session is between Fifty-Three to Sixty minutes.
2. Type of Therapy: Each patient may receive therapy individually. Family and group therapy are not part of it. 
3. Location: Hospitals, outpatient clinics, private practices, and telemedicine platforms, are available to provide the services.

CPT Code 90837 Category

The CPT code 90837 comes under the “Psychotherapy Services and Procedures” category in the code set. The American Medical Association (AMA) updates and manages it annually. 

90837 CPT Code Description

The 90837 CPT code strictly represents a 60-minute individual therapy session. Different psychotherapy techniques like insight-oriented, behavior modification, supportive, or interactive treatment, come under this code. 

CPT Code 90837 Reimbursement Rate

This coding system is used by insurance companies to determine their rates. The code 90837 is used by therapists to bill for individual therapy sessions lasting sixty minutes. The precise amount of reimbursement is determined by the insurance plan and the provider. To prevent billing inconsistencies and guarantee appropriate reimbursement for the prolonged session duration, this code must be used precisely.

CPT Code 90837 Documentation Requirements

Compliance and compensation are important while utilizing CPT Code 90837. Important elements to note in the documentation are;

1. Session Length: Clearly state that the 60-minute session (or 53 to 60 minutes) was in session.
2. The session’s contents were: Record the topics covered, the treatment approaches employed, and the advancements achieved in your notes.
3. Patient Condition: Note down the diagnosis, symptoms, and the complexity of the patient’s problems 

Therapy Schedule: Describe the objectives, techniques, and any modifications made to the treatment schedule.

CPT Code 90837 Considerations for Reimbursement

Insurance Plans

 Patient’s insurance policy plans and provider agreements may change the reimbursement rates.

Pre-authorization

 Some insurance companies may require pre-authorization for sessions billed under CPT Code 90837.

Medicare and Medicaid

Verify the regulations as these programs can have particular requirements and restrictions regarding using this code.

90837 CPT Code Modifier

CPT-Code 90837 does not require any modification. It is a standard Sixty-minute therapy session. If the therapy session is conducted virtually, you only need a modifier 95 with the CPT code. This indicates that the service was delivered via telecommunication technology. Otherwise, if the session is not virtual, you don’t need to add any modifier.  

Other CPT Codes for Psychotherapy

Some other types of CPT codes are used based on therapy duration. These codes include;

1. 90832: Used for Individual psychotherapy sessions of 30 minutes (16-37 minutes)
2. 90834: Used for Individual psychotherapy sessions of 45 minutes (38-52 minutes)
3. 90846: Used for Family sessions of 50 minutes (without the patient present)
4. 90847: Used for Family sessions of 50 minutes (with the patient present)
5. 90853: Used for Group psychotherapy sessions (other than for a multiple-family group)

CPT Code 90834 Description

CPT code 90834 signifies a 45-minute individual psychotherapy session with a licensed mental health professional. It covers various therapy techniques and is used for billing purposes, with reimbursement depending on insurance plans. This code excludes additional services like evaluations and focuses solely on the therapy sessions.

Reimbursement Rate of CPT Code 90834

The reimbursement rate varies depending on the payer agreements, geographic location, and insurance provider. It is difficult to determine an exact figure, but Medicare pays about $101.51 in 2024, which is between 70 and 80 percent of a 60-minute session (CPT code 90837).  

90834 CPT Code Modifier

Modifier 95 is used in virtual therapy (e.g., 90834-95). Extended service codes may be necessary for sessions longer than forty-five minutes. Although these are contingent upon certain requirements and guidance from an insurance representative or billing specialist.

Benefits of Using Modifier 95

Here are some benefits of Modifier 95:

• Accurate service representation
• Potential for reimbursement
• Streamlined billing process
• Compliance with regulations

Difference Between CPT Codes 90834 and 90837

The difference between CPT Codes 90834 and 90837 include;

Length of session: 45-minute sessions for CPT Code 90834. 60-minute sessions are for CPT Code 90837

Care components: CPT codes 90834 and 90837 solely cover in-person therapy; they do not include administrative components. CPT Code 90837, is utilized for longer sessions that can involve more sophisticated or extensive therapy.

Rates of reimbursement: Because CPT Code 90837 sessions are longer and may involve more sophisticated therapy than CPT Code 90834, reimbursement rates for this code may be higher.

Usage: CPT Code 90837 is used for longer, more involved treatment sessions, but CPT Code 90834 is more frequently used for standard psychotherapy sessions.

Add-On Codes in Psychotherapy

In psychotherapy billing, add-on codes are used to specify particular situations or extra services delivered during a session. They are added to the main CPT code to give a more thorough description of the services given. Here’s a detail of when to use Add-on codes;

• Extended Time: When a session goes beyond the typical timeframe 
• Specific Circumstances: For situations during a session requiring extra attention
• Additional Services: When a session includes services beyond core therapy 

Common Add-on Codes in Psychotherapy

These are some common Add-on codes in psychotherapy.

1. 90785 – Interactive Complexity:

Use this code when a session requires a high degree of therapist skill because of the patient’s emotional state or clinical issues. 

2. 90833, 90836 and 90838 – Duration 

These codes are used when psychotherapy is given for the extra time in a session. It represents the duration beyond the E/M service.

3. 90839 and 90840: The Crisis Codes

The crisis codes are used when a patient is experiencing a mental health emergency that requires immediate evaluation and treatment.

4. 99050 & 99051: 

These codes designate services offered after regular working hours (closed on weekends and holidays).

Conclusion

When it comes to correctly recording and billing for psychotherapy sessions, CPT coding is crucial. While giving insurance companies precise information, knowing codes and how to use them guarantees that therapists get paid appropriately.  Add-on codes can be used to represent extra services or special circumstances in certain scenarios during a session. To guarantee correct coding and optimize payment for the priceless psychotherapy services rendered, speaking with a healthcare billing specialist is advised.