Psychotherapy involves a range of techniques to address emotional, behavioral, and cognitive concerns. Accurate coding for psychotherapy services is crucial for proper billing and reimbursement. This guide explores the details of psychotherapy codes, specifically focusing on the +90836 CPT code.

Understanding Psychotherapy Code Sets

Psychotherapy codes are divided into two primary sets:

Primary Psychotherapy Codes

These codes represent the time spent providing psychotherapy services. They include:

• 90832: Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 30 minutes with the patient and/or family member (time range 16-37 minutes)
• 90834: Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 45 minutes with the patient and/or family member (time range 38-52 minutes)
• 90837: Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 60 minutes with the patient and/or family member (time range at least 53 minutes)

Add-on Psychotherapy Codes

These codes are used when psychotherapy is provided in conjunction with an evaluation and management (E/M) service. They include:

• +90833: Add-on code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 30 minutes with the patient and/or family member (time range 16-37 minutes)
• +90836: Add-on code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 45 minutes with the patient and/or family member (time range 38-52 minutes)
• +90838: Add-on code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 60 minutes with the patient and/or family member (time range at least 53 minutes)

+90836 CPT Code Description

The +90836 CPT code is an add-on code used for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, provided for 45 minutes with the patient and/or family member (time range 38-52 minutes). This code is specifically used when psychotherapy is performed in conjunction with an E/M service.

Documentation Requirements for CPT Code 90836

In order to bill for CPT Code 90836, the mental health professional must document the following information in the patient’s medical record:

• The date and time of the psychotherapy session.
• The duration of the psychotherapy session.
• The type of psychotherapy provided.
• The patient’s presenting problem.
• The patient’s progress in treatment.

Reimbursement for CPT Code 90836

The reimbursement rate for CPT Code 90836 varies depending on the type of insurance, the provider’s location, and the provider’s qualifications. Mental health professionals should check with their insurance carriers to determine the specific reimbursement rate for this code.

Accurate Coding Principles for Psychotherapy Services

To ensure accurate coding of psychotherapy services, adhere to the following principles:

Time-based Coding

Choose the CPT code that most closely aligns with the actual time spent providing psychotherapy services. Round down to the nearest 15 minutes.

Patient Presence

The patient must be present for all or some portion of the psychotherapy service.

Interactive Complexity

If a patient cannot communicate by any means, do not bill for interactive complexity codes.

Conjunction with E/M Services

When psychotherapy is performed in conjunction with an E/M service, use add-on psychotherapy codes (+90833, +90836, +90838) to indicate both services were provided.

Billing Examples for Psychotherapy Services

To illustrate the application of CPT codes for individual psychotherapy, consider these examples:

• Scenario 1: A psychiatrist provides 40 minutes of individual psychotherapy to a patient during the same encounter as an E/M service. The appropriate codes are 99212 (E/M service) and +90836 (add-on psychotherapy code for 45 minutes).
• Scenario 2: A psychologist provides 55 minutes of individual psychotherapy to a patient. The appropriate code is 90837 (individual psychotherapy code for 60 minutes).

Coding Considerations for Solo Practitioners

Solo practitioners who provide both E/M and psychotherapy services to patients on a weekly basis can independently code and document each service based on the patient’s presenting problem and the duration of psychotherapy provided.

Fee Distribution

When submitting invoices for psychotherapy services, some insurers may require the distribution of the total fee between the E/M and psychotherapy codes. A reasonable approach is to base the apportionment on the relative value units (RVUs) assigned to each code by Medicare.

To conclude,

Accurate coding of individual psychotherapy services is crucial for healthcare providers to ensure proper reimbursement and maintain comprehensive patient records. By adhering to the outlined coding guidelines and considering the billing examples provided, healthcare professionals can effectively navigate the intricacies of individual psychotherapy coding.

About PrimeCare

PrimeCare, a reliable medical billing company, understands the challenges of psychotherapy coding and can assist you in navigating the complexities of this process. Our team of certified coders possesses in-depth knowledge of the latest CPT guidelines and policies, ensuring that your claims are accurate, compliant, and reimbursed promptly. We can help you identify and apply the appropriate psychotherapy codes for your services, preventing errors and maximizing your revenue. Contact us today to learn more about our psychotherapy billing and coding services.

References:

• Billing and Coding: Psychiatry and Psychology Services – CMS
• CPT® 90836, Under Psychotherapy Services and Procedures

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The Current Procedural Terminology (CPT) code set is a standardized medical code set maintained by the American Medical Association (AMA). It is used to report medical, surgical, and diagnostic procedures. Psychotherapy codes are a subset of CPT codes that are used to report psychotherapy services. Before we understand the CPT code 90838, let’s understand the basics of psychotherapy codes.

Types of Psychotherapy Codes

There are two main types of psychotherapy codes:

Time-based Codes

These codes are based on the amount of time spent providing psychotherapy services. The time-based psychotherapy codes are 90832 (30 minutes), 90834 (45 minutes), and 90837 (60 minutes).

Add-on Codes

These codes are used when psychotherapy is provided in the same encounter as an evaluation and management (E/M) service. The add-on psychotherapy codes are +90833 (30 minutes), +90836 (45 minutes), and +90838 (60 minutes).

When to Use Individual Psychotherapy Codes?

Individual psychotherapy codes are used to report psychotherapy services that are provided to an individual patient. These codes can be used by a variety of providers, including psychiatrists, psychologists, social workers, and therapists.

Understanding CPT Code 90838

CPT code 90838 is an add-on code that is used to report 60 minutes of individual psychotherapy. This code can be used when psychotherapy is provided in the same encounter as an E/M service. Psychotherapy with E/M services is now reported with codes for E/M services plus a psychotherapy add-on code, +90833, +90836, and +90838.

• Code ‘exact’ time (in minutes) Actual Time Range (in minutes)
• 90832, +90833 30 16-37
• 90834, +90836 45 38-52
• 90837, +90838 60 At least 53

Psychotherapy times are for face-to-face services with the patient and/or family member. The patient must be present for all or some of the service. In reporting, choose the code closest to the actual time (i.e., 16-37 minutes for 90832 and 90833, 38-52 minutes for 90834 and 90836, and 53 or more minutes for 90837 and 90838). Do not report psychotherapy of less than 16 minutes duration.

About PrimeCare

PrimeCare, a reliable medical billing company, understands the challenges of psychotherapy coding and can assist you in navigating the complexities of this process. Our team of certified coders possesses in-depth knowledge of the latest CPT guidelines and policies, ensuring that your claims are accurate, compliant, and reimbursed promptly. We can help you identify and apply the appropriate psychotherapy codes for your services, preventing errors and maximizing your revenue. Contact us today to learn more about our psychotherapy billing and coding services.

References:

• Billing and Coding: Psychiatry and Psychology Services – CMS

• CPT® 90838, Under Psychotherapy Services and Procedures

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The No Surprises Act (NSA) is a federal law that prohibits surprise billing, the practice of balance billing patients for the difference between what their insurance company pays and the provider’s charge for the service. This act took effect on January 1, 2022, and applies to all non-grandfathered health plans, including those offered by employers, unions, and state and federal governments. This article explores into the details of the No Surprises Act and outlines the responsibilities of psychologists in adhering to its provisions.

The No Surprises Act and Psychologists

The NSA, enacted in 2020, emerged as a response to the growing concern over surprise billing practices, where patients faced unanticipated charges for healthcare services rendered by out-of-network providers. This act extends protection to patients seeking mental health services, ensuring that psychologists, like other healthcare providers, adhere to its guidelines.

Psychologists’ Obligations under the No Surprises Act

Psychologists, as healthcare professionals, bear the responsibility of complying with the NSA’s regulations. Key obligations include:

• Providing Good Faith Estimates (GFEs): Psychologists must furnish patients with a clear and detailed GFE, outlining the expected costs of services before treatment commences. This GFE should include the provider’s contact information, a service description, the estimated cost per service, the total anticipated treatment cost, the provider’s network status, and the patient’s right to dispute the GFE.
• Informing Patients of Dispute Resolution Rights: Psychologists must educate patients about their right to challenge unexpected bills. This entails informing them of the dispute resolution process, whether through the provider or the health plan.
• Adhering to Patient Protections: Psychologists must refrain from engaging in balance billing practices, where they charge patients the difference between the insurance company’s payment and the provider’s charge.
• Maintaining Compliance: Psychologists must continuously monitor their practices to ensure adherence to the NSA’s requirements. This includes maintaining accurate records, providing ongoing training to staff, and promptly addressing any compliance issues.

Providing Good Faith Estimate (GFE)

Psychologists are required to comply with the NSA if they provide services to patients who are uninsured, self-pay, or out-of-network. This means that they must provide patients with a good faith estimate (GFE) of the expected cost of their services before treatment begins. The GFE must be in writing and must include the following information:

• The provider’s name and contact information
• A description of the services to be provided
• The expected cost of each service
• The total expected cost of treatment
• The provider’s network status
• The patient’s right to dispute the GFE

Psychologists must also inform patients of their right to dispute unexpected bills. If a patient receives an unexpected bill, they can file a dispute with their provider or their health plan. Keep in mind the following is additional information about the NSA:

• The NSA applies to all non-grandfathered health plans, including those offered by employers, unions, and state and federal governments.
• The NSA does not apply to Medicare or Medicaid.
• The NSA does not apply to services provided by out-of-network providers at in-network facilities.

To summarize,

The No Surprises Act represents a significant step towards achieving a healthcare system that prioritizes patient well-being, transparency, and cost-effectiveness. By adhering to the act’s provisions, psychologists can play a pivotal role in fostering a patient-centric mental healthcare environment, where individuals can access essential services without the fear of unexpected financial burdens.

About PrimeCare

PrimeCare is a reliable medical billing company that can help you streamline your billing processes, maximize your reimbursements, and improve your cash flow. Our team of experienced professionals is expert in all aspects of medical billing, and we are committed to providing our clients with the highest quality service. We offer a wide range of medical billing services, including claims submission and tracking, insurance verification and eligibility, patient billing and collections, coding and compliance, and denial management. Contact us today to learn more about how we can help you improve your medical billing operations.

References:

• No Surprises Act

• American Psychological Association

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