Understanding CPT Code 90837: A Comprehensive Guide

Introduction

CPT code 90837 is a crucial code for mental/behavioral health providers seeking reimbursement for individual psychotherapy sessions lasting 60 minutes. This article serves as a comprehensive reference guide, outlining everything you need to know about using CPT code 90837 for accurate billing and insurance claims.

What Does CPT Code 90837 Represent?

CPT (Current Procedural Terminology) code 90837 signifies individual outpatient psychotherapy services delivered for one hour. This code encompasses various psychotherapy modalities, including insight-oriented therapy; behavior modification techniques; supportive psychotherapy; and interactive psychotherapy.

Reimbursement and Documentation Requirements

For successful insurance claim reimbursement using CPT code 90837, ensure you meet the following documentation criteria:

• Detailed Session Notes: Maintain thorough notes for each session billed with CPT code 90837. These notes should reflect the following:
  • Date and time of the session
  • Duration of the session (confirming it was at least 53 minutes)
  • Presenting problem(s)
  • Treatment goals and interventions discussed
  • Client progress and response to treatment
  • Plan for future sessions
• Accurate Diagnosis:  Link the psychotherapy session documented in your notes to a valid diagnosis code from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).
• Provider Qualifications: Only qualified healthcare professionals can utilize CPT code 90837. This includes:
  • Licensed psychologists
  • Psychiatrists
  • Licensed clinical social workers
  • Licensed professional counselors (depending on state regulations)
• Place of Service: CPT code 90837 is designated for outpatient settings.

Key Points to Consider

• The CPT Time Rule:  The CPT code system allows for some flexibility in session duration. You can utilize CPT code 90837 if the session lasts at least 53 minutes. Conversely, if the session was shorter than 38 minutes, you should consider using a different code (e.g., CPT code 90834 for 45-minute sessions).
• Prolonged Services: If a psychotherapy session extends beyond 60 minutes and reaches 90 minutes or more of direct patient contact, you may be eligible to bill for prolonged services using additional CPT codes alongside 90837. However, this cannot be done if the extended session also included an Evaluation and Management (E/M) service.
• Payer-Specific Requirements:  While CPT code 90837 provides a standardized approach, individual insurance companies may have additional requirements for documentation or specific diagnoses covered under this code. It’s advisable to consult your payer’s manual or contact them directly for clarification.

Additional Tips for Smooth Reimbursement

• Stay Updated:  CPT codes are periodically revised. Ensure you’re using the most recent version of the CPT codebook to avoid billing errors.
• Maintain Accurate Records:  Keep detailed session notes and supporting documentation readily available in case of audits by insurance companies.
• Seek Clarification: If you have any uncertainties regarding using CPT code 90837 or specific payer requirements, don’t hesitate to reach out to your insurance company or a healthcare billing specialist.

To conclude,

By following these guidelines and maintaining meticulous documentation, you can ensure accurate use of CPT code 90837 and receive proper reimbursement for your individual psychotherapy sessions. Remember, this article provides general information, and it’s always recommended to consult your payer’s specific guidelines for the most up-to-date information.

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Managing medical billing can be time-consuming and complex, especially for busy mental/behavioral health providers. PrimeCare MBS, a dedicated medical billing company with extensive experience in behavioral health services, can be your valuable partner. Our team of experts can handle all aspects of the billing process, ensuring accurate claim submission, maximizing reimbursements, and allowing you to focus on delivering exceptional patient care. Contact PrimeCare MBS today to learn how their services can alleviate your billing burden and optimize your revenue cycle.