While this won't take effect until January 1, 2013, heads up: Major changes are coming to the CPT billing codes that therapists use on insurance claims and invoices. These codes indicate what kind of service was provided. The changes will involve the most common codes therapists use. This article will give you an overview of the changes and what you need to do now, so that in January you don't end up with a month's worth of denied claims.
A few notable changes:
- There will now be just three timed codes to be used for psychotherapy in all settings.
- The code for extended therapy session 75-80 minutes (90808) is being deleted.
- There is no longer a code restricted to "individual therapy" - psychotherapy codes are now described as face-to-face with a client and/or family member
- New codes have been added for therapy with a client in crisis
- A distinction is made between diagnostic interviews done by physicians and non-physicians.
- Instead of separate codes for interactive psychotherapy, there will now be an add-on code for "interactive complexity" which may be used when treatment involves people other than the client (expected to be used primarily when treating kids)
- Family, couples, and group therapy codes will not change
- Prescribers will lose 90862 for medication management, and will have to use E/M (Evaluation/Management) codes, which have tougher documentation requirements
NEW 2013 CPT CODES FOR THERAPISTS (partial list)
Initial Psychiatric Evaluation
- Diagnostic evaluation: 90791 (currently 90801)
- Diagnostic evaluation with medical services: 90792 (this is a new code)
- Psychotherapy, 30 min. with client or family member: 90832 (currently 90804, 90816)
- Psychotherapy, 45 min. with client or family member: 90834 (currently 90806, 90818)
- Psychotherapy, 60 min. with client or family member: 90837 (this is a new code)
- Psychoanalysis: 90845 (no change)
- Family psychotherapy without the client present: 90846 (no change)
- Family or conjoint psychotherapy with the client present: 90847 (no change)
- Multiple-family group psychotherapy: 90849 (no change)
- Group Psychotherapy, other than a multiple-family group: 90853 (no change)
Interactive Complexity Add-On Code (new codes)
- Add-on code, use with codes for primary service of diagnostic evaluation, psychotherapy, or group psychotherapy: +90785
Psychotherapy for Crisis (new codes)
- Psychotherapy for crisis, first 60 minutes: 90839
- Add-on for each additional 30 minutes of psychotherapy for crisis, used in conjunction with code 90839: +90840
Again, this is not a complete list, and does not include codes for physicians.
What if your session isn't exactly 30, 45, or 60 minutes? Choose the code closest to the actual session length (e.g 90832 for 16-37 minutes, 90834 for 38-52 minutes, and 90837 for 53 minutes and beyond). As mentioned, the popular 90808 for sessions lasting 75-80 minutes is being deleted, so these extended sessions should now be coded under the 60 minute code, 90837.
What does this mean for working with insurance? Under HIPAA, all insurers are required to use the latest CPT codes. These plans will be required to transition to the new codes to ensure proper reimbursement.
So what do you need to do?
- Contact your billing service, clearinghouse, or practice software program tech support, to make sure they are ready for the new codes in time for January claims.
- Call Provider Relations at each insurance plan with whom you are contracted and ask when they will load the new codes into their claims and authorization systems, to help avoid reimbursement hiccups. Ask when an updated fee schedule will be available.
- Update your forms that might have CPT codes.
- Psychiatrists: If you are not familiar with E/M coding and documentation, the APA has an online course, Evaluation and Management Coding (CPT) and Documentation for Psychiatrists,www.apaeducation.org. Also, to view a more complete psychiatric code chart, click here
- Breathe. We have time to get questions answered.
- Stay tuned – I will give more details in coming e-newsletters. To join my mailing list, click here.
Want to see a helpful graphic showing old and new codes? View the AACAP chart.
Barbara Griswold is a Licensed Marriage and Family Therapist with over 19 years experience as a therapist. She is also the author of "Navigating the Insurance Maze: The Therapist's Complete Guide to Working With Insurance and Whether you Should" http://navigatingtheinsurancemaze.com/store/index.html. She is available for questions or consultations at firstname.lastname@example.org or 408.985.0846.
CPT® codes copyright 2011 by the American Medical Association (AMA). All Rights Reserved. Thanks to Ofer Zur PhD. for sharing chart links.
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