2017 CPT Codes Clarified/Changed; New Telemedicine Modifier

by Barbara Griswold, LMFT (Updated March 27, 2017)

While you may know that psychotherapy CPT codes  underwent radical changes in 2013, on January 1, 2017, more changes quietly went into effect.  According to the American Psychological Association, in the American Medical Association’s new 2017 CPT manual the following was clarified:

• The descriptions of codes 90846 (couple/family therapy without patient present) and 90847 (couples/family therapy with patient present) have been changed so they now have stated time lengths of 50 minutes. These codes should be used when providing family or couples therapy, with a minimum of 26 minutes.
• Psychotherapy codes (90832, 90834, and 90837) are now for individual therapy only. The description “psychotherapy with patient and/or family member” has now been changed to simply “psychotherapy with patient.”  Yes, the AMA says these sessions may occasionally involve “informants” such as family and caregivers, but these codes are to be used when the therapist is primarily providing individual counseling, and the patient is present for the majority of the session.
• Codes 90832, 90833, 90834, 90836, 90837, 90838 can be reported on the same day as 90846 or 90847. Include modifier 59 to emphasize the services were separate and distinct.  (Note: this doesn’t mean the insurance plan will cover them both, but this is how to code them).

Telemedicine changes

The manual also introduced a new CPT modifier, 95, for “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.”  While this will cover video sessions, you’ll notice this description doesn’t apply to phone sessions.  This modifier follows the code for the service provided — ex. If you provided 60 minutes of telemedicine, you would code 90837 with modifier 95. (Note: Many clients don’t have coverage for telehealth.  Also, payers have previously asked providers to use the GT modifier to indicate a telehealth session, so it is a good idea to check with plans before billing).

In addition, the manual clarified that the only codes appropriate for telemedicine are 90832, 90834, 90837, 90845, 90846, and 90847.

What is the Place of Service Code for Telehealth? The APA article suggests when recording the Place of Service code for telehealth sessions that you use the originating code for where the provider is located (typically 11 for office).  However, since the article was written, a new Place of Service Code, 02, took effect (January 1, 2017) to identify “The location where…services are provided or received, though a telecommunication system.”   As always, it is a good idea to check with the insurance plan to see which should be used.   For a complete list of Place of Service codes, click here.

 Click here to read my article on Telehealth

To read the complete APA article click here