Did You Get a 90837 Letter?
By Barbara Griswold, LMFT (posted August 5, 2020)
Did you get a letter from Blue Cross or another insurance plan, saying something about your use of the 90837 CPT code (Psychotherapy 60 min)?
Why are you getting this letter? The letter states you are receiving it because you use this code more than peers, but isn’t clear about what they want from you, other than to contact them. I interviewed Alma Granados, Anthem Provider Reimbursement Administrator, for the lowdown.
Granados states that Anthem Blue Cross reviewed one year of all their paid claims. They then calculated an average utilization of the 90837 CPT code for different provider specialties within each market. Individual providers then were compared to their specialty’s baseline. Providers whose claims showed a higher-than-typical use of the 90837 code received the letter.
What does the plan want from you? According to Granados, “our letter is strictly educational, the intent is to draw attention to the documentation guidelines for Psychotherapy Services. Our goal is to ensure that providers are following the documentation and coding guidelines set by the AMA and current CPT coding books, and that their documentation supports the level of care billed for each service.”
“Please be assured that we are in no way asking you to change the way that you provide care to your patients,” says Granados. “We recognize that each service is billed dependent on your clinical judgement and the nature of the presenting problem.”
While Anthem says the purpose of the letter is educational, the letter is not informative, so it leaves providers feeling confused and worried. Out of this fear, many therapists are choosing to “downcode” sessions, using the 90834 45-minute psychotherapy code instead, which typically represents lower reimbursement.
Here’s my view: There is one insurance plan — OPTUM/UBH/UHC — that does not want providers to use the 90837 unless it is a complex case, or unless you are doing EMDR, Systematic Desensitization, or some Trauma Informed Treatment that requires additional time. In fact, providers have received denials of claims, awaiting defense of the use of the 90837. So don’t use 90837 with OPTUM/UBH clients except in special circumstances.
However, when we are talking about the insurance plans that are sending these letters, they are NOT forbidding the use of the 90837 code. They are NOT telling you it is a problem that you use it more frequently than your peers. They are NOT saying you need to change your treatment. And you are NOT being singled out — the letter is being sent to thousands of therapists each year, in different waves.
What matters is whether you are using the code correctly. They are looking for fraud. If you aren’t committing fraud, why should you change anything?
Just don’t forget when you use this code:
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- The session length must be 53 minutes or longer; if the session starts late or ends early, you may have to use a 90834 code (38-52 minutes) or 90832 code (16 – 37 minutes)
- In each progress note, you must document the length of the session (use actual start/end times, not to include time spent scheduling, communicating with others, or documenting)
- It can be used only for individual sessions, or when family comes into a session to serve as informants for ongoing individual treatment. When a 90837 is used for a family visit, the client must be present for all or most of the session. This code should not be used for ongoing couples or family treatment.
- There is no need to document why you are using a 90837 vs. a 90834 (i.e. why your sessions are longer than 52 minutes).
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What you should do: If you got this letter, email them back. Tell them you understand each of the above, that you use the code only for sessions 53 minutes and over, and are documenting start and stop times in the client’s record that will back up the use of this code. And be sure you are using this code only when appropriate, downcoding for shorter sessions, when these occur.
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