Changes to CPT Billing Codes - Navigating the Insurance Maze

CPT Billing Codes Changes: What You Should Know

By Barbara Griswold, LMFT
(Updated June 8, 2015)

Major changes came about as of January 1, 2013 to the CPT billing codes that therapists use on all insurance claims and superbills/invoices. These codes are required to indicate what kind of service was provided. The changes involved the most common CPT codes therapists use. Yet many therapists and their clients are receiving insurance denials because they are still using old codes, or because they don’t know how to use the new codes properly. This article will give you a brief overview of the changes.

A few notable changes:

There are now just three timed codes to be used for psychotherapy, no matter what the setting
The code for extended therapy session 75-80 minutes (90808) has been 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, and these sessions can be extended sessions
A distinction is made between diagnostic interviews done by physicians and non-physicians.
Instead of separate codes for interactive psychotherapy, there is now 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 children)
Family, couples, and group therapy codes have not changed
Prescribers have lost 90862 for medication management, and will have to use E/M (Evaluation/Management) codes, which have tougher documentation requirements

2013 CPT CODES FOR THERAPISTS (partial list)

Initial Psychiatric Evaluation

Diagnostic evaluation: 90791 (was 90801)
Diagnostic evaluation with medical services: 90792 (for physicians — this is a new code)

Psychotherapy

Psychotherapy, 30 min. with client or family member: 90832 (was 90804, 90816)
Psychotherapy, 45 min. with client or family member: 90834 (was 90806, 90818)
Psychotherapy, 60 min. with client or family member: 90837 (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 has been deleted, so these extended sessions should now be coded under the 60 minute code, 90837. However, many insurance plans don’t reimburse for more than 45 minute sessions – check your insurance plan.

For a guide to everything you need to know about the latest codes, (including your options when billing for extended sessions, crisis sessions, complex sessions, the coding of couples or family sessions vs. individual sessions, and how to record multi-item codes like extended crisis sessions on the claim form, etc.) order Barbara’s “Special Report on the 2013 CPT Codes.”