Do You Do Longer Sessions? Prolonged Services Codes to be Discontinued in 2023
Most insurance plans don’t reimburse extra for longer sessions (e.g. 90 minutes or more). However, as I reported previously, some insurance plans have been known to reimburse more for longer individual or couples or family sessions if the session was billed using Prolonged Services CPT add-on codes 99354 and 99355. These codes could be added on to a CPT code 90837 (60-minute individual session) or a 90847 (50-minute couples or family session) to designate that the individual session was at least 90 minutes long or the couples/family session was at least 80 minutes long (if you missed my article on this topic, click here).
So what’s the important news? It seems this option will be taken away in just a few months. According to the American Medical Association, these two codes will be deleted as of 1/1/2023. And while it appears there is one possible replacement code (94117), as far as I can tell, this code cannot be used with 90837 or 90847 for extended sessions.
So, if you’ve been using 99354 and 99355 to bill for longer sessions, consider this your advance warning that they will not be reimbursed in 2023. I’ll stay tuned and will let you know if the AMA makes changes to these codes. In the past it took years for the AMA to allow Prolonged Service codes to be used with psychotherapy sessions; maybe we just have to urge our professional associations to pressure them to do so in this case.
To read the AMA notice yourself, click here.