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Do You Do Longer Sessions? Prolonged Services Codes to be Discontinued in 2023
By Barbara Griswold, LMFT (updated Feb 14, 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 sessions were 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 that 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? These options were taken away as of January 2023. According to the American Medical Association, these two codes were deleted as of 1/1/2023. And while it appears from a quick reading that there is one possible replacement code (99417), experts I consulted confirmed my reading of the CPT codebook which shows that this code cannot be used with psychotherapy codes 90837 or 90847 for extended sessions.
So, if you’ve been using 99354 and 99355 to bill for longer sessions, they will not be reimbursed in 2023. While these codes can be used for sessions prior to 1/1/2023, for sessions after this date we seem out of luck. This applies to all insurance plans, and all clients, whether you are in- or out-of-network.
I’ll stay tuned and will let you know if the AMA makes changes and allows 99417 to be used with psychotherapy sessions, or comes up with new codes to replace 99354 and 99355.
Keep in mind that 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.