UPDATE: Do You Use CPT Code 90837?  New Insurance Reviews

by Barbara Griswold, LMFT (June 5, 2021)

Many therapists have in the past received letters from Anthem Blue Cross about their use of the CPT code 90837 — 60 minutes individual psychotherapy–stating they used this code on average more than colleagues (see my article on these letters, click here).

However, one therapist shared recently that Blue Cross requested that she attend an “Education Team meeting” regarding her use of this code.

After a bit of panic, followed by a consultation with me, she had the review, and survived to tell the tale. She emailed me to tell me the results. “You were so helpful in preparing me to talk confidently and authoritatively about the proper use of the 90837 … The meeting took only about 20 minutes. They asked if I knew the proper use of 90837.  When I replied with the prepared response we talked about, they [agreed] to my use of 90837 for my clients.”  They told her that the call was not meant to be punitive, and was meant purely to make sure that she was knowledgeable about the appropriate use of this code.

But the therapist was surprised at what happened next. “They also asked if I update my treatment plans and diagnoses at 3-6 month intervals, what the average number of sessions I provide to clients, whether I work with ‘SMART’ goals, and if I have measurable goals that I set with clients.”

Conclusion? We may be seeing a trend of closer inspection of this code, one that may extend beyond Blue Cross. It seems likely that those of us who use the 90837 code regularly (including me) should be ready to defend our knowledge of the code’s appropriate use. But this is doable, armed with a little information (read on). If you’ve read my previous article, you’d know that I don’t recommend you use this code with UHC/UBH/OPTUM, as this plan view this code as only necessary for special circumstances, so using 90837 might make them more likely to review your treatment, not just your code use.

It also seems the Blue Cross may be taking a closer look at whether we are creating and updating treatment plans and diagnoses. Medicare also expects this. So, it may be time to start paying more attention to your treatment plans. (Need to brush up on your SMART-goal-writing and treatment-plan-writing skills? See my webinar “How to Write a 10-Minute Treatment Plan” — click here).

Wondering what advice I gave to help this therapist feel so confident and to pass the review?  See the 5 tips listed in my article here