Correct medical treatment coding is vital for accurate reimbursement in health care billing. Medical professionals can charge insurance companies for therapy sessions, including the individual receiving treatment and the therapist, using the CPT code 90846, which is used for psychotherapy. We highlight code 90846, explaining its complexity and giving you the necessary knowledge to bill with reliability.
Definition
Psychotherapists use CPT code 90846 for billing family or marital counseling sessions, which includes the person being treated and the therapist. When a psychotherapist visits numerous patients in a single session, they apply this code. The psychotherapist must be a certified medical professional, such as a clinical social worker, certified therapist, or marital and family therapist.
Time Length
CPT Code 90846 represents a procedure code for certified mental health professionals. 90846 involves 50 minutes of family counseling (in the absence of an individual around). Still, the length of time might change based on the therapists’ and the patient’s requirements. The length of the session may vary from 50 minutes to more, but the psychotherapist must record the exact amount of time.
Description
One of the distinctive features of CPT Code 90846 is its absence of actual patient involvement. It includes the time the psychotherapist spends assessing the patient’s development, creating or modifying treatment plans, and, if required, collaborating care with other medical professionals. This code honors the psychological and emotional work that the counselor performs, which goes above the period spent with the patient.
CPT Code 90846 Time Limit
For what duration are 90846 sessions required? Since the code description clearly states 50 minutes, do appointments have to last 50 minutes to be billed?
Similar to other time-limited CPT codes, 90846 has a more friendly range than what is listed in the code’s official description.
To be able to bill 90846 CPT code for an appointment, it must last at least 26 minutes. This procedure code cannot be used for shorter sessions. To make sure you can charge this code, always be sure that you’re maintaining records of the time used.
Evaluation and Management
Choosing the Right Code: Since counseling sessions for families are primarily covered by CPT code 90846, keep into consideration the following situations when different codes would be most appropriate:
Family member participation in individual treatment
Even if family members rarely engage, use CPT codes 90832 and 90837 for individual therapy.
Group treatment with non-family members
For group counseling sessions with people who are not members of your own family, use CPT code 90853.
Billing Tip
It’s essential to choose an appropriate CPT code and accurately record the time spent in each session when paying for psychotherapy (90846 CPT code). The therapist must also record the first and last names of the couple or family members in attendance. The psychotherapist must bill the correct number of minutes spent in the treatment session to the insurance company.
Billing Restrictions
There are just a few significant restrictions to 90846.
- When the patient shows up for a particular part of the session, remember to bill 9084 instead of 90846, as the two cannot be invoiced on the same day.
- An additional time can’t be reimbursed for 90846. In the event of a 90-minute (or extended) session, 90846 alone must be billed, not 90846 + 99354.
- 90846 is usually seen as something other than ordinary. In contrast to other psychotherapy treatment codes, 90846 is less widely recognized and is processed differently by insurance companies. Frequently, there are age restrictions of 18 or 21. Different insurance providers will not pay for 90846. To be sure, it’s advisable to call the insurance company in advance.
Does 90846 need to be authorized? This might happen under certain circumstances.
How to Bill CPT Code 90846
The customer has to be recognized as the session’s recognizable patient on the claim form. You or your biller need to fill out the CMS 1500 with all the necessary demographic data, just like you’d do for a regular psychotherapy appointment (like 90834 or 90837).
Reimbursement Rates
Psychology Code 90846 reimbursement rates differ according to the payer, geographical location, and the qualifications of the specific therapist. Specialists in mental health need to be conscious of the individual payment rates that apply to their specific field of service. It’s vital to keep updated on any modifications to the reimbursement guidelines to ensure the services are correctly billed and that experts receive adequate compensation for their knowledge.
Concerning 90846, there are no set guidelines; payment varies according to the insurance company. Furthermore, reimbursement depends upon the provider’s degree level; insurance fee schedules generally provide payouts between 90834 and 90837. This is anything from $60 to $115.
Getting reimbursed
Policies for insurance differ in terms of family codes.
Some insurance initiatives, such as Medicare permit family psychotherapy sessions, if the patient’s disease is the main reason for the appointment. As examples of this, consider:
When it is necessary to observe and change the patient’s communication with family members using psychotherapy techniques,
When it’s necessary to evaluate the problems or challenges within the household and educate the family members to control the patient using psychotherapy
90846 CPT Code Reimbursement Rate
- Reimbursement Rate of Code 90846 2022: $95.94
- Reimbursement Rate of Code 90846 2023: $95.56
- Reimbursement Rate of Code 90846 2022: $107.37
- Reimbursement Rate of Code 90846 2021: $99.10
Conclusion
In conclusion, it is a medical billing code where the family members or marital persons’ therapy sessions, including those receiving treatment and the psychotherapist, are billed with the Psychotherapy CPT code 90846. Usually lasting 50 mins, this code is described as “The family psychological treatment (in the absence of the patient being present), 50 minutes.”
This code has two key components: evaluation and administration. When charging for this code, it’s crucial to apply the appropriate code and record the amount of time spent during the session. The insurance provider and the therapist’s location determine the reimbursement rate for this code.