You know the CPT codes that make insurance payments if you’re a psychological practitioner managing medical billing. One of these CPT codes is 90837 for psychotherapy, which is responsible for an essential part of your billing services. However, what does 90837 indicate, and how can it be applied to get reliable and efficient billing? Continue reading to receive all the information you want about 90837 CPT code to maximize your claims and obtain the correct reimbursement.
Definition
A reimbursement code for lengthy sessions of mental health care is CPT 90837 for psychological treatment. The American Psychological Association (APA) states that psychotherapy aims to help patients analyze and change their thoughts, feelings, and behaviours using collaborative therapy sessions with a psychologist or psychiatrist. Psychotherapy is a valuable treatment for a wide range of mental health conditions, including anxiety, depressive disorders, and post-traumatic stress disorder (PTSD).
Time Length
90837 requires a minimum of “60 minutes” of in-person psychotherapy with your patient. But be careful—going beyond 60 minutes doesn’t mean switching to a new code immediately. The trick is to show that you are still doing therapeutic work over the more extended session.
Extended sessions rated as 90837 are justified, for example, when they concentrate on advanced treatments, comprehensive case understanding, or lengthy emotional processing. Recall that going above 85 minutes may need you to take code 90838 (90-minute psychotherapy) into consideration.
Description
The Medicare Services Centres CPT Code 90837 represents the delivery of individualized outpatient psychotherapy treatments for 60 minutes.
Services include interacting, supportive, behaviour-modifying, and/or behavioural psychotherapy.
Medicare requires billing for the following services in addition to 90837 CPT code.
- Conveying grooming information
- Keeping an eye on everyday activities (ADL)
- Therapeutic recreation through play, art, and dance
- Social interactions
Evaluation and Management
Though time is essential, 90837 isn’t about more than just maintaining a close watch on the clock. The AMA guidelines state that you need to include three essential elements in your documentation to support this code:
Detailed problem-focused history
It includes looking into the patient’s presenting issue in significant detail and documenting data on its development, past therapy attempts, and other relevant psychosocial aspects. Consider more than a simple assessment; go further to create a comprehensive picture.
Expanded problem-focused assessment
This passes the typical mental health assessment. Evaluate the patient’s behavioural, mental, and cognitive functioning concerning the issue now being presented. Make use of observations or specific tools to support the findings you make.
High-complexity medical decision-making
This involves figuring out challenging diagnosis issues, combining complex options for treatment, and implementing critical modifications to current therapies in response to the patient’s reaction and changing clinical picture. To show the complexity involved, record your decision-making process and reasons.
Can I use add-ons with 90837 CPT code?
You may implement the add-on 90785 for interaction difficulty if the presence of additional third parties, inappropriate communication, or translation services disrupts your session with a patient.
The add-on codes 99354 and 99355 are also significant. Before you get too optimistic, remember that these codes only indicate that you are consuming even longer than 90837 allows. You add a 99354 CPT code for 30-74 minutes of a 60-minute session. You add a 99355 CPT code for each 30 minutes before your session lasts longer than that.
CPT Code 90837 Rates of Reimbursement
It is accurate that 90837 pays out more than 90834 because of the longer term. Based on your abilities, we’ve established that 90837 appointments often pay $9–20 more than 90834 appointments. This equals to about 13–20% more on average each session.
Medicare’s Medicare’s 60-minute individual treatment reimbursement rates are available for viewing.
Reimbursement Rate
- 2024, Medicare Reimbursement Rate of CPT Code 90837: $149.64
- 2023, Medicare Reimbursement Rate of CPT Code 90837: $147.07
- 2022, Medicare Reimbursement Rate of CPT Code 90837: $164.84
- 2021, Medicare Reimbursement Rate of CPT Code 90837: $152.48
- 2020, Medicare Reimbursement Rate of CPT Code 90837: $141.47
Billing Tip
Implementing 90837 CPT code with complete and correct documentation is your most valuable companion for billing. Give an extensive overview of the session’s beginning and ending times, highlighting any unexpected interruptions or extensions that exceed 60 mins. Give a thorough narrative of your clinical experiences, including the specific therapeutic interventions you employed, your assessment of the client’s progress, and any plan revisions you made.
How to Bill Extended Sessions for Psychotherapy Over 60 Minutes
There currently needs to be a CPT code for sessions lasting more than 60 minutes. Are you stuck with only billing 90837 since you need more time?
An additional 30-74 minutes of therapy are included in the definition of CPT Code 99354, an extended services code.
What modifiers can I use with CPT code 90837?
Modifiers provide an essential context for your claims, which may increase reimbursement or support longer sessions. Besides 90837, consider these:
- Modifier 95 (Concurrent Care): When giving 90837 and a different CPT code, such as a medication management session (e.g., 90847).
- Modifier 25 (Significant & Unusually Timed Service): Describe how the intervention’s complexity and need for the best possible patient care justifies longer sessions beyond 60 minutes.
- Modifier 53: If a diagnostic examination (such as 90791) and 90837 are performed on the same day.
Conclusion
The 90837 CPT code covers psychotherapy sessions lasting 60 mins. To use this code, healthcare professionals must document the individual’s psychological state, the reason for the extended session, and their treatment plan. The insurance company and the medical provider’s location determine the payment rates for this code.
You may easily manage the payment by paying attention to details, maintaining consistent paperwork, and staying current on reimbursement rates. With this knowledge, you can confidently tackle the insurance industry and demand just compensation for your commitment to your customers’ mental health.