Introduction
Understanding the intricate world of mental health billing is crucial for therapists and providers to ensure accurate reimbursement and smooth claims processing. Here, we explore the top 5 CPT codes in mental health billing, providing a detailed breakdown of each code, its essential billing tips, and key considerations for compliant and efficient billing.
Top 5 CPT Codes in Mental Health Billing
1. CPT Code 90837: Psychotherapy, 60 minutes
This code signifies individual therapy sessions lasting 53 minutes or longer, encompassing insight-oriented, behavior-modifying, and/or supportive approaches. In progress notes, document session duration, interventions, and treatment plan goals. When family members are involved, utilize specific code modifiers (-96, -97) and submit detailed clinical documentation demonstrating medical necessity. Remember, billing for less than 53 minutes under this code or submitting vague documentation can lead to claim denials. Ensure informed consent is obtained for treatment and billing practices.
2. CPT Code 90834: Psychotherapy, 45 minutes
Similar to 90837, this code represents individual therapy sessions, but within a 38-52 minute timeframe. Adhere to the same documentation requirements as the former code, ensuring accurate session duration and modifier usage for family involvement. Before billing for 45-minute sessions, verify insurance coverage and authorization to avoid claim rejections.
3. 90791: Psychiatric diagnostic evaluation without medical services
This code specifically targets comprehensive psychiatric evaluations conducted without accompanying medical care. Ensure the evaluation is performed by a qualified psychiatrist and meticulously documented, including history, mental status examination, diagnosis, and treatment recommendations. Submit detailed clinical notes that justify the medical necessity of the evaluation. Remember, billing for this code when medical services are offered during the evaluation is incorrect. Additionally, incomplete documentation or neglecting to address confidentiality concerns with the patient can cause claim denials.
4. 90847: Family psychotherapy (with client present), 50 minutes
This code covers family therapy sessions where the client actively participates for 50 minutes. Identify family members involved and their roles in the session. Consistently use the -96 modifier to indicate the client’s presence and prioritize documentation focused on family interaction and interventions used. Billing for family therapy without the client’s participation or omitting the -96 modifier are common pitfalls to avoid.
5. 90853: Group psychotherapy (other than of a multiple-family group)
This code represents group therapy sessions, excluding family groups, of any duration: document group composition, size, and treatment interventions. Utilize appropriate modifiers for partial participation (-52) or leader-only sessions. Maintain detailed records of each patient’s progress within the group context, but remember that billing for individual therapy under this code is incorrect. Neglecting to document individual patient progress within the group setting can also lead to claim rejections.
By understanding these 5 CPT codes in mental health and adhering to the crucial billing tips mentioned above, therapists and providers can navigate mental health billing with confidence, ensuring smooth claim processing and optimal reimbursement for their services. Staying informed about billing updates and specific payer requirements is crucial for continued compliance and efficiency.
About Medisys Data Solutions (MDS)
Mental health providers, juggling patient care and paperwork, often find themselves overwhelmed by the complexities of accurate coding. Medisys can be your trusted partner in navigating this challenging landscape. Our team of certified coders, specifically trained in mental health billing, meticulously analyze your detailed clinical notes and apply the most appropriate CPT codes for each service you provide. With Medisys by your side, you can rest assured that your services are coded accurately and efficiently, maximizing your revenue.
Contact Medisys at 888-720-8884 / info@medisysdata.com and let us handle the mental health coding burden, so you can get back to what you do best.
References:
Psychotherapy codes for psychologists – APA Services
CPT® 90837, Under Psychotherapy Services and Procedures
*This article uses Current Procedural Terminology (CPT) codes, copyright 2024 by the American Medical Association.
All rights reserved. CPT is a registered trademark of the American Medical Association.
