Billing and coding

How to use CPT code 90785 for interactive complexity

Text on an abstract background reads "90785"

CPT code 90785 is an add-on code used to reflect communication difficulties during a psychiatric procedure, such as a psychotherapy session.

As essential as CPT codes are for billing, they can also be confusing. One common source of confusion is CPT code 90785, which reflects “interactive complexity” in a session. Read on to learn more about CPT code 90785, and how you should (and shouldn’t) be using it when filing claims for therapy sessions.

CPT code 90785 description

CPT code 90785 is an add-on code used to reflect communication difficulties during a psychiatric procedure, such as a psychotherapy session. It’s always used in conjunction with another CPT code, and never alone. For example, you may add a 90785 code when you’re billing for 50 minutes of psychotherapy that was more challenging or complex — not longer — due to communication issues during that session. 

According to Nadine Thomas, Headway’s provider operations lead, a psychotherapist with any license type can bill this code. “But it only applies to psychotherapy, not group or crisis psychotherapy,” she says. In addition, psychiatrists and nurse practitioners can only use the interactive complexity code when they’re actually conducting psychotherapy.

It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code. 

What is “interactive complexity”?

Interactive complexity refers to communication difficulties during a psychotherapy session. Interactive complexity may occur with clients who:

  • Are minors or adults who have other people legally responsible for their care
  • Request others to be involved in their care, such as adults with other family members or a language interpreter
  • Need a third party, such as social services, parole officers, or schools to be involved
  • Have psychiatric symptoms that interfere with their ability to communicate effectively, such as severe anxiety or reactivity
  • Have caregivers whose communication complicates the session
  • Reveal information you’re required to report to a third party
  • Using physical equipment or play equipment to assist with communication, such as during play therapy

When NOT to use 90785

It can be confusing to determine whether you should or shouldn’t use code 90785. Keep in mind a few key scenarios in which interactive complexity isn’t the right code. Given the definition of “interactive complexity,” a viable communication difficulty must be present to add 90785 to a claim. 

According to Thomas, seeing a client through telehealth — while it may indeed add a layer of complexity to your session — isn’t enough justification to bill code 90785. Additionally, it’s not required (or even valid) when the patient brings another person to therapy, but the communication doesn’t present any extra complexity. 

The 90785 code cannot be used along with the following codes: 

The American Academy of Child and Adolescent Psychiatry also offers helpful guidance on when reporting interactive complexity isn’t appropriate: 

  • Multiple participants in the visit with straightforward communication
  • Client attends visit individually with no sentinel event or language barriers
  • Treatment plan explained during the visit and understood without significant interference by caretaker emotions or behaviors

CPT code 90785 reimbursement rates

There’s no one, set reimbursement rate for interactive complexity codes. Reimbursement rates for sessions billed with 90785 will ultimately vary depending on the insurance plan, your contract, your location, and your license type.

Find out your rates with Headway

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.

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