How to use CPT code 99204
Code 99204 represents a new patient appointment that’s at least 45 minutes in duration.
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How to use CPT code 90833
How to use CPT code 99205
Billing and coding
How to use CPT code 90837
The 90837 CPT code is often understood to be the standard of a therapy session among providers. However, insurers have a tendency to flag 90837 more frequently than other codes.
CPT code 90837 description
Code 90837 represents a 60-minute session of psychotherapy (i.e. talk therapy), with at least 53 minutes of documented face-to-face time.
This is is how the American Medical Association defines 90837 in the official CPT codebook:
Psychotherapy, 60 minutes with patient
Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.
The psychotherapy service codes include ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of informants in the treatment process. These codes describe psychotherapy for the individual patient, although times are for face-to-face services with patient and may include informant(s). The patient must be present for all or a majority of the service.
Your documentation for this code should include all the standard elements of a progress note, including:
- Session details: Including patient name and date of birth on every page, start and stop times, date, and place of service
- Person-centered details
- Patient-centered observations
- Clinical interventions and evidence-based practices used during the session
- Progress towards goals
- Risk assessment
- Clinical path forward
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.
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CPT code 90837 time frame
The 90837 code is directly associated with a length of time: As the “60 minute” code, any session billed with 90837 is required to be at least 53 minutes in duration, as documented by the start and stop times in your progress notes.
The time requirement of the 90837 code should reflect only the face-to-face time spent on therapy, not any of the administrative work related to the session, like writing notes, scheduling future sessions, or collecting payment.
Will I get audited for using 90837?
Insurers are more likely to flag and place scrutiny on the use of 90837 codes. This can result in payment delays, requests for clinical documentation to support use of the 90837, and other confusion for what seems like a typical billing selection.
Ultimately, insurers are looking for evidence that the additional time was needed.
Every insurer is different, but most typically look for the following supporting conditions in 90837 documentation:
- Did the nature of the treatment justify the time length of the session? Insurers might be wondering whether the provider could have offered the same quality of treatment in a shorter session, in which case, 90834 should be used instead.
- Does the nature of the treatment justify the frequency of treatment sessions? Insurers might be questioning whether the client could achieve the same progress with fewer sessions, in which case, a reduced treatment session frequency should be considered. They want to confirm that the frequency of sessions is medically necessary and that no less frequent, equally effective treatment plan could meet the client’s goals and address their symptoms based on their diagnosis.
- Was the treatment rendered medically necessary? Insurers want to verify the care you give is clinically appropriate and that there is no less costly, equally effective service available to meet treatment goals and improve the client’s symptoms as it relates to their diagnosis.
To meet these expectations, your documentation can include more details about the client’s need for additional clinical intervention, as evidenced by:
- Severity of symptoms: Like recent suicidal ideation, traumatic event, etc.
- Acuteness of issues: Such as a recent panic attack, recent loss, etc.
- Diagnosis with modality combination: For example, PTSD with EMDR intervention.
- Chronic conditions impacting functioning: For example, GAD interfering with their health or vocation.
CPT code 90837 reimbursement rates
Reimbursement rates for sessions billed with 90837 will vary depending on the plan, your contract, your location, and your license type.
What’s the difference between 90837, 90834, and 90832?
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.
Billing and coding
How to use CPT code 99204
How to use CPT code 90833
Code 90833 represents an add-on for 16 to 37 minutes of psychotherapy with an E/M code.
How to use CPT code 99205
Code 99205 represents a new patient appointment that’s at least 60 minutes in duration.