How to use CPT code 90833
Code 90833 represents an add-on for 16 to 37 minutes of psychotherapy with an E/M code.
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How to use CPT code 90838
How to use CPT code 99204
Billing and coding
How to use CPT code 99205
Code 99205 represents a new patient appointment that’s at least 60 minutes in duration.
The 99205 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
CPT code 99205 description
Code 99205 represents a new patient appointment that’s at least 60 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99205 in the official CPT codebook:
CPT code 99205: New patient office visit, minimum 60 minutes
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
As a prescriber, you can bill insurance according to time or medical decision-making (MDM). Make sure to include sufficient documentation to support the method you choose.
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.
99205 vs 99215: New patient vs. existing patient
If you’re treating an existing patient, you should use 99215 instead. A new patient is someone you have not seen in the last three years.
CPT code 99205 time frame
CPT code 99205 documentation
Documentation for 99205 is essentially the same as other E/M codes, but geared toward a new patient.
- Medically appropriate history: Document relevant information about the patient’s presenting complaint, medical history, and any other important factors.
- Medically appropriate examination: Perform and document an evaluation that’s appropriate for the patient’s presenting complaint.
- High complexity medical decision making: Make a judgment about the patient’s diagnosis, create a care plan, and prescribe appropriate treatments or interventions. You can find a full table of levels and elements of MDM here.
- If you are billing based on time, include start/stop timers.
In the example note below, the following factors are present, making 99205 the best code for billing the session:
- A high number and complexity of problems
- A chronic illness
- A high risk of suicidal ideation
Patient Name: Ravi Desai
Date of Service: 03/27/2023
Patient DOB: 11/27/1973
Appointment Time: 8:30am-9:30am
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
The total time I spent caring for this patient today was 73 minutes which included: interviewing the client, documenting, reviewing the patient's responses to questionnaires, discussing treatment plans, coordinating care, prescription management and counseling the client on managing her mental health.
Subjective
Chief Complaint: Patient presents with severe anxiety, depression, and insomnia, expressing active suicidal ideation with a specific plan.
HPI: 50-year-old male with a history of major depressive disorder presents with worsening symptoms over the last 6 months. Reports frequent crying spells, loss of appetite, and insomnia. The patient states that he feels hopeless and has had frequent suicidal thoughts, including an active plan for overdose. Severe anxiety has led to avoidance of social situations and inability to work. He has had passive suicidal ideation in the past but recently formulated a plan, which increases the immediate risk.
General: Significant weight loss of 10 pounds in the past 3 months.
Neurological: Difficulty concentrating, no tremors.
Psychiatric: Depression, anxiety, and insomnia.
PMH/PSH:
Past medical history: Major Depressive Disorder, previously treated with Sertraline.
Past surgical history: None.
Medications: No current medications.
Objective
Allergies: No known drug allergies.
Substance Use Assessment: Denies tobacco and drug use, occasional alcohol use.
MSE:
- Appearance: Disheveled, tearful.
- Behavior: Agitated and restless, but cooperative.
- Speech: Pressured, slightly incoherent at times.
- Mood: Depressed, hopeless.
- Affect: Flat, blunted.
- Thought Process: Disorganized, tangential thinking.
- Thought Content: Expresses suicidal ideation with a specific plan (overdose). Denies AVH.
- Cognition: Oriented to person, place, and time, though struggles with concentration.
- Insight/Judgment: Poor insight, judgment significantly impaired due to current mental state.
Assessment
Diagnosis:
- Major Depressive Disorder (severe)
- Generalized Anxiety Disorder
Plan
- Medication: Initiate treatment with Escitalopram 10 mg daily and Zolpidem 5 mg for sleep as needed.
- Safety Plan: Discussed the creation of an SI safety plan. Provided a crisis hotline and advised having support available. The patient denies current intent to act on plan. They agreed to utilize the safety plan, call hotline, or go to nearest hospital should thoughts increase. Referral: Immediate referral to inpatient behavioral health facility for evaluation and potential admission due to active suicidal ideation with a specific plan.
- Follow-Up: Urgent follow-up within 24 hours to monitor the patient’s safety and treatment adherence.
PDMP Check:
The state’s PDMP was reviewed as required, and no concerning prescriptions were identified.
Risks and Benefits of Medication Adherence: The patient was thoroughly counseled on the risks and benefits of adhering to the prescribed medications, including the importance of regular use and potential side effects.
Risk: High risk due to active suicidal ideation with a specific plan and severe functional impairment.
Time spent: 60 minutes face-to-face.
Electronically signed by:
[Provider name, Credentials, Date signed]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Rationale and How the CPT Codes Were Selected:
- Number and Complexity of Problems Addressed: High, 2 chronic illness with severe exacerbation
- Data Reviewed/Analyzed: none
- Risk: High, referral to inpatient facility for evaluation and possible admission
Rationale: The client displays High number & complexity of problems with one chronic illness with severe exacerbation, No data reviewed, and High risk for current SI with plan and referral to inpatient/higher level-of-care.
Level of MDM: High
CPT Codes Selected: 99205
CPT code 99205 reimbursement rates
Reimbursement rates for sessions billed with 99205 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
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 90833
How to use CPT code 90838
Code 90838 represents an add-on for at least 53 minutes of psychotherapy with an E/M code.
How to use CPT code 99204
Code 99204 represents a new patient appointment that’s at least 45 minutes in duration.