Medical Billing Terms C: What Is a CPT Code? Home Visit, Crisis and Credentialing Terms

A CPT code is a five-character code that describes a medical, behavioral or diagnostic service for billing. This page defines the CPT code and the terms from CPT 99344 to crossover claim, including CPT 99417, crisis psychotherapy, credentialing and credit balance. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms C: What Is a CPT Code - MCM South Medical Billing Service, LLC

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On this page (23 terms)

CPT 99344
CPT 99345
CPT 99347
CPT 99348
CPT 99349
CPT 99350
CPT 99408
CPT 99409
CPT 99417
CPT Assistant
CPT Code
CPT Code Descriptor
CPT Editorial Panel
Credentialing
Credentialing Application Status
Credentialing Committee
Credentialing Software
Credentialing Turnaround
CredentialMyDoc
Credible
Credit Balance
Crisis Psychotherapy (90839 / 90840)
Crossover Claim

How to use these What Is a CPT Code definitions

Use this page as a quick reference for What Is a CPT Code, from CPT 99344 to Crossover Claim. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm What Is a CPT Code details with the payer before you bill.

Checklist: put the what is a cpt code definitions to work

Check the "what is a cpt code" entries above before you send a claim that depends on them.
Share this "what is a cpt code" page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions "what is a cpt code", find the matching entry and note the date you checked it.
Keep your "what is a cpt code" notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies "what is a cpt code" before you change a workflow.
Train new staff on "what is a cpt code" first, then move on to the rest of the glossary.
Log any "what is a cpt code" question that comes up twice, then add the answer to your billing procedures.
Use the source links under the "what is a cpt code" entries to confirm the current rule.
Print the "what is a cpt code" entries you use most and keep them at the billing desk.
Review your "what is a cpt code" notes each quarter, because payer and CMS rules change.
Mark where "what is a cpt code" work differently for psychotherapists and for psychiatrists in your own procedures.

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CPT 99344

General (all payers)

Also called 99344; new patient home or residence visit moderate complexity

Definition: CPT 99344 is a home or residence visit for a new patient with a moderate level of medical decision making. One published summary shows the time as 60 minutes or more.
Why it matters: Document either the moderate MDM or the total time. Do not count travel time.
Illustrative example: A prescriber evaluates a new home-based patient with several active problems and bills 99344.

Reference sourceSTFM Practice Management Handbook, Home or Residence Visits UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT 99345

General (all payers)

Also called 99345; new patient home or residence visit high complexity

Definition: CPT 99345 is a home or residence visit for a new patient with a high level of medical decision making. One published summary shows the time as 75 minutes or more.
Why it matters: It is the top new-patient home level. Medicare's prolonged home add-on, G0318, is reported with it when Medicare's own threshold is met.
Illustrative example: A prescriber sees a new home-based patient in a psychiatric crisis with complex risks and bills 99345.

Reference sourceSTFM Practice Management Handbook, Home or Residence Visits UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT 99347

General (all payers)

Also called 99347; established patient home or residence visit straightforward

Definition: CPT 99347 is a home or residence visit for an established patient with straightforward medical decision making. One published summary shows the time as 20 minutes or more.
Why it matters: Use the place of service that matches where the patient lives or is seen. Do not count travel time.
Illustrative example: A prescriber checks in on a stable home-based patient and bills 99347.

Reference sourceSTFM Practice Management Handbook, Home or Residence Visits UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT 99348

General (all payers)

Also called 99348; established patient home or residence visit low complexity

Definition: CPT 99348 is a home or residence visit for an established patient with a low level of medical decision making. One published summary shows the time as 30 minutes or more.
Why it matters: Level the visit by MDM or time. Document the location so the place of service is correct.
Illustrative example: A prescriber reviews a home-based patient's medication and side effects and bills 99348.

Reference sourceSTFM Practice Management Handbook, Home or Residence Visits UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT 99349

General (all payers)

Also called 99349; established patient home or residence visit moderate complexity

Definition: CPT 99349 is a home or residence visit for an established patient with a moderate level of medical decision making. One published summary shows the time as 40 minutes or more.
Why it matters: Support the level with the MDM elements or with documented time. Do not count travel time.
Illustrative example: A prescriber changes medication for a home-based patient with two active conditions and bills 99349.

Reference sourceSTFM Practice Management Handbook, Home or Residence Visits UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT 99350

General (all payers)

Also called 99350; established patient home or residence visit high complexity

Definition: CPT 99350 is a home or residence visit for an established patient with a high level of medical decision making. One published summary shows the time as 60 minutes or more.
Why it matters: It is the top established-patient home level. Medicare's prolonged home add-on, G0318, is reported with it when Medicare's own threshold is met.
Illustrative example: A prescriber manages a home-based patient after a crisis with complex risks and bills 99350.

Reference sourceSTFM Practice Management Handbook, Home or Residence Visits UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT 99408

General (all payers)

Also called 99408; SBIRT 15 to 30 minutes

Definition: CPT 99408 is alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services, 15 to 30 minutes. SBIRT stands for screening, brief intervention, and referral to treatment.
Why it matters: Many commercial payers and Medicaid programs use the CPT codes while Medicare uses G0396. Confirm the correct code and any diagnosis or provider limits.
Illustrative example: A commercial payer accepts 99408 for a 25-minute structured brief intervention.

Reference sourceAmerican Medical Association (AMA)SAMHSAchecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Behavioral Health Specific Terms

CPT 99409

General (all payers)

Also called 99409; SBIRT 30 minutes or more

Definition: CPT 99409 is alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services of more than 30 minutes.
Why it matters: Document the tool, the intervention, and the total time. Confirm coverage with each payer.
Illustrative example: A 40-minute SBIRT session is billed 99409 to a payer that follows CPT.

Reference sourceAmerican Medical Association (AMA)SAMHSAchecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Behavioral Health Specific Terms

CPT 99417

General (all payers)

Also called +99417; prolonged outpatient E/M service

Definition: CPT +99417 is a prolonged outpatient E/M add-on for extra time beyond the top of the E/M time range, used mostly with commercial payers and Medicaid. Medicare uses its own HCPCS add-on code instead.
Why it matters: Medicare has its own prolonged-service thresholds, so 99417 is not the code to send to Medicare. Confirm each payer's rule and threshold.
Illustrative example: A commercial plan pays 99417 with a level 5 E/M when total time exceeds the payer's threshold.

Reference sourceUTHealth Houston, 2023 Home or Residence Services STFM Practice Management Handbook, Home or Residence Visitschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code Entries Claims Processing

CPT Assistant

General (all payers)

Also called AMA CPT Assistant; CPT Assistant newsletter

Definition: CPT Assistant is an AMA publication that gives coding guidance and examples for CPT codes.
Why it matters: Coders and auditors cite it for guidance on how to apply a code. It is guidance, not law, and payers may have their own policies.
Illustrative example: A coder checks CPT Assistant to decide how to report a psychotherapy add-on.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing

CPT Code

General (all payers)

Also called CPT; Current Procedural Terminology

Definition: A five-character code set, published and copyrighted by the AMA, that describes medical, surgical, and diagnostic services and procedures.
Why it matters: CPT codes tell the payer what service was delivered and how much to pay.
Illustrative example: A therapist bills 90837 for a 60-minute session.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing Behavioral Health Specific Terms

CPT Code Descriptor

General (all payers)

Also called CPT descriptor; code descriptor; CPT code definition; AMA descriptor

Definition: A CPT code descriptor is the AMA's official wording that defines what a code represents. It includes the service, and often the time or the level of medical decision making.
Why it matters: Bill by the descriptor, not by a nickname. If the service you provided does not match the descriptor, choose a different code.
Illustrative example: A biller reads the 90837 descriptor to confirm the session met the time required.

Reference sourceAMA, CPT code set overviewchecked 10/9/26

CategoriesClaims Processing

CPT Editorial Panel

General (all payers)

Also called AMA CPT Editorial Panel; CPT panel

Definition: The CPT Editorial Panel is an independent group of clinical expert volunteers, appointed by the AMA Board of Trustees, that oversees the development and maintenance of the CPT code set. It meets three times a year to review applications for new or revised codes.
Why it matters: New psychotherapy or E/M codes and descriptor changes come through this panel. The AMA publishes updates for each year, and payers adopt them on their own schedules.
Illustrative example: A specialty society applies to the panel for a new digital mental health code.

Reference sourceAMA, CPT Editorial Panel and code approval AMA, CPT code set overviewchecked 10/9/26

CategoriesClaims Processing Audits & Compliance

Credentialing

General (all payers)

Also called provider credentialing; insurance credentialing; payer credentialing

Definition: The process a payer uses to verify a clinician's license, education, training, work history, and standing before allowing that clinician to join its network.
Why it matters: A clinician who is not credentialed cannot bill in-network, and claims for services before the effective date are often denied or paid at out-of-network rates.
Illustrative example: A newly licensed therapist submits an application to a payer and waits for the credentialing decision before booking that payer's members as in-network.

Reference sourceNCQA DataSpring (formerly CAQH)checked 10/9/26

CategoriesCredentialing & Enrollment

Credentialing Application Status

General (all payers)

Also called application pending; pending credentialing

Definition: The stage of a payer's review, such as received, in process, pending committee, approved, or denied.
Why it matters: Tracking status prevents duplicate submissions and missed follow-ups.
Illustrative example: A payer portal shows 'pending committee' for a submitted file.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment

Credentialing Committee

General (all payers)

Also called peer review committee; credentials committee

Definition: The panel of a payer or health plan that reviews completed applications and votes to approve or deny network participation.
Why it matters: The committee's meeting schedule can add weeks that the practice cannot speed up.
Illustrative example: A completed application waits for the payer's next scheduled committee review.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment

Credentialing Software

General (all payers)

Also called credentialing platform; provider data management software

Definition: Software that stores provider documents, tracks expirations, and manages payer enrollment tasks.
Why it matters: Reduces missed expirations but does not replace payer decisions.
Illustrative example: A group uses software to alert them 90 days before a license expires.

Reference sourceDataSpring (formerly CAQH)checked 10/9/26

CategoriesCredentialing & Enrollment EHR & Healthcare Technology Terms

Credentialing Turnaround

General (all payers)

Also called credentialing timeline

Definition: The elapsed time from a complete application to a payer's decision. It varies by payer, state, and file completeness.
Why it matters: Sets expectations for when a new clinician can see that payer's members in-network.
Illustrative example: Describe the steps of the process instead of quoting a number of days.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment

CredentialMyDoc

General (all payers)

Also called CredentialMyDoc software

Definition: A vendor offering credentialing and provider enrollment tools. Naming a vendor here is not an endorsement or partnership.
Why it matters: Part of the credentialing technology landscape.
Illustrative example: A group evaluates credentialing software vendors.

Reference sourceCredentialMyDocchecked 10/9/26

CategoriesCredentialing & Enrollment EHR & Healthcare Technology Terms

Credible

General (all payers)

Also called Credible Behavioral Health; Qualifacts

Definition: A vendor of behavioral health EHR and practice management software that merged with Qualifacts. Listed for reference; not an endorsement or partnership.
Why it matters: Used by community and residential providers.
Illustrative example: A residential program bills through Credible.

Reference sourceCredible (Qualifacts)checked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Credit Balance

General (all payers)

Also called provider credit balance; refund due to patient

Definition: A negative account balance created when payments exceed charges, which may be owed back to a patient or payer.
Why it matters: Credit balances can create unclaimed property and compliance issues if not resolved.
Illustrative example: A patient overpays and the practice refunds the excess.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPayment & Reimbursement Patient Financial Responsibility Terms

Crisis Psychotherapy (90839 / 90840)

General (all payers)

Also called 90839; 90840; crisis therapy

Definition: CPT codes for psychotherapy for crisis: 90839 for the first 60 minutes and +90840 as an add-on for each additional 30 minutes.
Why it matters: Payer time thresholds differ, so verify before billing.
Illustrative example: A therapist bills 90839 for a crisis session under payer rules.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing Behavioral Health Specific Terms

Crossover Claim

General (all payers)

Also called Medicare crossover; automatic crossover

Definition: A claim that Medicare automatically forwards to a secondary payer, such as a Medicaid or supplemental plan, after processing.
Why it matters: Explains why some secondary claims do not need separate submission, and why some do.
Illustrative example: A dual-eligible patient's claim crosses over to Medicaid after Medicare pays.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing Medicare & Medicaid Terms

Quick answer: What Is a CPT Code

What is a CPT code?

CPT Code is a five-character code set, published and copyrighted by the AMA, that describes medical, surgical, and diagnostic services and procedures. CPT codes tell the payer what service was delivered and how much to pay.

Frequently asked questions: What Is a CPT Code

What is CPT 99417?

CPT +99417 is a prolonged outpatient E/M add-on for extra time beyond the top of the E/M time range, used mostly with commercial payers and Medicaid. Medicare uses its own HCPCS add-on code instead. Medicare has its own prolonged-service thresholds, so 99417 is not the code to send to Medicare.

What is a credit balance?

Credit Balance is a negative account balance created when payments exceed charges, which may be owed back to a patient or payer. Credit balances can create unclaimed property and compliance issues if not resolved.

How is crisis psychotherapy billed?

CPT codes for psychotherapy for crisis: 90839 for the first 60 minutes and +90840 as an add-on for each additional 30 minutes. Payer time thresholds differ, so verify before billing.

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