Providers: Don’t Leave Money on the Table: Unlock the Potential of CPT Code 90837
Unlocking the Potential of CPT Code 90837:
Everything You Need to Know
CPT codes play a crucial role in medical billing and coding. They are used to describe medical procedures and services provided to patients and help healthcare providers get reimbursed for their services. One of the most important CPT codes for mental health providers is 90837. In this article, we will review the 90837 CPT code description, billing guidelines, reimbursement rates, and more.
Understanding CPT Code 90837
CPT code 90837 is a service code used by therapists to bill for psychotherapy services. It is used when a provider spends 53 minutes or more in a face-to-face session with a patient. The code covers the evaluation, diagnosis, and treatment of mental health disorders, and can be used by psychologists, social workers, and other mental health professionals.
CPT Code 90837 Definition
The official CPT code 90837 definition is “Psychotherapy, 60 minutes with a patient”. It is one of the evaluation and management codes used to describe the time spent by a provider with a patient during an office visit or telemedicine.
Which Providers can use CPT 90837?
Psychiatrists (MD)
Medical doctors (MDs) who specialize in mental health and have completed a residency in psychiatry.
Psychologists (Ph.D. or Psy.D)
Doctoral-level mental health professionals who hold either a Ph.D. (Doctor of Philosophy) or Psy.D (Doctor of Psychology) degree.
Licensed Clinical Social Workers (LCSW)
Master’s-level mental health professionals who have a master’s degree in social work (MSW) and are licensed by their state to provide mental health services.
Licensed Professional Counselors (LPC, LCSW, LMFT)
Master’s-level mental health professionals who have a master’s degree in counseling or a related field and are licensed by their state to provide mental health services.
Nurse Practitioners (NP) and Physician Assistants (PA)
Advanced practice clinicians who have completed a master’s degree or higher in nursing or physician assistant studies, respectively, and are licensed to practice under the supervision of a licensed physician or psychiatrist.
CPT Code 90837 Fee Schedule
The fee schedule or reimbursement for CPT code 90837 varies depending on the insurance company and location. Providers should check with their insurance companies to determine the allowed rate for this code. It is important to note that some insurance companies may not cover CPT code 90837 when billed alone and may require other codes to be billed with it. (Remember there is a difference between the bill rate and what is “allowed” by an insurance carrier).
List of major Healthcare private insurance companies in the US
Aetna (a subsidiary of CVS Health), Beacon Health Options, BCBS, or Blue Cross (Anthem, Inc, Empire BlueCross BlueShield, Carefirst, Health Care Service Corporation, Highmark, Premera, Cambia, Wellmark), Bright Health, Centene Corporation, Cigna or Evernorth Health, Harvard Pilgrim Health CareHealthfirst, Humana, Kaiser Permanente, Meridian Health Services, Molina Healthcare, Oscar Health, Tufts Health Plan, United Healthcare (Optum or UHC), WellCare Health Plans.
Telehealth CPT Codes
Telemedicine has become an increasingly popular way for healthcare providers to connect with patients, especially during the COVID-19 pandemic. Telehealth services are covered by most governmental and private insurance companies, including Cigna, Blue Cross Blue Shield, Aetna, United Healthcare, Medicaid, Medicare, and Tricare. Some popular telemedicine companies include Amwell, Teladoc, SimplePractice, TherapyNest, and TherapyNotes.
CPT Code 90837 Document Requirements
To bill for CPT code 90837, certain documentation requirements must be met. This includes documentation of the patient’s diagnosis, treatment plan, and progress notes. Providers should also include the place of service, the length of time spent with the patient, and any applicable modifiers.
CPT Code 90837 Billing Guidelines
When billing for CPT code 90837, it is essential to follow the billing guidelines set by insurance companies and CMS. Providers should ensure that the code is billed accurately, with the appropriate modifiers and place of service. They should also ensure that the documentation requirements are met and that the code is not being overused or misused.
Frequency usage of service code 90837
According to CMS guidelines, service code 90837 can only be used once per patient per day. Additionally, it is important to note that some insurance companies may have their own restrictions on how often this code can be used. Mental health providers should be aware of these limitations and communicate them clearly to their patients to avoid any confusion or potential billing issues. Overall, while service code 90837 is a useful tool for providers, it is important to use it within the guidelines to ensure proper reimbursement and avoid any issues with insurance companies or government programs.
Length of time for CPT code 90837
According to the American Medical Association (AMA), which publishes the CPT codes, there is no specific time requirement for this code. CPT code 90837 is an individual psychotherapy code. The time range for service code 90837 is 53-60 minutes of face-to-face time with the patient.
What is the difference between 90837 and 90834?
Another common CPT code used for psychotherapy services is 90834. The main difference between 90837 and 90834 is the length of time spent with the patient. CPT code 90834 is used for sessions lasting between 38 and 52 minutes, while CPT code 90837 is used for sessions lasting 53 minutes or more.
CPT Code 90837 is the most underutilized service code, as many counselors down code a 60-minute session and use 90834. This is important to understand the insurance companies that providers are paneled or in-network, to bill insurance accurately for the services that are rendered.
CPT Codes for Psychology (Non-E/M)
90791 – Psychiatric Diagnostic Examination without medical services
90832 – Individual psychotherapy (time range 16 – 37 minutes)
90834 – Individual psychotherapy (time range 38 -52 minutes)
90837 – Individual psychotherapy (time range 53 – 60 minutes) **
*** There is no code for a 75-minute session *** 1
*** There is no code for a 90-minute session ***
90853 – Group therapy
90846 – Family psychotherapy (without the patient present)
90847 – Family psychotherapy (conjoint psychotherapy) (with patient present).
ADDON CODES
+90785 Interactive complexity
+90839 Patient in crisis
+90840 Patient in crisis (each additional 30 minutes)
* 90837 may require special authorization by the individual insurance payer.
** Family visits can consist of spouses, parents and children, patients, and other family
members.
Essential terms for CPT 90837 and the solo private practice.
Credentialed with insurance (paneled with insurance)
Non-credentialed with insurance (non-paneled with insurance)
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a mental health insurance billing service. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing.
By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
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