Psychotherapy Codes

Accurate coding is essential for ensuring proper reimbursement and minimizing denials, especially regarding time-based psychotherapy CPT codes. As of 2023, prolonged service codes 99354 and 99355 have been deleted, and 99417 cannot be used with psychotherapy. Psychotherapy must now be reported as a single daily unit, even for longer sessions. This post will clarify the current CPT rules, address common billing misconceptions, and offer guidance to help physicians and behavioral health providers stay compliant.

Psychiatry and Psychology Services – Proper Use of Psychotherapy CPT Codes

Individual psychotherapy CPT codes (e.g., 90832, 90834, 90837) should be explicitly reserved for situations where individual psychotherapy is the primary service. These codes should not be used as a catch-all for other psychiatric services, such as evaluation and management (E/M) services or pharmacological interventions requiring different codes.

Regarding family psychotherapy, CPT codes 90846 and 90847 are used under specific conditions. Family psychotherapy is covered only when the goal is to treat the patient’s condition, particularly in cases where the treatment involves observing and correcting family dynamics that directly affect the patient’s mental health. For example, CPT 90847 applies when the patient is present, and 90846 is used for situations where the patient is not present but their condition impacts the family.

It’s important to note that multiple-family group psychotherapy (CPT 90849) is generally not covered by Medicare, as it does not meet the requirement of being a personal service for the patient. This code may be approved on a case-by-case basis, as determined by individual consideration.

Qualified healthcare professionals must always provide psychiatric services in compliance with Medicare and other insurance guidelines, ensuring the treatment is appropriately documented and the correct codes are used.

Understanding Individual Psychotherapy CPT Codes

There are two sets of CPT codes used to report individual psychotherapy, depending on whether psychotherapy is provided alone or in combination with medication management.

Standalone Psychotherapy Codes

Codes: 90832, 90834, 90837

These codes are used when psychotherapy is the only service provided during the visit. While psychologists, social workers, and other behavioral health professionals commonly report these codes, psychiatrists, psychiatric nurse practitioners (NPs), and physician assistants (PAs) can also report them, as long as medication management is not performed at the same encounter.

• These are time-based codes, and
• They follow the CPT mid-point rule, meaning:
  • For a 30-minute code, at least 16 minutes of therapy must be performed to report the service.
• The codes do not differentiate based on the type or location of psychotherapy.

Psychotherapy with Medication Management (Add-On Codes)

Codes: +90833, +90836, +90838

These add-on codes (indicated by a plus sign) are used in combination with an E/M service when both psychotherapy and medication management are provided on the same day.

• These can be reported only by psychiatrists, psychiatric NPs, and psychiatric PAs.
• They are not reported independently; they must be attached to a primary E/M service.

When to Use Individual Psychotherapy Codes

According to the CPT definition, 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 emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.”

Use individual psychotherapy codes when the primary focus is on the patient’s mental health, even if a family member or significant other is present for part or all of the session.

When to Use Family Therapy Codes

If the focus of the intervention is the relationship itself or the family dynamics, rather than the individual’s mental health, report the appropriate family therapy code instead. This distinction is essential for ensuring accurate documentation and reimbursement.

Documenting Time for Individual Psychotherapy

Question:
Can the time range in the selected code (for example, 90832: Psychotherapy 16-37 minutes) be used as documentation for the session duration?

Answer:
No, that is not sufficient. The therapist must document the actual time spent in the session. Simply selecting a code that includes a time range does not confirm or validate the time provided to the patient.

When psychotherapy is the only service provided during a visit, CPT guidelines do not require start and stop times, only the total time spent. However, documentation standards can vary:

• Always include the actual time spent providing psychotherapy in the clinical note.
• Do not use the scheduled appointment time; only document the actual time provided.
• Some payers may require start and stop times, so checking individual payer policies for compliance is essential.

Even if the correct code is selected based on time, the documentation must support that time to avoid denials or audits.

Individualized Treatment Plans and Goal Setting

To support ongoing psychotherapy, beyond just a few sessions, most Medicare contractors and private payers require a documented, individualized treatment plan. This plan should outline:

• The type of therapy being provided
• The frequency and duration of sessions
• The anticipated treatment goals

For Medicare patients, there must be a clear expectation that the patient will either improve or that therapy will help prevent deterioration or hospitalization for the service to be considered medically necessary.

While traditional Medicare does not set strict limits on the length of therapy, many managed Medicare, Medicaid, and commercial plans do. To stay compliant:

• Review treatment goals periodically with the patient
• Document progress and update goals as needed
• For long-term therapy, a quarterly update is generally considered reasonable

Note: Some payers may require pre-authorization for extended session codes 90837 and 90838 (60 minutes or more), so verify requirements in advance.

Add-On Psychotherapy Codes (When Performed with Medication Management)

These codes are reported when psychotherapy is provided on the same day as an E/M service:

• +90833: Use when psychotherapy is provided for 16 to 37 minutes
• +90836: Use when psychotherapy is provided for 38 to 52 minutes
• +90838: Use when psychotherapy is provided for 53 minutes or more
• May require pre-authorization from some payers

Standalone Psychotherapy Codes (No Medication Management on Same Day)

These codes are used when psychotherapy is the only service provided:

• 90832: Use when psychotherapy is provided for 16 to 37 minutes
• 90834: Use when psychotherapy is provided for 38 to 52 minutes
• 90837: Use when psychotherapy is provided for 53 minutes or more
• May require pre-authorization from some payers

Family and Group Therapy Codes

Family and group therapy services play a distinct role in behavioral health treatment and require accurate coding and documentation to ensure compliance and reimbursement.

Group Therapy - 90853

• Reported with CPT code 90853
• Not time-based: one unit is reported per patient, regardless of session length
• Typical session length is 45 to 50 minutes
• Some payers limit group size to 12 participants
• Many insurers require documentation of group size in each patient’s record
• Group documentation must include:
  • A summary of the group’s goals and objectives for the session (can be shared across records)
  • Individual notes on each patient’s participation, engagement, and response

Family Therapy

• 90846: Family psychotherapy without the patient present (50 minutes)
  • This code is restricted under Medicare
  • Coverage and payment depend on individual payer policies
• 90847: Family psychotherapy with the patient present (50 minutes)
  • This is an active Medicare code
  • Documentation must include:
    • Names and roles of individuals present
    • Observations of interactions
    • The therapeutic focus of the session

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