Proper billing is key in mental health practice to ensure practitioners receive fair reimbursement for their services while remaining compliant with insurance regulations. One of the most frequently utilized billing codes is CPT Code 90837, specific to a particular psychotherapy service. This blog will discuss CPT Code 90837 in detail, including its practical application and uses.

What is CPT Code 90837?

CPT Code 90837 is a term used to describe a type of 60-minute psychotherapy within the Current Procedural Terminology (CPT) system maintained by the American Medical Association (AMA). It deals with problems identified during psychotherapy as emotional, psychological, or behavioral and exceeds 53 minutes.

• Description: Psychotherapy, greater than 53 minutes with patient and/or family member.
• Average Length: Although the code applies to sessions that are at least 53 minutes, most sessions are usually 60 minutes long. Practitioners should not use this code for sessions less than 53 minutes.
• Application: The code is intended for intense therapeutic interventions that treat deep-seated issues like trauma, anxiety disorders, depression, or other mental health issues.

When to Use CPT Code 90837

The CPT Code 90837 will only be used appropriately when a mental health professional ascertains that the session will satisfy the following conditions:

• Duration: The minimum duration is at least 53 minutes. If the session was less than 38-52 minutes, use the CPT Code 90834.
• Service Type: Therapy involves direct face-to-face interaction between the clinician and the patient or family member. A telehealth session would qualify if the payer has agreed to it.
• Medical Reasoning: The consultation must relate to significant psychological distress or intensive therapeutic methods.
  Some common clinical reasons for the use of CPT Code 90837 will include the following:
• Evidence-based trauma treatment such as Eye Movement Desensitization and Reprocessing (EMDR).
• Severe anxiety or depressive Cognitive Behavioral Therapy (CBT).
• Solution-Focused Brief Therapy (SFBT)
• Interpersonal Therapy (IPT)
• Dialectical Behavior Therapy (DBT)
• Mindfulness-based therapies
• Psychodynamic therapy
• Family therapy sessions aimed to enhance relational functioning.

Benefits of using CPT Code 90837

• Fair Compensation: Longer sessions require more time and expertise. Therefore, CPT Code 90837 enables practitioners to be fairly compensated for their extended services.
• Tailor-made Treatment: The extended sessions enable us to explore complex issues in depth and, hence, make meaningful progress in therapy.
• Flexibility: Such a code can be applied to face-to-face and telehealth visits, which makes it more applicable in today’s more digitally oriented-healthcare sector.

Challenges and Considerations

While CPT Code 90837 has its benefits, there are some drawbacks and best practices to note as well:
Insurance Scrutiny: Payers are also likely to scrutinize the use 90837 due to its higher reimbursement rate. Be prepared to document the necessity of the session extensively.

• Include extensive notes about the patient’s condition, the therapeutic methods employed, and the outcomes achieved.
• Session Timing: Ensure sessions meet the minimum time requirement of 53 minutes. Sessions shorter than this may lead to claim denials or audits.
• Pre-authorization: Some insurance plans require pre-authorization for using CPT Code 90837. Verify coverage before scheduling extended sessions.

Documentation Best Practices

Accurate and comprehensive documentation is key to using CPT Code 90837. Here are some tips:

• Record the exact duration of the session in your notes.
• Clear justification for the extended session, including the patient’s presenting issues and progress toward treatment goals.
• Emphasis on the therapeutic techniques applied and their relevance to the needs of the patient

Applying CPT Code 90837 for Telehealth

The CPT Code 90837 has become necessary in telehealth, considering that virtual therapy sessions have increased. For telehealth, it is essential to consider the following when billing:

• Use the telehealth modifier according to the payer’s requirements; it could be either 95 or GT.
• Ascertain telehealth services coverage within a patient’s plan
• Implement HIPAA-compliant virtual session venues.

Streamlining CPT Code 90837 with Medatron

Medatron enables seamless utilization of CPT Code 90837 by integrating this mental health CPT code to automatically track and maintain all session details. The system ensures tracking of the exact duration of the session, assists with clear and concise treatment note generation, and provides templates to allow for easier documentation that can lead to easier justification of lengthy therapy sessions. Medatron also interfaces with insurance databases whereby practitioners can check coverage and submit claims directly through the system, reducing administration and minimizing errors. This holistic approach increases the accuracy of bills and enhances the workflow by ensuring timely reimbursements and a more seamless experience for providers and patients.

Let us handle your medical billing for CPT Code 90837 so you can focus on your patients while we ensure accurate and timely reimbursements.

Conclusion

CPT Code 90837 is essential for mental health professionals who provide additional psychotherapy sessions. By knowing their requirements, benefits, and challenges, practitioners are better prepared to maximize reimbursement while delivering quality care. Good documentation and following the payer policies ensure that the claims are not denied.
As a mental health provider, you should know billing codes like 90837 so your practice runs efficiently. For further information, you can get help from billing specialists like Medatron, who have information on mental health billing.
Using CPT Code 90837 correctly will help you manage your practice efficiently and comprehensively for your patients.