When CPT codes for psychotherapy were revised in 2017, it became possible to bill for longer therapy sessions. The one being addressed in this blog, is 90837, which is 53 minutes or more. Many of us spend 55 to 60 minutes with clients anyway because for many clients, the additional 10 -15 minutes makes a huge difference in what clients get out of their sessions. Now it’s possible to get paid for that time.
Reimbursement rate for 90837: Though it is not allowed to give the actual amount of payment by an insurance company because doing so violates the Sherman Antitrust Law, it is safe to say that payment is up to $30 more than what is paid for 90834. Not billing for the time you spend leaves a lot of money on the table.
Will all insurance companies accept or pay 90837? Insurance companies have been reluctant to pay for 90837 and slow to get on board so it is best to check with the company. But BCBS does honor this code and so do many other insurance companies. According to Care Paths, the denial rate for BCBS in 2017 was 1.29%, which is a down from 3 to 4% in 2013 and 2015. Denial rates for Medicare and Medicaid are higher but have also come down. Current 90837 denial rates for Medicaid is 5.9% and for Medicare it’s 4.12%.
Will the use of 90837 trigger an audit? It should not. But again, to be on the safe side double check with your client’s insurance company for their policy or discuss it with your biller, if you use one. This person should know.
Can I use 90837 for all my sessions? Theoretically, yes. But practically, no. The CPT code is based on face-to-face time, meaning you can only bill for the time actually spent with the client. If the client is late, you need to bill at 90834 (38 – 52 minutes). Otherwise, you risk insurance fraud.
Is there specific documentation required when using 90837? According to BCBS, using 90837 “cannot be for the convenience of the provider.” This means, though specific documentation is not required, play it safe by including justification on your progress note.
For example, let’s say:
- your client has an Adjustment D.O: “90837 is medically necessary to sort through complicated issues related to (what client is adjusting to) and clinical presentation.”
- your client may have a trauma history: “90837 is medically necessary because significant trauma hx necessitates taking time to create safe space for disclosure and then containment.”
- Or: “90837 is medically necessary to address complicated diagnosis and clinical presentation.”
- One of my Medicare clients is a lovely and highly intelligent and high functioning 72 year old gentleman who has few contacts outside his family and a LOT to process as he is makes sense of his life’s decisions, which, according to developmental theory, is exactly what he’s supposed to be doing at this stage of his life. For him, I write, “90837 is medically necessary because client has no friends with which to sort through complicated life issues. Having more social contacts is one of the goals but is taking a long time to achieve.”
Once you start thinking this way, you will be able to come up with the rationale that fits your client.
The bottom line is that it is possible to earn substantially more money by either spending a little more time with the client — or by getting paid for the time you already spend.
This is one of many tips I give in my training, “Misery or Mastery; Documenting Medical Necessity for Psychotherapists.”
Beth,
Thanks for this helpful article.
Question: I have an unstable patient requiring 90 minute psychotherapy sessions twice a week. I am an out of network provider for his insurance plan (Blue Cross). Since the max time allowed for psychotherapy session is 60 min (90837), what code(s) and/or modifiers would I use to identify the longer sessions?
Thanks
Hi David,
Thanks for your question.
Even though billing and clinical documentation are related, I’m not an expert in billing, which draws on a knowledge base that is so different than the clinical side, it has it’s own certification course! I’ve only used the ad-on emergency code one time and didn’t remember what I did, so I contacted my biller who reminded me.
Use 90839 (NOT 90837) for the 1st hour and then 90840 for each additional 30 minutes.
Here’s why: 90837 is used for sessions that are 53 minutes or MORE, meaning unlimited. So you want to use 90839 for the first hour and 90840 for every 30 minutes after that.
These codes should be used sparingly, not for each session and definitely not for 2 sessions each week because these codes are, by definition, used for emergencies. Repeated usage will draw attention you don’t want. Reserve the emergency sessions for when the client is suicidal, in high distress and/or under complex or life-threatening circumstances that demand immediate attention. It is also important to document why the use of this set of codes is important or medically necessary. Write a session note for 90839 and one for each 90840.
Given your particular client, you may want to be try the proactive approach and call the insurance company. See if you can get extended sessions pre-approved. If you don’t, your client could be responsible to pay for them. Or get three weekly sessions approved without extended sessions. If you insurance company will not pay for extended sessions or multiple sessions per week, you may consider having a conversation with the client about cost sharing. Insurance pays for the 1st 53 minutes and the client pays for anything over that.
I hope this is helpful. Good luck with this!
Beth
Hi Beth, a CMS document (LCD L31887) suggests that every encounter note should include:
* Diagnosis
* Symptoms
* Functional status
* Focused mental status exam
* Treatment plan, prognosis, and progress
* Name, signature, and credentials of the person performing the service
Do you put all of these in every note? Much of it would be quite repetitive, particularly for clients who are seen frequently.
Thank you.
Yes, they all need to be in every note. Having a template with these items on there helps cut down on how repetitive this process can be. You might want to check out Master Clinical Forms. These forms let you create a master for each client with all the info that does not change from session to session.
Thank you for this clear and insightful explanation of the nuances of 90837! With gratitude and cheers💕
HI Lisa! Glad you found this helpful. Thanks for letting me know.