Use CPT Code 90837 for Higher Reimbursement Rates!

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.”