Billing Guidelines Using the New CPT Codes

Dennis Given, Psy.D.

Licensed psychologist & owner of Psychology Associates of Chester County, Inc.

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24 Responses

  1. Ellen says:

    Thanks – very informative!

  2. Thanks for the info..I can hardly wait to see how they cut our income!

  3. Julie says:

    Do you have an example fpr the interactive complexity add-on code? When is it appropriate to use this code. If a client has a DSS worker, and there is collaboration? Or if you make a CPS report outsied of the session or in the session? Are these appropriate uses of the code?

  4. Thank you for your time and effort writing and sharing this post.

  5. rachel says:

    Is 90791 a time-based code? For example, if an initial evaluation takes 3 hours, is it billed as 3 units?

    • I don’t believe there is a time component for the 90791. There also wasn’t one when the initial eval was coded as a 90801, however, I generally do an hour for these. I would use crisis codes 90839 for the first hour and 90840 for each additional 30 minutes. I’m assuming there is a crisis if your initial eval last three hours. In this case you should bill one unit of 90839 (1 hour) and four units of 90840 (additional 2 hours in 30 minute units).

  6. Kay says:

    We’re a hospital outpatient program and are having trouble billing 90853 and 90785 to Medicare. Has anyone else had this problem?

  7. Kathleen says:

    I do monthly billing for a phychiatrist. We just started using the new 2013 codes last month and I am wondering how we break up the old fees into the two new codes?

  8. Kim Longbottom says:

    Thank you for the information. I’m a provider for bcbsnc and I saw that Medicare does not reimburse for the crisis code 90839, but does BCCSNC?
    Thanks.

  9. Kim Longbottom says:

    I meant to ask does BCBSNC reimburse for the crisis code 90839?

    • I haven’t had any trouble being reimbursed by my local BCBS in PA for the crisis code, so I would guess that you should be OK. Also, I believe that Medicare does now pay for the code which started in 2014.

  10. I am understanding that a two hour therapy session would be 90837, unless it’s a crises situation in which it would be 90839 and two 90840. Does that sound correct? And those add on codes would be separate lines on the claim form, correct? Dr. Anson Service has asked me to help with billing but it’s rather new to me. Thank you for your help!

    • That is correct. It would be a 90837 unless it meets criteria for a crisis session. In this case you bill 90839 for the first hour and 90840 for each additional 30 minutes. The 90840 would be a separate line charge on the claim for, in this case for 2 units. (or two additional line charges for 90840 at one unit each).

  11. Claire Marchand says:

    A new provider that I am billing for is asking that I bill for a 2 hour session. What code would I use for doing that? Do I need to check with each payer?

  12. Jack Kallahan says:

    Above you state: One of the following must exist:Maladaptive communication (e.g., high anxiety, high reactivity, repeated questions or disagreement) among participants that complicates the delivery of care)
    Emotional or behavioral conditions inhibiting initiation of treatment plan
    Mandated reporting required (e.g., abuse or neglect)
    Play equipment, devices, interpreter or translator required due to inadequate language expression or different language between client and provider

    Can you refer me to the document or source for that. I can’t seem to find it in the AMA CPT. Thanks.

  1. November 11, 2013

    […] The transition to ICD-10 will occur on October 1st, 2014.  ICD, which stands for the International Classification of Diseases, is the worldwide standard for reporting diagnostic codes. ICD-10 is in its tenth edition and replaces ICD-9 which is now 30 years old. It is important to note that ICD-10 is used for diagnostic reporting only and is not replacing CPT or procedure codes. […]

  2. March 17, 2015

    […] insurance claims. If you need a refresher on the basics of insurance claims see my article on CPT Billing codes. Let’s get […]

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