Billing codes, or CPT codes, are used by mental health providers to submit claims to insurance companies for reimbursement.
As of January 1st, 2013 there are several new billing codes that you need to familiarize yourself with. Here are some of the important changes.
Initial Evaluation and Psychotherapy Codes
An initial diagnostic evaluation performed by a psychologist or other mental health provider will no longer be a 90801. The new code for a psychiatric diagnostic evaluation will be 90791.
Regarding psychotherapy, the most common code used is 90806 (individual therapy 45-50 minutes), which is being replaced with 90834 (psychotherapy, 45 minutes with patient and/or family member).
An individual therapy session lasting 20-30 minutes (current CPT code 90804) is being replaced with 90832 (psychotherapy, 30 minutes with patient and/or family member)
Also, noteworthy is the elimination of 90808 (individual therapy, 75-80 minutes). This is being replaced with 90837 (psychotherapy, 60 minutes with patient and/or family member).
Note that the this code only allows for 60 minutes rather than 75-80 minutes. The codes for family therapy (90846 and 90847) and group therapy (90853) have not changed.
New Crisis Codes
Another change coming in 2013 is the addition of crisis codes. CPT code 90839 is used for a 60-minute crisis session and 90840 is used for each additional 30 minutes.
Add-on codes are new in 2013 and are to be used in combination with diagnostic evaluation and psychotherapy codes. This new code (90785) is referred to as an interactive complexity add-on code which is to be used when there are factors present that complicate the delivery of the evaluation or session.
One of several factors identified in the CPT manual must be present in order to bill with the add-on code. The add-on code can be used with the initial evaluation (90791), psychotherapy (90832, 90834, 90837) and group therapy (90853).
There is also an add-on code for pharmacologic management (90863) when used in combination with psychotherapy services (90832, 90834, 90837).
The new CPT manual also has additional codes for those who are eligible to bill evaluation and management (E/M) codes.
To help prepare for this transition I have compiled some resources that might be helpful.
Reference Guide for New Psychotherapy Codes (American Psychological Association)
Crosswalk of 2012 to 2013 Codes (American Psychiatric Association)
Express Reference Coding Card Behavioral Health (American Medical Association)
Given, D. (2012) New Psychotherapy Billing Codes in 2013. Successfulpractice.net
Given, D. (2012). New Psychotherapy Billing Codes in 2013. Psych Central. Retrieved on December 10, 2013, from http://pro.psychcentral.com/2012/new-psychotherapy-billing-codes-in-2013/001072.html
Last reviewed: By John M. Grohol, Psy.D. on 15 Nov 2012