‍This article is co-authored by Headway

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If you’re a therapist planning to bill insurance companies, you need to wrap your head around CPT codes. Using the correct CPT codes when you bill ensures you’re reimbursed correctly and on time. 

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You don’t need to memorize these codes, but you should at least get familiar with the ones you most frequently use. It will speed up the form-filling process and help you catch errors before you bill.

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It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.

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Here’s everything you need to know about CPT codes, and the ones most common for therapy practices.

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What are CPT codes?

CPT stands for Current Procedural Terminology. CPT codes are created and maintained by the American Medical Association (AMA). They’re used to track different types of medical services across medical fields, including mental health, to make sure clients and insurance companies are billed correctly. 

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CPT codes are five characters long. Typically that means five digits, but occasionally they are four digits and one number.

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Some CPT codes have modifiers designated by a dash (-), which alter an already-existing code. For instance “-95” is used as a modifier for telehealth services billed by therapists.

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Other codes are preceded with a plus sign (+), indicating that they’re add-on codes. These add-ons typically change the way an existing code is billed, for instance specifying that a particular service was provided outside of normal operating hours.

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The most common CPT codes for therapy practices

The CPT codes listed below are those most commonly used by therapy practices. Psychiatrists use a different set of codes.

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The typical reimbursement rate listed for each of these codes is based on data from the Centers for Medicare and Medicaid Services (CMS).

90791: Psychiatric diagnostic evaluation (without medical services)

You can use 90791 to bill for your initial evaluation of a new client, if you’re not providing medical services (prescribing providers can use 90792). It’s typically reimbursed by insurance at a higher rate than 90837 or 90834. Typically, Medicare allows you to bill for this service once per client per year. Private insurers may allow you to bill once per six months; it varies according to the insurer.

90837: 60-minute psychotherapy with patient

The 90837 code is used for mental health treatment sessions lasting at least 53 minutes, after completing an initial evaluation.. It includes a wide range of in-office treatments across many different modalities, and may be modified with add-on codes (see next section). 

90834: 45-minute psychotherapy with patient

The 90834 code is used for mental health treatment sessions lasting 38 to 52 minutes, after completing an initial evaluation. It includes a wide range of in-office treatments across many different modalities, and may be modified with add-on codes (see next section). 

90832: 30-minute psychotherapy with patient

The 90832 code is used for mental health treatment sessions lasting 16 to 37 minutes, after completing an initial evaluation. It includes a wide range of in-office treatments across many different modalities, and may be modified with add-on codes (see next section). 

90847: Family psychotherapy/conjoint psychotherapy with patient present, 50 minutes

The 90847 code is used for 50 minutes (or at minimum 26 minutes for billing purposes) of couples or family counseling with the patient(s) present. The code is only billed once, to cover both clients, and typically reimburses at a higher rate to cover the cost of seeing both. 

90853: Group psychotherapy (other than family)

The 90853 code is used for group psychotherapy sessions typically 45 to 60 minutes in length. Sessions should include a maximum of 10 patients. Medicare allows you to bill this code once per day.

90839: Psychotherapy for crisis, 60 minutes

The 90839 code is used for unscheduled therapy sessions of up to 60 minutes when clients are facing crises.  If you provide this service remotely (by phone or online conferencing), add the modifier “-95” to the code when billing. 

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CPT add-on codes for therapists

CPT add-on codes modify codes you’re already using to report treatment when you bill insurance. For example, many add-on codes are used to report sessions that lasted longer than the original code indicates. 

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On bills, add-on codes are indicated with a plus (+) sign. 

90785: Interactive complexity

The 90785 add-on indicates sessions where there were difficulties in communication. 

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That could be because the client requested third parties (schools, social services) family members, or language interpreters to be present; is not legally responsible for their care (due to disability or status as a minor); struggled to communicate due to disability or the state of their mental health; required tools like toys or art supplies to communicate; or provided information you’re legally obligated to report to a third party.

90840: Additional 30 minutes’ treatment, used with 90839

If you provide a client with unscheduled treatment due to a crisis and the session extends considerably beyond the 60 minute mark, use the 90840 code to report each additional 30 minutes.

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Upcoding and downcoding for therapists

Upcoding and downcoding are two sides of the same coin. They’re both ways therapists and other medical health professionals sometimes inaccurately bill insurance companies by assigning the wrong codes for procedures.

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Upcoding consists of assigning a more highly-reimbursed CPT code to a particular treatment than it merits. 

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Upcoding can be done fraudulently and intentionally, such as a therapist who uses 90837 on their bill when 90834 would be a more accurate code, in order to receive a higher reimbursement from the insurance company. But upcoding may also be done unintentionally, such as billing for unnecessary medical services.

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Downcoding is the opposite of upcoding. It consists of reporting a less extensive (and less highly reimbursed) form of treatment in place of one that’s more complex. A therapist might do this in error, or they may do it because they’re worried about having their claims questioned by the insurance company, or because they’re trying to work around limits on how frequently units under a certain code may be billed. One example: The one-per-day limit on group psychotherapy billed to Medicare.

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Upcoding or downcoding may lead to audits of your practice by the insurance company, reimbursement takebacks, and charges of fraudulent billing. Your license to practice may be put in jeopardy. It’s best for the long-term health of your practice and your reputation as a professional to avoid inaccurate coding.

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New to running your own therapy practice? Here’s how to get credentialed with an insurance provider.

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Headway is a free service that makes it easier and more profitable for therapists and psychiatrists to accept insurance. From built-in client documentation, and scheduling to free CEUs and dedicated support, Headway provides the foundation you need to grow your insurance practice. Talk to a practice consultant to learn more.

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This post is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult their own attorney, business advisor, or tax advisor with respect to matters referenced in this post.

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