CPT Code Basics What You Should Know
Current procedural terminology (CPT) codes are essential components of the health insurance billing process. It's critical to use the appropriate procedure codes to receive reimbursement for your services and avoid an audit. However, using the correct CPT codes for medical billing involves understanding a complex system.
There are thousands of codes to choose from and many different guidelines to follow. Nevertheless, it is possible to use medical codes properly and receive maximum reimbursement rates for your services.
This post will cover some basics of CPT codes for mental health, and provide tips for avoiding claim denials. The better you understand current procedural terminology, the more time you'll have to care for patients, and the easier it will be to get paid.
What are CPT Codes?
CPT is a uniform coding system developed by the American Medical Association (AMA). The AMA first established this system in 1966 to standardize terminology and simplify record-keeping for physicians and staff. Since its development, CPT has undergone several changes. The most recent edition focuses on using CPT codes to report physician services.
CPT codes describe medical procedures — such as tests, evaluations, surgeries, and other practices — performed by a physician on a patient. For example, behavioral health CPT codes describe the length of a psychotherapy session with a client or a diagnostic interview. CPT codes are necessary to receive reimbursement from health insurance companies.
Why CPT Codes Are Essential for Clinicians
CPT codes are essential parts of practice management for clinicians and health care staff because they determine compensation and the practice's overall success. To receive the correct reimbursement rates, clinicians must ensure the codes on insurance claim forms accurately reflect the services they provided before submitting the claims to insurance companies.
How do CPT Codes Work?
CPT coding tells insurance payers what you would like to get paid for. Along with the International Classification of Diseases codes, CPT codes paint a complete picture for health insurance companies, and you need both types for reimbursement.
The ICD code set describes the diagnosis and why the treatment was necessary, and the CPT code explains the services provided. Examples of mental health ICD codes include the following.
- F41.9: Anxiety disorder
- F31.31: Bipolar disorder, current episode depressed, mild
- F42: Obsessive-compulsive disorder
- F43.11: Post-traumatic stress disorder, acute
For example, a social worker might use F41.9 with CPT code 90832, which is the code for individual psychotherapy for 30 minutes, to bill for a session with a client experiencing anxiety. You would include both codes on a health insurance claims form.
There are three distinct categories of CPT codes, which we will look at next.
What Are the Three Categories of CPT Codes?
The three categories of CPT codes are as follows.
- Category I: Most coders spend the majority of their time working with Category I codes. There are different sections of these codes based on the field of healthcare. The six sections of the CPT codebook are Evaluation and Management, Medicine, Surgery, Radiology, Anesthesiology and Pathology, and Laboratory. Each has a unique set of guidelines. The CPT codes under Category I are five digits long.
- Category II: Category II codes contain four digits, followed by the letter F. Category II codes are optional. They provide additional information and are not a replacement for Category I or Category III codes.
- Category III: Category III codes are temporary and represent new or experimental procedures or technology. For example, if you can't find a new practice in Category I, you might use a Category III code. Category III codes are four digits long and end in the letter T.
Since Category I is the most frequently used, here's a look at the numerical range of codes within this category.
- Evaluation and Management: 99202 to 99499
- Anesthesia: 00100 to 01999 and 99100 to 99150
- Surgery: 10021 to 69990
- Radiology: 70010 to 79999
- Pathology and Laboratory: 80047 to 89398
- Medicine: 90281 to 99199 and 99500 to 99607
Each of these sections contains subfields to correspond to a particular healthcare field and include guidelines to follow. For example, therapists commonly use psychotherapy CPT codes falling in the range of 90832 to 90853 under the Medicine's psychiatry section. Psychiatrists, primary care physicians, and other authorized prescribers might use evaluation and management codes for providing general medical services.
CPT codes also have various modifiers. Modifiers have two numbers or letters, and you can add them to a CPT code. They describe specific critical parts of a procedure.
Some codes have instructions below them in parentheses to tell the coder there may be a better code to use. Codes must be as specific as possible for a mental health billing claim to get accepted.
How to Use the Correct CPT Code in Psychiatry
The CPT code set is a complex system. It is not always easy to determine if you've met the required elements to code appropriately for the maximum reimbursement amount. It may help to break the process down into steps for new and established patients.
First, you might bill two types of psychiatric service or procedure CPT codes for new patient office visits. These are:
- E/M codes
- Psychiatric diagnostic evaluation codes
Depending on the situation and time involved, it may be appropriate to bill for both codes. Here are a few guidelines to follow.
- E/M: Use E/M codes when evaluating a new medical issue. With the AMA's 2021 coding changes, you can select an E/M code based on the complexity of medical decision-making or the total time you spent on the patient's care on the day of the encounter. If you provide E/M services with a psychotherapy add-on code, you must choose a code based on medical decision-making and not total time.
- Psychiatric diagnostic evaluation: Use psychiatric diagnostic evaluation codes for a diagnostic assessment. You may need to use these codes more than once if it takes more time to complete the initial evaluation.
Regarding established patients, the rules allow you to bill an E/M service with every psychotherapy visit, but they don't require you to do so with every encounter. Only bill E/M services if you addressed and documented a separate medical issue during the visit.
For example, if you address medication's side effects during an encounter, you might bill for an E/M visit in addition to a psychotherapy session.
However, if a patient has been stable and on the same medication for years and attends a psychotherapy visit, you can only bill for the psychotherapy session. You cannot bill for E/M because there are no medical or medication concerns expressed during the visit.
Also, to bill for E/M, your documentation must prove your active management or discussion of a medical or medication problem distinct from the psychotherapy service.
The 3 Major Components of E/M Documentation
According to the Centers for Medicare and Medicaid Services, insurance companies might want to see documentation to ensure the client's policy covers necessary services and confirm the following pieces of information:
- The service site
- The medical necessity of the services provided
- The accuracy of the services reported
Your client's medical records must include the following three components to support the E/M codes you choose.
- History: The history section must include the history of present illness, a review of body systems, and the family and social history.
- Examination: The examination section includes the type of examination performed based on your judgment and the nature of the problem. According to the CMS, the levels of E/M services derive from problem-focused, expanded problem-focused, detailed, or comprehensive exams.
- Medical decision-making: The medical decision-making section includes the number and complexity of problems addressed during the specific encounter, the complexity of the data reviewed, and the risk of complications.
When selecting an E/M code with psychotherapy, you'll base your choice on medical decision-making. It's also necessary to choose a CPT code that reflects the service site and whether the patient is new or established. Take these steps:
- Select the type and level of E/M service based on medical decision-making.
- Choose timed psychotherapy add-on codes based on the time spent providing psychotherapy.
For example, if you choose E/M code 99202 to evaluate and manage a new patient in an outpatient setting with straightforward decision-making and need to bill for 30 minutes of psychotherapy, you would include the add-on code 90833.
Make sure to keep your E/M code and psychotherapy codes separate. The time associated with the E/M service cannot count toward the time of the psychotherapy service. The E/M service must be significant and distinct from psychotherapy.
The Most Common Psychotherapy CPT Codes
While family therapists and counselors may not use E/M codes like psychiatrists or primary care physicians, they will bill for psychotherapy services. The American Psychological Association lists standard CPT codes used by therapists.
- 90832: 30 minutes of individual psychotherapy
- 90834: 45 minutes of individual psychotherapy
- 90837: 60 minutes of individual psychotherapy
- 90845: Psychoanalysis
- 90846: 50 minutes of family psychotherapy without the client present
- 90847: 50 minutes of family psychotherapy with the client present
- 90849: Multiple-family group psychotherapy
- 90853: Group psychotherapy
Though CPT codes describe specific times, such as 30, 45, and 60 minutes, therapists have some flexibility, since sessions might go over or under that exact amount.
When choosing a psychotherapy CPT code, therapists must select the closest one to the time spent in the session. The APA lists the following psychotherapy session durations.
- 90832: Choose this code for sessions that run between 16 and 37 minutes.
- 90834: Select this code for sessions that are 38 to 52 minutes long.
- 90837: This code is appropriate for sessions lasting 53 minutes or longer.
- 90846 or 90847: Choose these codes for 26 minutes or more of family psychotherapy.
Psychotherapy Crisis Codes
CPT codes for crises allow behavioral health professionals to bill for emergency sessions. Care providers typically use the following crisis codes for patients in great distress who require immediate attention or are in a life-threatening situation.
- 90839: First 60 minutes of psychotherapy for crisis
- 90840: Add-on code for each additional 30 minutes of psychotherapy for crisis
- 99050: Add-on code for services provided when the office is usually closed
- 99051: Add-on code for services provided during regularly scheduled hours on evenings, weekends, or holidays
If a crisis session falls below 60 minutes, you will bill for a regular psychotherapy code, such as 90834.
Other Add-On Codes
Providers may use add-on codes to describe additional services. Behavioral health clinicians can only apply add-on codes in combination with psychotherapy and diagnostic evaluation services. Providers must include the principal CPT code and add-on code on the billing form, and list them separately. Add-on codes include the following.
- 90785: Interactive complexity
- 90863: Psychopharmacology with psychotherapy
- 90833: 30 minutes of psychotherapy with E/M service
- 90836: 45 minutes of psychotherapy with E/M service
- 90838: 60 minutes of psychotherapy with E/M service
Clinicians might use code 90785 for factors that complicate service delivery, such as a client's angry family member or a third party like a probation officer. Psychologists might use code 90863 when reviewing or prescribing medication on the same day as delivering psychotherapy services. Psychiatrists do not use code 90863.
Mental Health Test and Assessment Codes
CPT codes for mental health tests and assessments include the following.
- 96105: Aphasia assessment
- 96110: Developmental screening
- 96112: Developmental test administration with interpretation
- 96113: Each additional 30 minutes of developmental test administration with interpretation
- 96116: Neurobehavioral status exam, 60 minutes
- 96121: Each additional hour of neurobehavioral status examination
- 96125: Standardized cognitive performance testing, 60 minutes
- 96127: Brief emotional or behavioral assessment
- 96130: Psychological testing evaluation services provided by a physician or qualified health professional, 60 minutes
- 96131: Each additional hour of psychological testing evaluation services performed
- 96132: Neuropsychological testing services, 60 minutes
- 96133: Each additional hour of neuropsychological testing services performed
- 96136: Psychological or neuropsychological test administration and scoring by a physician or qualified health professional, 30 minutes
- 96137: Each additional 30 minutes of neuropsychological test administration and scoring by a physician or qualified health professional
- 96138: Psychological or neuropsychological test administration and scoring by a technician, 30 minutes
- 96139: Each additional 30 minutes of neuropsychological test administration and scoring by a technician
- 96146: Psychological or neuropsychological test administration via an electronic platform with automated results
- 96156: Health assessment or reassessment
- 96160: Patient-focused health risk assessment
- 96161: Caregiver-focused health risk assessment
Psychiatry CPT Codes
Psychiatrists use CPT codes to bill for psychiatric diagnostic evaluations, psychotherapy, and other psychiatric services. CPT codes for psychiatric services include the following.
- 90791: Psychiatric diagnostic evaluation without medical services
- 90792: Psychiatric diagnostic evaluation with medical services
- 90865: Narcosynthesis
- 90867: Therapeutic repetitive transcranial magnetic stimulation
- 90870: Electroconvulsive therapy
- 90875: 30 minutes of individual psychophysiological therapy with biofeedback
- 90876: 45 minutes of individual psychophysiological therapy with biofeedback
- 90880: Hypnotherapy
- 90899: Unlisted psychiatric procedure or service
Psychiatry Evaluation and Management Codes
Psychiatrists may use E/M codes to bill for evaluation and management services either alone or with psychotherapy. For psychiatrists and other physicians, psychotherapy is an add-on code to the primary E/M service.
- 99202 to 99205: Outpatient E/M services for a new patient
- 99211 to 99215: Outpatient E/M services for an established patient
- 99241 to 99245: Consultations for a new or established patient in an outpatient setting
- 99221 to 99223: Initial hospital E/M services for a new or established patient
- 99231 to 99233: Hospital E/M services for a new or established patient after initial visit
- 99251 to 99255: Inpatient consultations
Common Behavioral Health Case Management CPT Codes
Like licensed counselors, clinical social workers who provide psychotherapy services use CPT codes to get reimbursed. Here's a CPT description list of frequently used codes, according to the National Association of Social Workers:
- 90832: 30 minutes of psychotherapy
- 90834: 45 minutes of psychotherapy
- 90837: 60 minutes of psychotherapy
- 90785: Interactive complexity add-on
- 90839: 60 minutes of psychotherapy for crisis
- 90840: Each additional 30 minutes of psychotherapy for crisis
- 90791: Psychiatric diagnostic evaluation
- 90845: Psychoanalysis
- 90846: 50 minutes of family psychotherapy without the patient present
- 90847: 50 minutes of family psychotherapy with the patient present
- 90853: Group psychotherapy
Telehealth CPT Medical Coding List
With an increasing number of behavioral health professionals moving their practices online, it helps to know CPT codes for virtual therapy. Telehealth CPT codes are especially relevant today under the Coronavirus Preparedness and Response Supplemental Appropriations Act, which expands access to Medicare telehealth services.
According to the Centers for Medicare and Medicaid Services, telehealth visits are the same as in-person visits and get paid at the same rates. Therefore, you will use the identical CPT code for a virtual therapy session as you would if you were billing for a face-to-face meeting. For example, if you meet with a patient online, you would still use the code 90832 for 30 minutes of psychotherapy. However, you would apply different modifiers for telehealth services, as follows.
- 95 modifier: Add the modifier 95 to the appropriate CPT code. This modifier describes a real-time interaction between a clinician and patient via a telecommunications system, such as through video conferencing. You may also use the modifier GT instead.
- 02 for place of service: Use Code 02 to describe the place of service (POS) as a telecommunications system. It may replace the commonly used POS code 11, which describes providing therapy in an office.
As you'll see, some telehealth codes belong to the Healthcare Common Procedural Coding System (HCPCS). HCPCS codes are not part of the CPT set, and they cover specific services and products needed to provide care. HCPCS codes consist of a single letter followed by four numbers. Here are codes you might use specifically for telehealth.
- G2012: Virtual check-in or brief, patient-initiated visit
- G2010: Remote evaluation of a recorded video or image provided by an established patient
- 99421: Online digital evaluation and management service conducted via a patient portal for an established patient, five to 10 minutes of cumulative time over seven days
- 99422: Online digital evaluation and management service conducted via a patient portal for an established patient, 11 to 20 minutes of cumulative time over seven days
- 99423: Online digital evaluation and management service conducted via a patient portal for an established patient, 21 or more minutes of cumulative time over seven days
Non-physician healthcare professionals may use the codes G2061, G2062, or G2063 to provide an online assessment and management service for an established patient.
New CPT Codes for Behavioral Health Services
Every year, health professionals can expect revised or new mental health CPT codes. According to the American Psychological Association, as of Jan. 1, 2020, psychologists must use new therapy CPT codes to get reimbursed for health behavior assessment and intervention services from third-party payers. Providers use these services to address psychological, emotional, cognitive, or behavioral issues that impact the treatment of a physical health problem. Psychologists may provide these services to an individual, group, or a patient's family to help the client cope with physical health conditions.
HBAI codes require a physical health diagnosis or an ICD code and are not for mental health services. Here are the code revisions.
- Code 96156 replaces codes 96150 and 96151: Clinicians must now use code 96156 to bill for a health and behavior assessment or reassessment. The new code for assessment services is now event-based rather than time-based.
- Code 96152 is now 96158 plus 96159: Code 96152 for an individual, face-to-face health behavior intervention is now 96158 for the first 30 minutes. List code 96159 separately for each additional 15 minutes of the intervention.
- Code 96153 is now 96164 plus 96165: Code 96153 for a face-to-face group health behavior intervention is now 96164 for the first 30 minutes. Tack on the code 96165 for each additional 15 minutes of service.
- Code 96154 is now 96167 plus 96168: Code 96154 for a face-to-face family health behavior intervention with the patient present is now code 96167 for the first 30 minutes. Use code 96168 for each additional 15 minutes.
- Code 96155 is now 96170 plus 96171: Code 96155 for a face-to-face family health behavior intervention without the patient present is now 96170 for the first 30 minutes. Use code 96171 for each additional 15 minutes.
For additional information about the 2021 E/M coding changes, check out our blog post here.
How CPT Code Changes Impact the Reimbursement Process
Reimbursement rates change all the time, and a lot depends on the decisions made by the CMS. The CMS accepts the American Medical Association's CPT code recommendations and makes the final decisions regarding code values.
The code selection process also impacts how much clinicians get paid. For example, with the recent E/M coding changes, clinicians can bill for the total time they spend in one day on an encounter, which includes non-face-to-face time, and gets credit for tasks like interpreting exams performed by other physicians.
Clinicians can also choose an E/M code based on total time or medical decision-making, selecting the one that makes the most financial sense.
CPT Code Reimbursement Rates
Reimbursement rates depend on the insurance payer, location, and practitioner level. For instance, a psychiatrist will receive a higher reimbursement rate than a social worker.
The CPT code you choose also affects compensation. In general, the longer you spend with a patient delivering services, the more you'll get paid. For example, according to the Mississippi Division of Medicaid's 2020 fee schedule, psychotherapy rates were:
- 90832: $60.07
- 90834: $79.90
- 90837: $119.68
If you're concerned you're not getting the highest reimbursement rate possible, let us know at ICANotes. We've designed our electronic health record software to help behavioral health specialists maximize reimbursement.
ICANotes keeps track of documentation elements in clinical notes and automatically calculates the highest-level E/M code supported by a note. ICANotes makes it easy to establish all the required details of accurate E/M documentation by providing pre-templated buttons and an easy-to-use interface. With ICANotes, clinicians can stay up to date on CPT changes and make sure they comply with the Health Insurance Portability and Accountability Act.
Tips for Maximizing Reimbursement and
Avoiding Insurance Claim Denials
If you hope to avoid issues with claims, you mostly want to remember that medical necessity determines the level of service to bill. It would not be appropriate to document a higher level of service if it is unnecessary. Always make sure the documentation supports the level of care you are billing. Here are a few more tips to keep in mind.
1. Ensure Correct Coding
To receive reimbursement, a clinician must complete accurate coding. Coding errors can lead to payment delays or rejected claims. Frequent or consistent errors could lead to an audit or charges of fraud. Strive for the highest accuracy, and cut down on simple errors like incorrect patient information or policy number mistakes. Always refer to the AMA’s most recent CPT manual to make sure you use the right codes in your practice.
Also, make it a habit to check and recheck work, and thoroughly read all the therapy notes included with the codes. Encourage staff members to do the same. One of the most common causes of claim denials is the improper use of modifiers. Therefore, make sure to familiarize yourself with modifiers before using them. Modifiers can be the difference between maximum reimbursement and reduced reimbursement, so it's crucial to review the rules.
2. Claim Only What's Medically Necesarry
Medicare and other payers define what's medically necessary in different ways, but in general, it's about doing what's best for the patient at the right time. A claim for a service that is not a medical necessity will likely get denied.
To help demonstrate a medically necessary claim, make sure to choose the appropriate ICD code and link it to the associated CPT codes that are valid for the visit. Doing so enables staff and insurance payers to see the reason for each service.
3. File Claims on Time
You must submit claims by a specific deadline. For example, Medicare requires you to file no later than 12 months after the date of service. These dates can vary depending on the payer, and some claims may be due within 90 days or 180 days after service. By meeting deadlines, you'll ensure you receive adequate reimbursement.
4. Emphasize Quality Documentation
Inadequate documentation can affect the reimbursement process. Make sure everyone in your practice understands the value of correct, legible, and complete documentation. Otherwise, it will be challenging to make an accurate or complete claim.
5. Identify and Educate
Identify coding errors, review past mistakes, and aim to correct the errors by educating staff and staying current on any code changes. Schedule regular training meetings to keep information fresh and share any updates.
Use ICANotes for Fast and Accurate Billing
Proper coding requires knowledge and practice. Most behavioral health clinicians want to spend their time and energy providing patient care — not worrying about coding and claims. ICANotes can step in and take care of the work for you, so you can get back to doing what you love.
With ICANotes, you can expect automatic coding at the highest reimbursement level possible to ensure claims get accepted and you get paid. Without the need to fix errors or resubmit claims, you’ll save time, money, and energy. To experience the benefits of ICANotes behavioral health EHR software firsthand, sign up for a free trial today!
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