Current Procedural Terminology (CPT) Codes: What Every Mental Health Clinician Needs to Know

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller 

Does the hassle of billing seem like too much to handle amid the responsibilities of your practice? Are you coping with complicated claims? Do you feel overwhelmed by months of procrastination and uncertainty about your ability to bill insurance correctly?

It sounds like you need some support. And a streamlined process for understanding how to maximize the billing process and reimbursement. Essentially, you need to understand the Current Procedural Terminology (CPT) code system and some other key information. Fortunately, this is the place for both.

Let’s take a look together at what you need to know:

What Are CPT Codes Exactly?

What’s your gut response to a discussion about billing codes? It’s not unusual for mental health clinicians to feel intimidated or anxious at the thought of tackling insurance billing for your work. Yet, with a bit of guidance, and a bit of information editing, you can sift out what you need to bill appropriately and leave the extraneous advice aside.

CPT codes were devised to standardize medical billing across various disciplines and practices.

Therefore, it’s important for you to know that many of these codes have little or nothing to do with mental health work. To be reimbursed for your services, you’ll likely only need to record a few codes. Memorizing the appropriate CPT codes, in the right circumstances, will make billing much easier and make the most of reimbursements.  Key points when considering billing include the following:

  • CPT codes list the individual services you offer and could bill for in your sessions (diagnostic interview, individual therapy, group therapy, etc).
  • More than one CPT code may be assigned to one session as long as you truly provided those services or treatments at that time.
  • Each CPT code is assigned a specific time period. Those combined times may not exceed the session time. To illustrate, three different CPT codes may not be assigned 30-minute time intervals during your 60-minute session.

Is There a Cheat Sheet for the Codes Most Pertinent for Mental Health Clinicians?

Thankfully, the answer is yes!

While it’s true that mental health providers wishing to be reimbursed will need to master CPT billing, many of us put it off. Worse, we may never tackle it at all. Why? Because memorizing and applying the correct codes seems daunting and tedious. With all of your other responsibilities, poring over the American Medical Association’s CPT manual to pluck out the right codes is likely not your idea of a good time.

Still, the payoff is too good to let the billing opportunity slip by. Fortunately, in this situation, a “cheat sheet” is a great resource. A resource I am happy to provide. Of course, every practice is unique. However, the most common codes are as follows:

CPT Codes Cheat Sheet

  • Everyday Codes for Regular Office Visits
    • 90791 Intake Interview (you can usually bill this more than once)
  • Ongoing Psychotherapy Sessions
    • 90832 for 16 to 37 minutes
    • 90834 for 38 to 52 minutes
    • 90837 for 53 minutes or longer
  • Family Psychotherapy Services
    • 90847 for family psychotherapy with the client present; 26 minutes or longer
    • 90846 is family psychotherapy without the client present; 26 minutes or longer
  • Group Psychotherapy Services
    • 90853 no time limit; usually 45- 60 minute sessions
  • Emergency/Crisis Psychotherapy
    • 90839 for crisis sessions; 30- 74 minutes
    • 90840 for each additional 30 minutes beyond 74 minutes
  • Behavioral Assessment
    • 96127 for use up to 4 times per session, 4 times each year
  • Extender Codes for longer sessions
    • 90833 (0-30 minutes longer;; used with 90837)
    • 99354 (30- 47 minutes longer; used with 90837)
    • 99355 ( for each additional 30 min period; used with 99354)

Identifying the codes you use most frequently is an invaluable timesaver. Keeping them close by will maintain your confidence in the system, ensure accurate billing, and keep your practice thriving.

Are There Key Strategies for  Best Use of the CPT Codes

Again, the answer is yes!

You want to do your best not to interrupt the billing pipeline and back up your reimbursement. Thus, it is important that you bypass the most common CPT billing code errors. This isn’t difficult; you just need the right information. Fortunately, you don’t have to go anywhere to find it. Below you’ll see a few strategies to keep in mind:

  • Avoid using extender codes alone. Don’t forget to add the extender code to the appropriate primary code. These are considered +codes 
  • Avoid mixing up codes. Don’t confuse codes meant for private practice and facility-based codes.
  • Avoid duplicate billing. Don’t use the same billing code twice or bill a single service with different codes.
  • Avoid memorization overload. Use the cheat sheet and check billing guidelines routinely for changes.
  • Avoid bailing out too soon. If a billing code is rejected don’t give up on the whole process. Simply review the reason for rejection. Was it a transcription mistake? Has the billing criteria changed? Just maintain a learning mindset and do your best to stay up-to-date on billing norms.

Okay, Sounds Good, So Where Do My Billing Codes Go?

Good question!

To get things going, you’ll add the codes you use to an HCFA 1500 form. This claim form is used to clearly and accurately document your procedures. Essentially, it is just an insurance claim form specifically meant for medical professionals. You or your office will office complete it and submit it directly to the health insurance company.

Keep in mind that when you call insurance companies to discuss benefits, you can ask them about CPT codes too.

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Finally, and most importantly, know that you aren’t the first therapist to approach billing with some measure of trepidation. The great thing about you? You realize that help is available. Your time and energy are undoubtedly worth the money. You deserve to bill for it.

I’m on your side. Please reach out now for support to get started and guidance when you need it.

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