Billing codes can be very frustrating for most mental health practitioners. At times, it can even feel like a foreign language you can’t understand, no matter how hard you try.
With everything going on in your professional and personal life, the last thing you want to do is spend countless hours trying to figure out the exact codes to bill insurance for. You need to feel confident that you are not only choosing the correct code, but the one that will get you the most reimbursement.
You’ve likely looked at and tried researching the different CPT codes you can use for insurance. You come across the CPT 90837 Modifier 95 code and wonder if this is the right code to use. Before we go over the CPT 90837 Modifier 95 code, let’s start with why using the correct codes is important.
When To Use CPT Code 90837
CPT Code 90837 is used for sessions that last 53 minutes or longer. It is for ongoing sessions that you will have with one client. Thankfully, there are codes you can use with CPT Code 90837 should the session length go much longer. When you are billing, you can use an extender code to go along with 90837. Extender codes are designated by the length of time the session is extended by.
Extender Codes For 90837
- Use the extender code 90833 for sessions that are 30 minutes longer than 90837 (53 min).
- Extender code 99354 is for sessions that go for 30-47 minutes longer.
When/Why Would I Use CPT Code 90837 Modifier 95?
In 2017, there was a major overhaul of CPT codes for psychotherapy sessions. One of the new changes introduced was Modifier 95. Modifier 95 should be used for any telehealth services you provide for a client. However, this modifier code should only be used for real-time audio and video sessions. Please note: this modifier does not apply to phone sessions, just the sessions you conduct via a video client with audio. (exception: During COVID 19 PHE mandates phone sessions are allowable and billable as telehealth)
So, you would use the CPT Code 90837 Modifier 95 for virtual sessions that are 53 minutes or longer. To further maximize your reimbursement, include the appropriate extender code if the session exceeds 53 minutes.
Why Is The Right Billing Code So Important?
Overwhelmed by all of the codes you see online that you could use? You aren’t alone. CPT codes were created so there would be a standard in medical billing. Unfortunately, there are many CPT codes out there that don’t apply to mental health sessions at all. So pouring through the guidelines, codes, and modifiers can make you want to pull your hair out.
Using the right codes from the beginning can help you streamline the billing process and ensure you get the most reimbursement from insurance companies. With how many codes there are, I created this CPT codes cheat sheet with some of the most common codes used in mental health practice.
CPT codes for mental health professionals are broken up by the type of service you provided as well as the session length. Some common CPT category codes you should keep at the forefront of your mind when billing are:
- Regular office visit codes
- Ongoing session codes
- Family therapy services
- Group psychotherapy
- Emergency therapy
- Behavioral assessments
- Codes for extended longer sessions
Some codes can even be combined in billing for one session if there is proof that you provided these multiple services in one session.
Billing Codes Can Be Confusing, But You Don’t Have To Figure This Out Alone
Providing the best service you can to your clients is your number one priority. You also have to ensure you are looking out for yourself. Reach out to me on my contact form or by emailing info@kymtolson.com. I also have a Facebook group, Insurance Billing for Telehealth Practitioners, that you can join.