As practicing mental health professionals, we have many tools that we can use to help treat a client. There are also many CPT codes that you can use, depending on the session type. When you are in a talk therapy session involving a specific treatment method such as CBT, EFT, or EMDR, you may feel you need to bill with a certain code to ensure that you receive the most money back through their insurance. In actuality, there is a lot of misunderstanding about what you need to bill for when using these treatment methods. Let’s dive in so you can understand how to bill for these types of situations appropriately.
Insurance And Treatment Methods
You want to be sure you are using the right codes and combinations to get paid properly. CPT codes are useful because, across the medical field, they help to standardize billing for insurance purposes. They are also incredibly overwhelming to understand.
Knowing these codes can be frustrating, especially when you get rejections for the claims. With so many codes out there that apply to the medical field, I created a cheat sheet of the most applicable CPT codes for mental health services. In this cheat sheet, you will notice no mention of codes for specific treatment methods. This is for a good reason—you don’t actually need to bill for them—and yes, that does include EMDR.
Wait, There Is No CPT Code For EMDR?
Nope! Shocking, I know. The truth is, insurance companies don’t really care what treatment method you use to help your client. When you are billing insurance, they just require proof of the session, the length, and what service you provided. So your normal CPT codes can be used based on the session length. There are modifiers and extended codes that you can use in addition to the main CPT code. Let’s explore this.
For ongoing psychotherapy sessions, which can include multiple EMDR sessions you’ll likely need with a client, you can use these codes:
*** UPDATE: as of 1/1/23 these codes have been deleted. See my video here explaining the change and how it relates to EMDR Billing.
- 16 to 37-minute sessions should use CPT code 90832
- 90834 is the CPT code for 38-52 minute sessions
- 90837 for 53 minutes or longer
CPT Code 90834 Is The Most Commonly Used Code For EMDR Sessions
Typically, most therapy sessions are in the 38 to 52-minute range, including EMDR therapy. Sometimes, these sessions extend past that time, so what then? All you need to do is add an extended CPT code to cover this extra time.
- CPT code 99354 can be added for sessions that are 0-30 minutes longer.
- CPT code 99355 is for sessions that go for 60 minutes longer.
It is important to note that when billing for any of the main codes or with an extender, you include the diagnostic code and the treatment plan for Acute Stress Disorder or PTSD.
EDIT: AS of 1/1/23 THESE CODES ARE NO LONGER ACTIVE CPT CODES! THERE IS HOPE THAT A NEW OPTION G2212 IS A POSSIBILITY BUT ONLY A FEW BCBS STATES ARE ALLOWING THIS. CALL YOUR NETWORK REP AND ASK ABOUT A CODE TO REPLACE 99354 AND 99355
Will Insurance Always Cover These Sessions?
Here is where it can get kind of tricky. If you are using EMDR to treat PTSD or Acute Stress Disorder, you will likely not get a rejection for billing specifically for that. However, certain insurance companies will not always honor the extended CPT codes you can use. They won’t reject the main code being billed, such as 90834 or 90837, but they may not honor the extension codes. To save yourself some headache, familiarize yourself with the codes that the client’s insurance will accept before sessions to prevent the dreaded rejection of a claim.
Learning The Ins And Outs Of Billing Is Tricky, But Not Impossible
It’s frustrating trying to memorize what exactly to do for billing insurance. I have been there before. I am here to support you through these challenges. Contact me or join my Facebook group, Insurance Billing For Telehealth Practitioners.