Coding Guideline for Psychologists and Psychiatrists for Virtual Consults 2023May 15, 2023
All mental health professionals use the same Current Procedural Terminology (CPT®) codes, including psychologists, psychiatrists, nurses, and social workers. Consequently, they can bill clients and file insurance claims with third-party payers, like Medicare, Medicaid, and private insurers.
In 2013, this group of codes was last revised to simplify the coding framework and to make all codes applicable in all settings instead of describing services specific to a particular site.
This article will discuss the coding guideline for psychologists and psychiatrists for virtual consults implemented in October of 2022. Also, this guideline applies to the calendar year 2023.
Psychiatry CPT Codes 2023
The table below are some of the most commonly reported psychotherapy CPT codes. Please note that this is not a complete list of CPT codes. The information is merely a general outline of mental health services commonly provided.
|CPT Code 90791||Psychiatric diagnostic evaluation without medical services|
|CPT Code 90792||Psychiatric diagnostic evaluation with medical services|
The following psychiatry CPT codes above are used for billing psychiatric diagnostic evaluations, psychotherapy, and other psychiatric services.
Psychotherapy CPT Codes 2023
According to CPT, the following psychotherapy services are appropriate for virtual consultations:
|90832||Psychotherapy, 30 minutes with patient|
|90834||Psychotherapy, 45 minutes with patient|
|90837||Psychotherapy, 60 minutes with patient|
|90846||Family psychotherapy (without the patient present), 50 minutes|
|90847||Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes|
|90849||Multiple-family group psychotherapy|
|90853||Group psychotherapy (other than of a multiple-family group)|
When to Use Psychotherapy CPT Codes?
The therapist must select the closest CPT code to the time spent during a psychotherapy session. Here is the APA’s list for the duration of psychotherapy sessions.
|CPT Code 90832||16 and 37 minutes|
|CPT Code 90834||38 to 52 minutes long|
|CPT Code 90837||53 minutes or longer|
|CPT Codes 90846 or 90847||26 minutes or more of family psychotherapy.|
Hence, individual psychotherapy CPT codes should be used only when individual psychotherapy is the focus of treatment.
A psychotherapy CPT code should not be used if another CPT code is more appropriate. For instance, using a pharmacological code or an evaluation and management (E/M) code for some services may be more appropriate. The CPT codes for psychotherapy are also time-based.
Although each psychotherapy code has a specific amount of time (30, 45, or 60 minutes) to be spent with the patient and/or family, the coding manual allows for some flexibility.
When the time does not match the exact time increments specified in the CPT code, the American Academy of Child & Adolescent Psychiatry (AACAP) has implemented a rule that ensures accuracy in recording time.
Find more information about psychotherapy from the U.S Department of Health and Human Services.
Psychotherapy Crisis Codes 2023 Changes
Behavioral health professionals can bill for emergency sessions using CPT codes for crises. In cases of distress or life-threatening situations, care providers generally use these crisis codes:
|90839||First 60 minutes of psychotherapy for crisis|
|90840||Add-on code for each additional 30 minutes of psychotherapy for crisis|
The CPT code 90839 represents a crisis psychotherapy session requiring urgent assessment, history, mental status evaluation, and disposition. The first 60 minutes of psychotherapy are billed for a patient in crisis. For sessions shorter than 60 minutes, you will bill for a regular psychotherapy code, such as 90834.
To qualify for the new crisis codes, the patient in high distress must present with a life-threatening or complex issue requiring immediate attention.
Interactive Complexity Add-On Code for Psychotherapy
|90785||Interactive complexity (List separately in addition to the code for primary procedure)|
Can be reported with the appropriate primary procedure (90791, 90832, 90834, 90837, or 90853) if at least one of four specific complicating factor(s) are present.
The add-on CPT code 90785, Interactive Complexity, was revised further in 2022 to ensure proper use and reporting. Furthermore, it refers to specific communication factors complicating mental health care delivery.
Typically, these factors are present in patients who:
- Other legally responsible individuals, like minors or adults with guardianships, can take care of them
- Involve others such as family members or interpreters during the visit
- Obtain third-party involvement, such as from schools or probation officers
For translation and interpretation services alone, interactive complexity cannot be reported.
The code 90785 may be reported in conjunction with codes for diagnostic evaluation (90791), psychotherapy (90832, 90834, 90837), and group psychotherapy (90853).
To report the interactive complexity code as an add-on to the principal psychological procedure, at least one of the four complicating factors identified in the CPT manual must apply.
Mental Health Add-On CPT Codes 2023
For routine outpatient mental health billing, below is a list of the most frequent Add-On codes.
|Add-On CPT Code||Descriptor|
|90785||Interactive complexity. Example: play therapy using dolls or other toys. This is an interactive complexity add-on code that is not a payable expense. This code only indicates that the treatment is complex in nature.|
|90863||Pharmacologic Management after therapy.|
|99050||Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.|
|99051||Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.|
|99354||Additional time after the additional time of 74 minutes. Adding another 30 minutes. (Only use if the duration of your session is at least 90 minutes for 90837 or 80 minutes for 90847).|
|99355||Additional time after the first 60 minutes. First additional 30 to 74 minutes.|
|90840||30 additional minutes of psychotherapy for crisis. Used only in conjunction with CPT 90839.|
|90833||30-minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, then has 30-minute session.|
|90836||45-minute psychotherapy add-on. Example: Clinical Nurse Specialist evaluates medication response, then has 45-minute session.|
In conclusion, we hope that this coding guideline will assist psychology and psychiatry practices in determining which CPT codes to use for their services. Providers of all fields must complete the necessary medical documentation, explain the medical necessity for services, and submit clean insurance claims.
Behavioral Health CPT Add-On Codes for 2023
A large number of these behavioral health CPT add-on codes correspond to a specific CPT code or a small set of CPT codes and cannot be applied in any other way.
Adding an “+” at the beginning of the number signifies that the number is an add-on code; for instance, +90840 is an add-on code for extra time during crisis psychotherapy.
|Add-On CPT Code +90785||Diagnostic or a normal psychotherapy session, but not a crisis psychotherapy session|
Other Behavioral Health CPT Codes for 2023
|90404||Cigna / MHN EAP CPT Code|
|96101||Psychological testing, interpretation and reporting by a psychologist (per Hour)|
|90880||Hypnotherapy – limit 10 units/hours per application|
|90849||Multiple family group psychotherapy|
If you are not sure what your license is for your state, you can consult this American Counseling Association page , which confirms your license and what you need.
Another Important Note:
All CPT codes displayed or referenced above are trademarked and copyrighted by the American Medical Association (AMA). The information is provided solely for educational purposes, with all rights reserved.
Tap Into Our Expertise
The American Medical Association hopes that the new coding will simplify physicians’ lives. It can be overwhelming to dive into coding changes. Concentrate only on the codes that pertain to your specialty— you’ll find it much easier.
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