Last Modified: 9/6/2024
Location: FL, PR, USVI
Business: Part B
First Coast in collaboration with CMS continues to focus on lowering CERT (Comprehensive Error Rate Testing) error rates. One area of concern identified in the CERT data is lack of documentation of face-to-face time to support the psychotherapy code billed.
The medical record must indicate length of time spent in the psychotherapy encounter.
The following timed psychotherapy codes apply in all settings (e.g., office, outpatient, inpatient). Select the code that most closely matches the actual time spent.
• 90832: Psychotherapy, 30 minutes with patient (16 to 37 minutes)
• 90834: Psychotherapy, 45 minutes with patient (38 to 52 minutes)
• 90837: Psychotherapy, 60 minutes with patient (53 minutes or longer)
Note: Do not report psychotherapy codes for any session lasting less than 16 minutes.
E/M (evaluation and management) services performed on the same day as a psychotherapy service (same physician or other health care professional) must be significant and separately identifiable to bill both psychotherapy and E/M.
The following time-based psychotherapy codes are "add-on" codes to E/M services (99202-99255, 99304-99337, or 99341-99350). Select the psychotherapy code that most closely matches the actual time spent.
• 90833: Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (16 to 37 minutes)
• 90836: Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (38 to 52 minutes)
• 90838: Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (53 minutes or longer)
Note: Do not report psychotherapy codes for any session lasting less than 16 minutes.
Effective January 1, 2023, codes 99354, 99355 have been deleted. No new CPT code(s) have been created to take their place.
• 99354 and 99355 -- Prolonged service with direct patient contact (except with office or other outpatient services)
For prolonged Medicare E/M services on the date of an outpatient service, home or residence service, or cognitive assessment and care plan, use HCPCS code G2212. This code can only be used with E/M codes, not psychotherapy codes 90837 or 90847.
Reminder -- you can still use 99354 and 99355 to bill for sessions on dates of service prior to January 1, 2023.
CPT codes 90832-90838 include all psychotherapy provided to a patient with family members as informants, if present, for a single date of service. Family psychotherapy (e.g., CPT codes 90846, 90847) focused on the patient addressing interactions between the patient and family members may be reported separately with psychotherapy (CPT codes 90832-90838) on the same date of service if performed as a separate and distinct service during a separate time interval.
Psychotherapy (CPT codes 90832-90838) performed in a Medicare partial hospitalization setting (POS 52) may be reported with more than one unit of service to reflect the amount of psychotherapy provided during a single date of service.
Note: CPT codes 90832-90834 and 90836-90838 should not be reported with a unit of service greater than one except when performed in a Medicare partial hospitalization setting (place of service [POS] 52). Effective July 1, 2022, services are denied when reporting more than one unit of service (except in POS 52).
References:
American Medical Association (AMA) CPT Professional 2022 Book
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