In the realm of medical billing and coding, each medical service is assigned some specific code, which is a standardized number universally accepted by healthcare professionals, private insurers, and Medicare. These are called CPT codes and they hold significance in making the billing system effective and easy for all concerned parties. There are CPT code families for different health problems. Psychotherapy and mental health therapy also have some specific codes concerned with services provided to mental health patients. The 90833 CPT code defines psychotherapy with specifically defined criteria. Understanding billing and coding CPT code 90833 is very important for healthcare professionals to get used to this process for positive outputs.
In this blog, we will learn about the 90833 CPT code description, its clinical significance, eligibility criteria, and fee schedule. This PCC quick guide will also familiarize you with the billing guidelines, reimbursement guidelines, documentation guidelines, and other codes related to it.
90833 CPT Code description
When it comes to the mental health services, there are some standalone codes and some add-on codes for the services provided to the patients. Each mental health service and procedure has given a specific code which is mentioned in the medical bills rather than a full description of the medical services rendered.
90833 is a psychotherapy code that is concerned with the mental health therapy provided to the patient along with emergency and management (E/M) services. The 90833 CPT code time range is 16-37 minutes. The 90833 CPT code time includes both the time spent with the patients and the family members. The service can be both for therapeutic and counseling purposes. It is an add-on code, and it is billed with some other psychotherapy code. Services defined by the 90833 are provided with the medical evaluation and management.
Understanding CPT code 90833 is essential for effective billing and timely reimbursement to avoid potential revenue loss. Description about 90833 helps to bill the correct code, keeping in mind the time duration and the type of service provided. It is essential to note the time in one-on-one meetings between doctor and patient.
Understanding of add-on codes
In psychotherapy and many other health management plans, add-on codes work as supplement codes used in the medical bills to define the additional services provided along with primary management during the same visit. Add-on codes reflect the interactive complexity, crisis intervention and management, and other medical interventions during a therapy session.
CPT code 90833 is itself an add-on code that is billed with other codes for medical evaluation and management for established patient visits (e.g., 99213). It is used when psychotherapy sessions of 16-37 minutes are provided to the patients in the same visit for E/M services. A few important add-on codes used in mental health services are below:
- 90833: For psychotherapy sessions lasting 16 to 37 minutes with interactive complexity.
- 90836: For psychotherapy sessions lasting 38 to 52 minutes with interactive complexity.
- 90838: For psychotherapy sessions lasting 53 minutes or more with interactive complexity.
- 90839: For crisis psychotherapy, initial 60 minutes.
- 90840: For crisis psychotherapy, each additional 30 minutes.
Other CPT Codes in Mental Health
Psychotherapy generally comes with evaluation and management services, and it is important to know the E/M codes used in the field of psychotherapy and mental health. These codes are billed for the therapy sessions, and additional services are defined by the add-on codes. By understanding these codes, we can bill for the therapy sessions along with E/M services, and it also gives us an idea about the approach used in mental health treatment. There are a few E/M codes used in psychotherapy below:
CPT code | Description | Time interval (minutes) |
99201 | New patient evaluation and management | 10 |
99202 | New patient evaluation and management | 20 |
99203 | New patient evaluation and management | 30 |
99204 | New patient evaluation and management | 45 |
99205 | New patient evaluation and management | 60 |
99211 | Established patient evaluation and management | 05 |
99212 | Established patient evaluation and management | 10 |
99213 | Established patient evaluation and management | 15 |
99214 | Established patient evaluation and management | 25 |
99215 | Established patient evaluation and management | 40 |
Apart from E/M codes, there are many other codes that are also used in psychotherapy sessions to diagnose the mental health problems in the patient. These are diagnostic and evaluation codes. Two important diagnostic codes in the psychiatry departments are:
- 90791 defines the psychiatry diagnostic evaluation.
- 90792 defines the provision of medical services along with psychiatric diagnostic evaluation.
Difference between CPT codes 90832, 90833, 90834, and 90836
It should be kept in mind there are many other codes that define psychotherapy sessions. They differ from 90833 in time duration and associated E/M services.
- CPT 90832: It is a standalone code defining a therapy session of 30 minutes. There is no E/M service.
- CPT 90833: It is an add-on code defining a therapy session of 30 minutes. There is an E/M service provided.
- CPT 90834: It is a standalone code-defining therapy session of 45 minutes. There is no E/M service.
- CPT 90836: It is a standalone code-defining therapy session of 45 minutes. There is an E/M service provided.
90833 CPT Code Reimbursement Guidelines
Reimbursement is a very important part of the whole billing system and it is considered as cornerstone in maintaining financial stability. Therefore, it is recommended to understand and know every bit of information beforehand. Reimbursement guidelines as per federal and state laws should be followed to comply with rules and get reimbursed on time. There are few factors which influence the reimbursement rate.
Geographical Location: Location of your hospital setting matters a lot and according to the living cost of that area, reimbursement rate varies. In urban areas, reimbursement rates are different from that of rural areas. You can get the idea from reimbursement rates per session in different states of the US.
California | $175 per session |
New York | $150 per session |
Texas | $130 per session |
Type of Payer: Generally, reimbursement rate varies from $60 to $100 depending on the type of payer you use. Government plans like Medicare and Medicaid have less reimbursement rates as compared to the private insurers.
Medicare Reimbursement for CPT 90833
90833 CPT code reimbursement guidelines for Medicare are a bit different from the private insurers. The Medicare program does not ask for prior authorization or limitations on the number of therapy sessions. However, their other guidelines are strict as they need proper reports on the necessity of medical evaluation and management and psychotherapy sessions for mental health patients. Time duration should also be documented, and it should comply with code 90833. Everything should be documented and provided along with the claim for rendered services.
Private Insurance Reimbursement for CPT 90833
Private insurers are strict about everything from documentation to the number of sessions. Some insurers have guidelines like prior authorization and limits on the frequency of sessions. Healthcare professionals get the authorization for services by submitting the clinical indication report. It is recommended to go through all the rules and regulations of private insurance companies before contracting them.
Common Billing Errors with 90833 CPT Code
For billing code 90833, healthcare professionals can face a few issues leading to claim rejection and payment delay. If the objections are not addressed timely, then claims can be permanently denied, resulting in a revenue leak. Revenue is a major problem for any healthcare organization as it can compromise the quality of medical services and patient safety. Healthcare professionals should take care of the following common errors:
1. Insufficient Documentation
It is necessary to remember that 90833 is an add-on code. Billing it as standalone code can lead to direct claim denial and such silly mistakes can damage trust between healthcare professionals and payers. It can’t be billed separately. It is billed along with appropriate E/M code.
2. Incorrect Use of Code 90833
90833 CPT code time duration is the key factor in medical billing of this code, and this must be documented correctly. From clinical indication for psychotherapy session to the final result, everything should be documented and maintained as health records. Any missing document can lead to hindrance in smooth and effective billing. The time duration between 16-37 minutes should be mentioned separately for meeting with the patient and his family members.
3. Double Billing for E/M Services
This is a common error when E/M psychotherapy services are billed together. It is recommended to record time separately for E/M and psychotherapy sessions and document it properly. Overlapping time of E/M and psychotherapy results in double billing, which leads to claim rejection for good.
4. Billing for Non-Eligibility Providers
Government and private payers have their specific guidelines for the eligibility criteria to bill for 90833. Not all health professionals are allowed to bill for mental health services. Few categories of healthcare professionals are allowed to bill for 90833, i.e., psychiatrists and licensed qualified psychologists. Physician assistants can also bill for this code under the supervision of licensed physicians. Before providing psychotherapy sessions, providers must check their eligibility criteria to comply with all billing rules.
Conclusion
90833 CPT code is an add-on code that is used for billing for psychotherapy sessions, which last for 16-37 minutes. It can never be billed separately. Psychotherapy sessions for 90833 patients are given, along with evaluation and management sessions during the same visit. Therefore, it is billed along with the E/M code. There are many other CPT codes in mental health billing that are relevant to 90833. 99201-99215 are the diagnostic and evaluation codes for new and established patients.
CPT 90833 reimbursement rates depend on some factors including geographical position and type of payers. Medicare and private payers have specific requirements to comply with in order to get reimbursement. Documentation is of huge importance in the billing process, and it is advised that all information about the patient, provider, and duration of therapy sessions be documented. Common billing errors like insufficient documentation, double billing, and incorrect use of 90833 should be avoided for smooth claim approval.
FAQ - People Also Asks
CPT code 90833 is the add-on member of the mental health CPT code family. It is used to bill for psychotherapy sessions provided along with a conjunction of evaluation and management services. The 90833 CPT code time range is 16-37 minutes.
Fee structure for the 90833 psychotherapy sessions vary from state to state. Geographical location and type of payer affects the reimbursement rate. Some states offer higher rates than others depending on the living cost. Similarly, private payers pay higher rates than government payers like Medicare.
Code 90833 is used for the therapeutic or counselling purposes to take care of the patient in mental health. Psychotherapy sessions are provided to the patients during their E/M visit to the provider. Clear clinical indications, time spent with patients, management plan and positive outcomes are the main pillars of this code and these should be documented for billing.