- Individual psychotherapy codes are time based codes
- They may be reported as a stand alone service, or at the same visit as medication management
- They follow the CPT time rule: use the code when the mid-point in the defined time is met
- 2023: No longer a prolonged care code for use with psychotherapy services. Prolonged codes 99354, 99355 were deleted in 2023. The existing prolonged care CPT code for office visits, 99417, may not be used with psychotherapy codes 90837 or 90838. There is no way to report prolonged care with psychotherapy. Psychotherapy codes are reported as one unit/day. Using two units with the highest level psychotherapy code is bound to be denied.
- CPT Assistant July 2022 was asked about prolonged services codes with psychotherapy and said that the prolonged services codes in the E/M section could not be reported by practitioners who don’t have E/M in their scope of practice.
Individual psychotherapy, 90832, +90833, 90984, +90836, 90837, +90838
There are two sets of psychotherapy codes. One set is the set of codes to report psychotherapy only. (90832, 90834, 90837) While these are most frequently reported by social workers, psychologists and therapists, they can be reported by psychiatrists, psychiatric NPs and PAs if medication management’s not performed at the same visit. These are time-based codes and do not differentiate by the type of psychotherapy or the location of the therapy. The psychotherapy codes follow the CPT® mid-point rule which state that in order to report the service you need to meet the threshold of over half of the time described in the CPT® code. That is, if the time described in the code is 30 minutes, the clinician must perform that service for at least 16 minutes in order to report the service.
The second set of individual psychotherapy codes set are add-on codes, +90833, +90836, +90838. These are indicated by a plus sign in the chart below, which are added on to an E/M service, when both medication management and psychotherapy are performed on the same calendar date. These are billed by psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants.
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