CPT Code 90837: Essentials, Benefits, and Pitfalls

CPT code 90837 is a code used to document and bill a psychotherapy session that lasts for 60 minutes or more. This code is widely utilized by mental health professionals. They include psychologists, social workers, and psychiatrists. This way, they are appropriately compensated for extended individual therapy sessions.
Correct usage of this code requires an understanding of the specific time requirements, documentation standards, and payer policies. In this blog, we will explore the nuances of CPT code 90837, its indications, common issues, and best practices. They will help you manage the complexities of mental health billing.
What is CPT Code 90837?
CPT code 90837 is used for individual psychotherapy sessions lasting at least 60 minutes. For shorter sessions, use CPT 90832 (30 minutes) or CPT 90834 (45 minutes).
The 90837 CPT code is intended for comprehensive therapy sessions that require extended time to address complex mental health conditions such as severe depression, PTSD, and dual diagnosis cases. Providers typically use this code when intensive treatment is necessary to meet the patient’s clinical needs. Accurate medical coding ensures proper reimbursement and compliance with payer guidelines.
When to Use CPT Code 90837?
- Complex Cases: Use CPT 90837 when dealing with patients with complex psychological issues that require a more in-depth therapeutic approach.
- Trauma or Crisis Intervention: This code is suitable for patients who need crisis intervention or trauma-related therapies. For such services, a shorter session may not be sufficient to manage the situation.
- Comprehensive Treatment Planning: The additional time allows therapists to engage in thorough evaluations, patient management, and detailed treatment planning.
Documentation Essentials for CPT 90837
Accurate documentation is crucial when using CPT code 90837. The American Medical Association (AMA) guidelines stipulate that the session must be face-to-face. They should last at least 53 minutes to qualify for this code. Here are some of the key components that should be included in your documentation:
- Session Duration: Always record the exact start and end times of the session to justify the use of this code.
- Therapeutic Approach: Describe the therapeutic approach and techniques used during the session, such as cognitive-behavioral therapy (CBT) or psychodynamic therapy.
- Patient Response: Document the patient’s response to treatment, progress made, and any changes in their condition.
- Medical Necessity: Outline the necessity of a longer session, particularly for complex cases or crisis management.
Benefits of Using CPT Code 90837
There are various benefits that you can avail of by assigning the 90837 code to your service. Let’s take a look at some of those benefits in detail:
Enhanced Patient Care
Using CPT code 90837 enables providers to spend more time with patients who require intensive therapy. It enables a deeper exploration of psychological issues. This can lead to more accurate diagnoses and more effective treatment plans. As a result, you can ultimately improve patient outcomes.
Increased Reimbursement Rates
The CPT code 90837 is designated for longer sessions. It often results in higher reimbursement rates compared to shorter session codes like 90832 or 90834. This is beneficial for providers who need to allocate more time to patients with severe mental health conditions. It ensures that they are compensated fairly for their time and expertise.
Common Pitfalls in Using CPT 90837
Apart from the benefits, there are certain pitfalls as well that you must also consider. We have detailed the major ones for you below:
Upcoding Risks
One of the most common issues with using CPT 90837 is upcoding. It occurs when a provider bills for a 60-minute session when the session didn’t actually meet the time requirement.
Upcoding can lead to claim denials and may trigger audits or even legal repercussions. Therefore, it’s essential to accurately track and document the session duration to avoid compliance issues.
Lack of Supporting Documentation
Insufficient documentation is another common pitfall. Failing to document the medical necessity for the extended session length adequately can result in claim rejections. Always include details about why a longer session was required and how the patient benefited from the additional time.
Insurance Reimbursement Challenges
Insurance companies often scrutinize claims involving CPT code 90837 more closely. This is due to its higher reimbursement rate. As a result, providers may face increased denial rates and may need to submit additional documentation.
They may also have to go through a lengthy appeals process to get paid. Understanding payer-specific guidelines and maintaining comprehensive records can help mitigate these challenges.
Best Practices for Using CPT Code 90837
Healthcare providers have been implementing several best practices while assigning the CPT code 90837. Here is a look at the practices recommended by top providers:
- Adhere to Time Requirements: Ensure that sessions last at least 53 minutes as recommended by the AMA. This is the only way you can qualify for CPT 90837. Any session that falls short should be billed using an alternative code.
- Pre-authorization and Verification: Check with insurance companies beforehand to verify whether they cover 60-minute therapy sessions. Some payers may require pre-authorization or additional documentation to approve the claim.
- Use Modifiers When Needed: Use appropriate modifiers like -25 or -59 to indicate multiple services or sessions performed on the same day. Proper use of modifiers can prevent denials and improve claim acceptance rates.
- Thorough Documentation: Maintain detailed session notes that reflect the complexity of the patient’s condition, the interventions used, and the patient’s response to therapy. This not only supports medical necessity but also helps in case of audits or claim reviews.
Utilizing CPT Code 90837 for Different Conditions
The CPT code 90837 can be assigned to services meant for different mental health conditions. We have explained what goes on when you assign it to the common conditions:
Treating Major Depressive Disorder
Patients with severe depression often require prolonged sessions to delve into their symptoms, identify triggers, and implement coping strategies. CPT 90837 allows therapists to conduct comprehensive evaluations and provide in-depth therapy. It addresses the root causes of depression, rather than just managing symptoms.
Working with PTSD and Trauma Survivors
Trauma-focused therapies comprise prolonged exposure therapy and trauma-focused cognitive-behavioral therapy. They are time-intensive processes that necessitate longer sessions. CPT 90837 provides the necessary framework to address trauma-related issues effectively. This way, they enable in-depth exploration and processing of traumatic experiences.
Managing Anxiety Disorders
You may also have to treat patients with severe anxiety or panic disorders. For them, 60-minute sessions enable therapists to apply specialized techniques. Those techniques comprise exposure therapy and mindfulness-based stress reduction. They may require more time to be effective.
Avoiding Common Errors in Mental Health Billing
Providers frequently encounter issues when billing for CPT 90837. This can happen due to coding inaccuracies or inadequate documentation. Here are some common mistakes to avoid:
- Incorrect Use of Modifiers: Ensure that you use the appropriate modifiers, if necessary, to indicate multiple sessions or services provided on the same day.
- Inadequate Documentation: Failure to document the session duration or therapeutic approach used can lead to claim rejections. Be thorough and precise in your notes.
- Billing for Non-Face-to-Face Time: CPT code 90837 should only be used for face-to-face time with the patient. Time spent on documentation or coordination of care should not be included.
Strategies for Successful Reimbursement
We have also prepared a concise list of effective strategies that you can implement with this code to ensure maximum reimbursements:
- Regular Audits: Conduct regular audits of 90837 claims to identify and rectify any issues before they lead to denials.
- Staff Training: Train staff on the specific requirements for billing CPT 90837, including documentation and payer guidelines.
- Use Technology: Consider using electronic health records (EHR) systems that support time tracking and have built-in coding tools to minimize errors.
The Bottom Line
CPT code 90837 serves an essential function for mental health providers by enabling them to bill for extended therapy sessions. Accurate use of this code not only ensures fair reimbursement. It also allows providers to offer comprehensive care for patients with complex mental health conditions.
You have to follow best practices, fulfill documentation requirements, and stay informed about payer-specific guidelines. This way, you can maximize your reimbursement potential and reduce the risk of claim denials. Contact Health Quest Billing and onboard an expert team of medical coders.