2013 CPT Code Revisions: What the Changes Mean for Counselors

2013 CPT Code Revisions: The mental health community is abuzz about the 2013 Current Procedural Terminology (CPT) code changes. Don’t worry; CPT codes are still boring! This article will explain the changes, and what you need to know to prepare for them.

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Starting January 1, 2013, a number of CPT codes for psychiatry and psychotherapy services will be revised. For instance, if you bill a “90806” to a third party payer after December 31st, the claim will be denied. And if you talk about having a “90806 appointment” with colleagues in 2013, they will roll their eyes at you because “Gosh Judy, you’re so last year!”

CPT codes are set by the American Medical Association (AMA), and are revised on an annual basis. This year, the revisions are substantial. Fortunately for counselors, many of the changes concern psychiatry, and not psychotherapy.

Major Psychiatric Revisions

The CPT revisions that effect psychiatrists are more complicated than those that effect counselors and psychologists. For those who run group practices, here are five major psychiatric CPT revisions:

  1. Evaluation and management (E&M) plus psychotherapy codes will be retired (including “90805” and “90807”)
  2. Codes for psychotherapy and E&M services are now differentiated
  3. The code “90801” will be replaced by “90792” for “a diagnostic evaluation with medical services”
  4. Pharmacologic management codes will be retired (providers are to use an E&M code)
  5. 2013 introduces “add-on” codes for psychiatry, which are services in addition to a primary service (not a stand-alone service)[i]

…and several other changes.

Major Psychotherapy Revisions

The CPT code revisions that effect counselors are simple and straightforward. Here is a list of psychotherapy CPT codes that will be retired, and their 2013 comparables:

  • 90801 –> 90791 (diagnostic evaluation without medical services)
  • 90804 –> 90832 (was 20-30 minutes psychotherapy, now 30 minutes)
  • 90806 –> 90834 (was 45-50 minutes psychotherapy, now 45 minutes)
  • 90808 –> 90837 (was 75-80 minutes psychotherapy, now 60 minutes)

 

Family therapy codes (90847 and 90846) will remain unchanged, as will codes for psychological testing.

A Note on Service Duration Changes:

As seen above, unlike existing codes that provide a service time range (i.e., 45-50 minutes), 2013 code descriptions list fixed times (i.e., 45 minutes). However, according to the 2013 CPT manual, providers still have flexibility. Respectively, 16-37 minutes for code “90832,” 38-52 minutes for code “90834,” and 53 minutes or more for code “90837.” When reporting a service, a provider should choose the code closest to the actual duration.[ii]

Will Reimbursement Rates Change?

It is unlikely that the 2013 CPT code revisions will affect reimbursement rates for counselors. That said, several large third party payers (including Medicare and Medicaid) are expected to announce their 2013 service rates in November.

Preparation

An experienced medical biller should be able to adjust to the 2013 CPT codes without much difficulty. Similarly, quality practice management software companies are already prepared for the code revisions, and are ready to apply them on 1/1/13. For most psychologists, social workers, and professional counselors, adopting the new CPT codes will be a simple administrative change that won’t affect their clinical workflows.

Need more? Continue reading about CPT Code Add-Ons For 2013

Author:

Counseling Private PracticeDr. is CEO of Thriveworks, is Private Practice Consultant for the American Counseling Association, and Author of “How to Thrive In Counseling Private Practice.” Learn more at http://thriveworks.com/counseling-private-practice-book/

Looking for help starting or growing a private practice? We can help! Learn more at http://thriveworks.com/private-practice


[i] Source: National Council for Community Behavioral Healthcare at www.TheNationalCouncil.org

[ii] www.apapracticecentral.org/update/2012/09-27/psychotherapy-codes.aspx. The 2013 AMA CPT Professional Edition Manual can be purchased on Amazon.com: www.amazon.com/Professional-Edition-Current-Procedural-Terminology/dp/1603596844

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Comments

  1. says

    I am in CO which does not require licensure for a psychotherapist. Can a bachelor’s level counselor bill CPT coding for individual and family psychotherapy services?

  2. says

    I was wondering if anyone can tell me the reimbursement rates for major insurance companies for the following codes: 90834 (45 minute outpatient psychotherapy session) and 90837 (60 minutes) for Master’s Level and Doctorate Level?

  3. Tammie Presley says

    I am a LPC-MHSP and a LSPE in my private practice in TN. I have been seeing a client through her Workers Compensation which is managed by Gallagher Bassett Services out of Florida where the robbery took place. I have not got paid for any 2013 claims because of a rejected procedure code. I initially billed for the new 90837 which replaced our old 75 minute code. when I got the denials I assumed that the Workmans Compensation denied because they would only accept the new 45 minute code, so I rebilled using the 90834. However, the claims were still rejected because of invalid cpt codes. When I called to speak with someone today at Gallagher Bassett/workmans compensation services, I was told that denial was for invalid code but that they were not billers so I would need to search acceptable cpt codes for Workman Compensation in Florida. Could there be a different set of cpt codes for Workman Compensation in Florida and if so I would someone suggest I find out what the accepted codes are? It just feels like I am getting the round around. Tammie Presley

  4. Amanda says

    I’ve received the same issue with TMHP (Texas Medicaid & Healthcare Partnership) and the 90791. I guess when they changed from 90801 they decided to change the underlying guidelines for reimbursement as well! Which is very frustrating. I’ve asked the reps at Medicaid and they are of no help. I’ve scoured the internet and this is the first article I have come across that has talked about the intake code issue with Medicaid.

    For LPCs, we cannot be reimbursed for 90791 or 90792 or the interactive complexity add on 90785! I’m thinking about just sending in 90837 so we can at least get some sort of reimbursement for our time!

    If anyone has found a different solution for this, please email me at amandaprokos@spiritreins.org. It would be greatly appreciated!

  5. Kathy says

    We are a billing company and for our therapist we have been using the 90837 for workers compensation patients and we are getting denied not a valid code. Please help me in determining the correct 2013 cpt code fo workers compensation claims in the state of Florida.

    • Anthony Centore says

      Without knowing what insurance company you are billing, it is hard to say. Sometimes workman’s comp companies do not use the specific codes and forms that you normally use; they may have their own method. It could also be that you do not have an authorization to bill for the 60 minute session. Some of our regular insurances will only allow up to 45 minutes. 90837 is a valid code but they may require different coding based on the particular insurance.

      thanks!

      Alicia
      Medical Billing

  6. Sherri says

    I have been having the same problem as Dawn stated above and TMHP told me the same thing today. So I was wondering if someone could please help me with this issue or had any other information regarding this. Thanks in advance.

  7. Dawn says

    Hi, just wanted to know if anyone is getting denials for CPT code 90791 for a LPC. I’m being told this is not a covered service for a LPC only for a Psychiatrist.

  8. Sylvia says

    its important that all therapists value their time and demand equitable payment. I for one will drop any insurance carrier who drops my reimbursement past $60.00. I’d rather get a part-time job and not have to deal with all the paperwork than take less money. By the time you look at the overhead what are you really making?

  9. Barbara says

    I am in Ohio. I am cash only – out of network. I give superbills to pts so they can get reimbursement from their insurance companies. If State or Federal secrets were as closely guarded as the insurance companies are guarding their information about how to code in a way that they will accept then there would be no leaks of classified information. They will not disclose to me or my pts what codes they will accept other than to say many will not be accepted unless clinician is MD or PhD. I have not been able to find a replacement they will accept for 90 minutes. Has anyone been able to get reimbursement for 90 min?.

  10. Elley1994 says

    I’m in Illinois and have not seen a rate change for bcbs. For a 45 min session the reimbursement rate is 88.20. This is the same rate as last year. Humana lowered their Rates last year to 43 for a standard 45 min session so I did not renew my contract with them. Cigna and Aetna have remained the same at 60. I’m out of network with united and usually get reimbursed around 70 something. I don’t know if illinois is different right now or if I’m not getting the updated reimbursement rates yet? I bill electronically and get my eob payments in about 3 weeks from bcbs and have been paid for 2013 sessions. As for a 60 min code…. Well alot of instance companies want you to get pre auth for it or you need to appeal the claim after it gets rejected submit your case notes to prove why that length of a session was medically necessary to justify that length of treatment. Family sessions are still being paid out as a 90847 with a higher rate of reimbursement vs a individual session through bcbs but Cigna and Aetna pay less for a family… Why? There’s no consistency with reimbursement claims when clearly a family session is more work! Seems only bcbs recognizes this. Also with the inter comp add on code I’ve been getting denied on that code from bcbs for several patients saying that their claim does not cover that code. So it seems that it depends on each individuals policy. When you call to verify benefits ask if the policy covers codes xx, xx, xx etc and see if pre auth is necessary for a 60 min session. What use to be a 90808…. Also I’ve experienced a rejected on a crisis code so I needed to submit notes to prove it was a crisis. Just a scam to get out of paying a higher reimbursement claim in my opinion.

    Does anyone have info on a lpc being paid lower than a Lcpc for 2013? Or insurance companies now my allowing a lpc to get reimbursement from ? What insurance companies while billing under a group?

  11. Karyn says

    I can tell you from receiving my first out of network claim payment,one of the REAL Large carriers-NE is paying $40 less for the 90837 (and this is used in a private practice)than for the 90808. This is going to be a drastic assault on my relationship with my analyst (whom I meet with multiple times a week). Somebody needs to do something fast.

  12. lynda holliday says

    But the Rates DID get reduced and in MA, BCBS is ONLY reimbursing 90834 (formerly know as the 90806 — 50 min session f/u), at $50.51 (NOT the former $70.10/ 50 minute session). They are also DENYING 90837 codes — outright for private practitioners here. ( I am a LMHC ).I am in a small, private practice that is approx. 30-40% BCBS — this change represents a HUGE cut in revenue for me. What should I do? Any suggestions? I have several colleagues in the same situation altho it seems (some) other states are not having the same issue. Thanks for ANY help you can offer. ~ Best, Lynda
    PS: no other rates or reimbursement seem to have been reduced EXCEPT the BCBS – why?

  13. Roberta Rinaldi says

    Pardon me, but you are absolutely wrong that our reimbursement rates will not change. I just got a letter from Cigna today, stating that what used to be 90806, paid at $60/session, has now become 90834, paid at $42/session. It’s bad enough that we haven’t had a raise in over 20 years, now this!!!

    • Anthony Centore says

      Hi Roberta!
      Thanks for your comment! I’m sorry to hear that your rates went down–ouch! I think in the video I was explaining that rates won’t go down because of the new codes, but rates will and do change all the time. In particular, every November many companies announce their rates for the following year. It’s likely that United/UBH’s rates are going down in response and preparation for the new healthcare reforms…but who knows, really….I agree that it completely sucks. I know some providers that are calling UBH and complaining. If enough providers refuse to accept the new rates, UBH’s customers (the clients) will begin complaining, as will their employers…all this will put pressure on United to raise their reimbursement rates. I hope this helps Roberta!

  14. Sondra Brumett says

    Hi Dr. Centore, I almost always see clients for 60 minutes (sometimes more) and was wondering how can I find out (without actually calling every insurance company) which insurance companies will require clinicians to get pre-authorizations to bill the 90837 code?

    • Anthony Centore says

      Sondra,
      Thanks for your comment. I think that’s just something you’re going to need to call about.
      If you find more information than we have, please let us know!

  15. Kim says

    We are having a discussion now in our office on how to bill. Our typical sessions last 45-50 minutes and we did the required paperwork in the last 10 minutes from the (51-59 minute range). The typical remimbursment rate was $65 more or less.
    Now the new code allowed for LPC’s is to replace a 90806 with a 90834 with a reimbursement rate of $50, a $15 paycut per client.
    My question is can we bill for 90834 (38 minutes-up to 52 minutes). Could we see the client for 38 minutes and spend the rest doing paperwork? Here is the new definition regarding all the new codes. My question what constitures Time spent with the patient vs. face to face? If we saw clients as we previously had 45-50 minutes we would lose $150 a day or more.
    Definition of new codes.
    ” THE TIME FOR EACH PSYCHOTHERAPY CODE IS NOW DESCRIBED AS BEING AS TIME SPENT WITH THE PATIENT AND/OR FAMILY MEMBER, A CHANGE FROM THE PREVIOUS PSYCHOTHERAPY CODE TIMES, WHICH DENOTED ONLY TIME SPENT FACE-TO-FACE WITH THE PATIENT. ”

    Hope that makes sense. As we can’t bill 90837 a 60 minute session. I don’t believe we can add on time either say for example a 90832 and 90834.

  16. Holly Yates says

    I am actually one of those counselor s that has billed 90808 retry regularly. I find some if the most important work gets done in gets done in those remaining 15 minutes. Be that as it may As far as reimbursement what can I expect to be reimbursed for a 90837

    Thank you

  17. Jennifer Krumm says

    I am wondering about the reimbursement of the new 90834. I have a 60 minute hour and always billed the 90806 for $90 an hour. If I did an extended session, up to 90 minutes I would bill the 90808. But the new code for that has the time being more than 53 minutes. So do I charge the $90 for a 90837 and find another code for an extended session? Or do these codes assume that counselors use a 50 minute hour? If that’s the assumption I will continue to bill $90 an hour under the 90834. Did this make sense? I even got confused. ha ha

  18. Lauren says

    Where can I find a comprehensive list of E/M codes for psychiatry/psychotherapy? We are a small office and neither myself or the office manager have more than 3 years of medical billing experience so we don’t know how to use other codes aside from good old 90801, 90805, 90807, and 90809. Thank you in advance!

  19. joan says

    What can you tell me about the code add on for interactive (the soon invalid 90812, 90814, 90802 etc). Most specifically, how to use the 90785 on a CMS 1500. Also, what is criteria for using the new code for crisis?

  20. Jan Stillpass says

    According to the material I’m reading, I assume that as a LCSW I no longer use 90808 for extended sessions and that I am free to continue seeing a few people for extended time as long as I don’t expect to get paid for that additional time? Or do I use the new 90837 code with an add-on code or the interactive complexity code for psychotherapy sessions? I am also assuming that we no longer use 90847 as I can’t seem to find it listed anywhere? Lastly, I still do paper claims; are there any resources that provide examples of a HCFA 1500 with new changes?

  21. Barbie says

    Our practice has contracts with several insurance companys and we bill the standard codes: 90801, 90806 etc. Our contracts do not stipulate the new codes coming in 2013. Is it possible if we bill the new 2013 CPT codes, they will be denied because we don’t have contracted rates for these new codes?

    • Thriveworks says

      HI Barbie.
      Good question! The answer is that your claims should be fine, and your contract should honor the new codes without a problem. It is likely that your contract lists the CPT codes simply to identify the specific services that are allowed you to bill for (of course, if you are still concerned you can always call your insurance company but I am pretty certain you are all set). I hope this helps!

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