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Psychotherapy is the treatment of mental illness and behavioral disturbances in which a physician or other qualified health care professional establishes professional contact with a patient through therapeutic communication and techniques, attempts to alleviate emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.
Psychotherapy times are for face-to-face services with the patient and/or family member. The patient must be present for all or some of the service. The psychotherapy service CPT codes 90832–90838 include ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of family member(s) or others in the treatment process.
In calendar year 2016, Medicare Part B allowed approximately $1.2 billion for psychotherapy services, including individual and group therapy. A prior Office of the Inspector General (OIG) review found that Medicare allowed $185 million in inappropriate outpatient mental health services, including psychotherapy services. The review found that psychotherapy services were particularly problematic, noting that almost half of the psychotherapy services reviewed were inappropriate.
Specifically, Medicare paid for services that were not covered, inadequately documented, or medically unnecessary. The OIG plans to review Part B payments for psychotherapy services to determine whether they were allowable in accordance with Medicare documentation requirements.
In calendar year 2014, the Comprehensive Error Rate Testing contractor (CERT) found the following documentation errors:
- No documentation of the amount of time (length of the session) spent with the patient
- No documentation of the modalities of treatment
- No documentation of progress to date
- No updated treatment plan
When a beneficiary receives an Evaluation and Management (E/M) Service service with a psychotherapeutic service on the same day, by the same provider, both services are payable if they are significant and separately identifiable and billed using the correct codes.
An add-on code is eligible for payment only if reported with an appropriate primary service performed on the same date of service. Time spent for the E/M service is separate from the time spent providing psychotherapy and time spent providing psychotherapy cannot be used to meet criteria for the E/M service.
Because time is indicated in the code descriptor for the psychotherapy CPT codes, it is important for providers to clearly document in the patient’s medical record the time spent providing the psychotherapy service rather than entering one time period including the E/M service.
Coding guidelines for Psychotherapy include the following:
- CPT Code 90832: 30 minutes with the patient and/or family member
- CPT Code +90833: Psychotherapy, 30 minutes with patient and/or family member when performed with an E/M service (list separately in addition to the code for primary procedure)
- CPT Code 90834: Psychotherapy, 45 minutes with patient and/or family member
- CPT Code +90836: Psychotherapy, 45 minutes with patient and/or family member when performed with an E/M service (list separately in addition to the code for primary procedure)
- CPT Code 90837: Psychotherapy, 60 minutes with patient and/or family member
- CPT Code +90838: Psychotherapy, 60 minutes with patient and/or family member when performed with an E/M service (list separately in addition to the code for primary procedure)
Note: (+) represents an add-on code
For psychotherapy services provided without an E/M service (CPT codes 90832, 90834, 90837), the correct code depends on the time spent with the beneficiary.
In general, providers should select the code that most closely matches the actual time spent performing psychotherapy. CPT® provides flexibility by identifying time ranges that may be associated with each of the three codes:
- CPT code 90832 (or + 90833): 16 to 37 minutes
- CPT code 90834 (or + 90836): 38 to 52 minutes
- CPT code 90837 (or + 90838): 53 minutes or longer
Note: Do not bill psychotherapy codes for sessions lasting less than 16 minutes.
The correct E/M code selection must be based on the elements of the history, exam, and medical decision making required by the complexity/intensity of the patient’s condition.
The psychotherapy code is chosen on the basis of the time spent providing psychotherapy.