CPT Codes for Behavioral Health Billing

Accurately using CPT codes for behavioral health billing is important for mental health professionals to ensure proper reimbursement for their services. These codes categorize the specific services provided during a patient encounter. Understanding these codes and their appropriate application helps streamline the billing process and avoid potential claim denials.

The Importance of CPT Codes for Behavioral Health Billing

CPT codes act as a common language for insurance companies to understand what services therapists provide. These codes translate the type of therapy (individual, family, or group), session duration, and patient involvement into a format for accurate reimbursement.

Why are these Codes Important?

  • Get Paid Right

Using the right codes ensures you get properly reimbursed for your services.

  • Faster Billing

Knowing the codes helps bill insurance companies quickly and easily.

  • Less Hassle

Using the correct codes reduces the risk of getting your claims denied.

The Top 10 CPT Codes for Behavioral Health Billing 

Here’s a breakdown of the top 10 CPT codes for behavioral health billing in 2024:

  1. Individual Psychotherapy

  • 90832: Psychotherapy, 30 minutes (16–37 minutes)
  • 90834: Psychotherapy, 45 minutes (38–52 minutes)
  • 90837: Psychotherapy, 60 minutes (53 minutes and over)

These codes represent individual therapy sessions with varying durations. Code selection depends on the actual session length. It’s important to document the session start and end times accurately to ensure proper coding.

  1. Family Psychotherapy

  • 90846: Family or couples psychotherapy, without patient present (family meeting with therapist)
  • 90847: Family or couples psychotherapy, with the patient present (traditional family therapy session)

These codes differentiate between family therapy sessions where the patient is present (90847) and those solely involving family members without the patient (90846).

  1. Group Psychotherapy

  • 90853: Group psychotherapy (not family)

This code applies to therapy sessions involving multiple patients who are not related.

  1. Initial Diagnostic Interview

  • 90791: Psychiatric diagnostic evaluation without medical services

This code is used for the initial evaluation session, where the therapist gathers information to diagnose a mental health condition. There’s no medical component to this service.

  1. Individual Therapy with Biofeedback Training

  • 90875: Individual therapy with biofeedback training

This code is used for individual therapy sessions incorporating biofeedback techniques, which involve monitoring physiological responses to help patients manage stress or anxiety.

  1. Telephone Therapy

  • 98968: Telephone therapy (non-psychiatrist): limit 3 units/hours per application (check with your payer for specific limits).
  • 99443: Telephone therapy (psychiatrist), limit 3 units/hours per application (check with your payer for specific limits)

These codes are used for therapy sessions conducted over the phone. The specific code depends on whether the provider is a psychiatrist (99443) or another qualified mental health professional (98968). It is important to confirm coverage and limitations with each payer regarding telephone therapy.

  1. Couples Therapy

While not a separate code category, couples therapy can be billed using the family therapy codes (90846 & 90847) as it involves two individuals in a committed relationship.

  1. Evaluation and Management Services (E/M)

While not exclusive to behavioral health, E/M codes (e.g., 99201-99205 for new patients, 99211-99215 for established patients) are used for psychiatry services that involve a medical component, such as medication management or co-occurring medical conditions.

  1. Preventive Medicine Counseling

  • 99404: Preventive medicine counseling for 60 minutes

This code applies to counseling sessions focused on preventing mental health concerns or promoting emotional well-being.

  1. Additional Codes

There are several other CPT codes for behavioral health billing that may be used in specific situations. It’s essential to consult the latest CPT code manual or reliable resources for a comprehensive list.

Understanding Modifiers

While CPT codes provide the foundation for billing, modifiers add additional details about the service provided. These can impact reimbursement or clarify specific circumstances. Here are some common modifiers used in behavioral health billing:

  • 95 Modifier: Identifies synchronous telehealth services, meaning the therapy session occurred virtually in real-time with audio and video technology.
  • GT Modifier: Similar to 95, but specific to Medicare for synchronous telehealth services.
  • 25 Modifier: Indicates a significant, separately identifiable evaluation and management service provided on the same day as another service by the same provider.
  • 52 Modifier: Used for reduced psychotherapy services, meaning the session was shorter than the typical duration for the billed code.

Staying Updated on CPT Codes

CPT codes are updated annually. Here are some resources to stay informed:

  • The American Medical Association (AMA) publishes the CPT code manual and offers coding resources.
  • The American Psychiatric Association (APA) provides resources for mental health coding.
  • The National Alliance on Mental Illness (NAMI) offers coding guidance for behavioral health services.
  • Online Coding Resources: Several websites offer information on CPT codes, including sections on behavioral health coding.

Conclusion

Understanding and applying CPT codes accurately, along with relevant modifiers, ensures proper reimbursement and streamlines billing. By familiarizing yourself with these top codes and using the available resources, you can confidently navigate the coding and make sure you receive fair compensation for your valuable services.

FAQs

  1. Why are CPT codes important for therapists?

CPT codes are a language used by therapists and insurance companies. They tell the insurance company exactly what kind of therapy session you provided (individual, family, or group), how long it lasted, and who participated. Using the right CPT code ensures you get properly reimbursed for your services.

  1. What are some of the most common CPT codes for therapy billing?

There are many CPT codes, but some of the most common ones for therapists include:

  • Individual therapy (different codes for 30, 45, and 60-minute sessions)
  • Family therapy (with or without the patient present)
  • Group therapy
  • Initial diagnostic interview
  • Telephone therapy
  1. What are modifiers and why are they important?

Modifiers are like extra details you can add to a CPT code. They tell the insurance company something specific about the session, like if it was done virtually or if it was shorter than usual. Using the right modifiers can help ensure your claim gets paid correctly.

  1. How can I stay up-to-date on CPT codes and modifiers?

CPT codes and modifiers are updated every year! Here are some resources to help you stay informed:

  • American Medical Association (AMA)
  • American Psychiatric Association (APA)
  • National Alliance on Mental Illness (NAMI)
  1. Where can I find a complete list of CPT codes?

The official CPT code manual is the most comprehensive list of codes available. You can purchase it from the AMA website.

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