Can You Bill CPT Code 90785 and 90837?
Billing for mental health services can sometimes feel like navigating a maze, especially when you’re trying to figure out which CPT codes apply.
Hubur Enterprises LLC’s medical billing services can take the guesswork out, allowing you to focus on what matters most—caring for your patients.
Two of the most common yet often confusing codes are CPT code 90785 and CPT code 90837. But can you bill these two together? Let’s break it down.
What Is CPT Code 90785?
The 90785 CPT code refers to interactive complexity, which is used to report sessions where communication factors complicate the treatment. These might include working with individuals who have language barriers, are highly emotional, or involve the presence of multiple participants like family members or caregivers. In mental health, it’s especially relevant for providers handling more complex cases.
CPT Code 90785 Definition and Description
The 90785 CPT code description highlights its role in interactive complexity. Providers can bill this when certain elements increase the complexity of communication during therapy. Interactive complexity examples include managing emotional family dynamics, dealing with language barriers, handling patients with behavioral disturbances or developmental delays, or those requiring communication assistance like translation services.
This add-on code is billed alongside primary psychotherapy codes like 90837, 90791, or 90832. It highlights the additional time and effort required to manage these complexities effectively.
But how frequently can you bill for code 90785 under Medicaid? It depends on the specific guidelines of your Medicaid plan and whether the patient’s treatment requires it for each session. Always ensure your documentation reflects why the interactive complexity CPT code was necessary.
By documenting these complications properly, providers can bill for interactive complexity when warranted, ensuring more accurate reimbursement for involved care.
What Is CPT Code 90837?
On the other hand, CPT code 90837 is for a psychotherapy session lasting 60 minutes. It’s one of the most frequently billed codes in mental health because many therapy sessions last for an hour.
So, if you’re providing EMDR therapy or other extended treatments, you’d likely use this code. Speaking of which, the CPT code for EMDR therapy also typically falls under 90837 or related psychotherapy codes.
Detailed Psychotherapy with CPT Code 90837
CPT code 90837 is designated for 53-60-minute psychotherapy sessions. It covers more intensive therapy involving complex interventions like Cognitive Behavioral Therapy (CBT) or crisis management. Accurate documentation is crucial, including session duration and medical necessity.
Additionally, insurance limitations may restrict its use to specific diagnoses or frequency caps. Proper billing of 90837 maximizes compensation while ensuring compliance.
Can You Bill CPT Code 90785 and 90837 Together?
Here’s the million-dollar question: can you bill CPT code 90785 and 90837 at the same time? The answer is yes, but it’s important to understand the criteria. CPT code 90785 is considered an “add-on code” for services that involve interactive complexity, which means you can bill it alongside 90837 if the session meets the complexity requirements. For instance, if you’re performing family therapy with a patient who has language barriers, both codes can be billed.
That said, some payers, like Medicaid, might have specific limitations. How frequently you can bill for 90785 under Medicaid will depend on the patient’s case and the payer’s guidelines. Always check with your payer to avoid denied claims.
Billing Considerations for 90837
Psychologists often ask, “Can you bill two units of 90837?” As the session for psychotherapy is specifically for 60 minutes, you cannot bill two units of 90837 for one session. However, you can bill other codes, like CPT 90832 for a shorter session (16–37 minutes) or CPT 90839, which can sometimes be used in crisis scenarios alongside 90837.
Final Thoughts: Navigating CPT Codes for Mental Health
When it comes to billing CPT code 90785 and 90837, ensure your documentation supports the need for each code. Using the right CPT codes not only ensures accurate billing but also reflects the care and complexity involved in the session.
FAQs about Billing CPT Code 90785 and 90837
Can you bill CPT code 90785 and 90837 together?
Yes, you can bill both CPT codes together. CPT code 90785 is an add-on for interactive complexity, which can be billed alongside 90837 when a session requires handling communication challenges or other complexities.
How often can CPT code 90785 be billed under Medicaid?
Billing frequency for CPT code 90785 under Medicaid depends on the patient’s case and payer guidelines. It’s essential to document the necessity for each session accurately.
What is the duration for CPT code 90837?
CPT code 90837 covers a psychotherapy session that lasts between 53-60 minutes, typically used for more intensive therapeutic interventions.
Are there any restrictions on using CPT code 90837?
Yes, some insurance providers may restrict the use of CPT code 90837 based on diagnosis or limit the number of times it can be billed. Make sure to get it checked and verified with specific insurance provider.
What types of therapy can CPT code 90837 be used for?
CPT code 90837 is often used for various types of psychotherapy, including Cognitive Behavioral Therapy (CBT), EMDR therapy, and crisis intervention sessions.
