Psychotherapy Codes for Psychologists

All mental health professionals including psychologists, psychiatrists, nurses, and social workers delivering psychotherapy services use the same applicable CPT^® codes when billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid, and private health insurance carriers. This family of codes was last revised in 2013 in order to simplify the coding framework and allow all codes to be used in all settings, instead of describing site-specific services; however, additional revisions were made to CPT code 90785; Interactive Complexity, in 2022 to ensure proper use and reporting of the service.

The time for each psychotherapy code is described as time spent with the patient and/or family, and although the time for each code is specific (30, 45, or 60 minutes), the coding manual allows for some flexibility.

When reporting a psychotherapy service, the provider may apply the CPT “Time Rule” and choose the code closest to the actual time of the session:

There are “add-on” codes for specific services that can be provided only in combination with other diagnostic evaluation, psychotherapy, and group psychotherapy services. Add-on codes identify an additional part of the treatment above and beyond the principal service. Both the principal service code and add-on code should be listed on the billing form.

There are psychotherapy services that can be provided via telehealth. See the telehealth services web page.

Add-on code 90785 for interactive complexity refers tospecific communication factors that complicate the delivery of a mental health procedure.

At least one of the four complicating factors identified in the CPT manual must pertain in order for providers to report the interactive complexity code as an add-on to the principal psychiatric procedure.

Complicating factors include, for example, difficult communication with acrimonious family members and engagement of verbally undeveloped children. These factors are typically found with patients who:

• Have others legally responsible for their care, such as minors or adults with guardians
• Request others such as family members or interpreters to be involved during the visit
• Require the involvement of third parties such as schools or probation officers

Interactive complexity cannot be reported solely for the purpose of translation or interpretation services.

Code 90785 may be reported with codes for diagnostic evaluation (90791), psychotherapy (90832, 90834, 90837) and group psychotherapy (90853).

Of particular interest to prescribing psychologists, add-on code 90863 is used for pharmacologic management, including prescription and review of medication, when performed on the same day as one of the stand-alone psychotherapy codes (90832, 90834, 90837).

A psychologist providing a psychotherapy service with medication management should report the 90863 add-on code along with the applicable psychotherapy code.

CPT code 90839 is the principal code for a crisis psychotherapy session requiring urgent assessment and history of the crisis state, mental status exam, and disposition. It is billed for the first 60 minutes of psychotherapy for a patient in crisis.

If/when the crisis psychotherapy session lasts longer than 60 minutes, the add-on code, 90840, can be billed for each additional 30 minutes of psychotherapy for crisis.

In order for the new crisis codes to apply, the presenting problem must typically be life-threatening or complex and require immediate attention to a patient in high distress.

• 2022 guidelines for reporting interactive complexity
• The 2013 psychotherapy codes: An overview for psychologists
• Psychotherapy services frequently asked questions

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