What Is CPT Code 90837 and When Should You Use It?
Demystify CPT Code 90837. Learn its precise application, usage criteria, and critical documentation for accurate psychotherapy billing and compliance.
Medical services require a standardized way to describe them for consistent record-keeping and processing. These standardized descriptions are fundamental for clear communication among healthcare providers, insurance companies, and patients. They play a significant role in ensuring that services rendered are accurately identified and appropriately processed for reimbursement, facilitating the efficient flow of healthcare operations.
Understanding CPT Codes
Current Procedural Terminology (CPT) codes are medical codes used to describe medical, surgical, and diagnostic services. These codes provide a uniform language for documenting and reporting healthcare procedures and services. They serve as a critical link in the healthcare system, allowing for precise communication regarding the types of care patients receive.
These codes are regularly updated to reflect advancements in medical practice and technology. Healthcare professionals utilize CPT codes to report services to payers, enabling consistent billing and reimbursement processes across various healthcare settings. This standardization helps streamline administrative tasks and contributes to the transparency of medical services.
Specifics of CPT Code 90837
CPT Code 90837 designates “Psychotherapy, 60 minutes with patient and/or family member when present.” This code is used for individual psychotherapy sessions, focusing on direct therapeutic interaction between a licensed mental health professional and a patient. The service involves a face-to-face encounter, where the clinician employs various therapeutic interventions aimed at addressing the patient’s mental health conditions.
The time component associated with this code is important for billing. While labeled as “60 minutes,” the industry standard typically requires the session to last 53 minutes or longer. This duration represents the actual time spent in direct therapeutic engagement with the patient, excluding administrative tasks or breaks. The interventions provided during this period are designed to facilitate insight, symptom reduction, and improved coping mechanisms.
Psychotherapy under this code encompasses a range of therapeutic modalities, such as cognitive-behavioral therapy, psychodynamic therapy, or dialectical behavior therapy. The focus remains on the patient’s specific mental health needs, with the therapist guiding the session to explore issues, develop strategies, and support the patient’s journey toward mental well-being. This requires a structured clinical approach.
Criteria for Applying CPT Code 90837
Applying CPT Code 90837 requires specific conditions. Only qualified healthcare professionals are eligible to bill for this service, typically including licensed psychiatrists, psychologists, clinical social workers, and professional counselors. These providers must possess the appropriate licensure and credentials to deliver psychotherapy services.
The service type must be individual psychotherapy. The session must involve direct, face-to-face therapeutic interaction between the patient and the qualified provider. This code is not for services like medication management or general health counseling.
A time requirement dictates the use of this code, requiring a session duration of 53 minutes or more of direct patient contact. This time threshold ensures that a substantive therapeutic intervention has occurred. The service must demonstrate clinical necessity for the diagnosis and treatment of a mental health condition.
Documentation Supporting CPT Code 90837
Thorough documentation is essential to substantiate the use of CPT Code 90837 for psychotherapy services. Each session requires a record of the date of service. Precise start and end times of the face-to-face interaction must be noted to verify that the session met the minimum 53-minute duration requirement.
The patient’s mental health diagnosis must be recorded, providing the medical justification for the psychotherapy. This diagnosis should align with established diagnostic criteria and support the necessity of the therapeutic intervention. Documentation must also include how the session fits into the patient’s overall treatment plan, outlining the goals and objectives.
A summary of the session content and therapeutic interventions used is required, detailing what was discussed and the techniques employed by the therapist. Notes on the patient’s response and progress towards their treatment goals provide evidence of the session’s effectiveness and clinical utility. The provider’s signature and credentials must be present, confirming who delivered the service and their professional qualifications.