2013 CPT Code Revisions: The mental health community is abuzz about the 2013 Current Procedural Terminology (CPT) code changes. Don’t worry; CPT codes are still boring! This article will explain the changes, and what you need to know to prepare for them.
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Starting January 1, 2013, a number of CPT codes for psychiatry and psychotherapy services will be revised. For instance, if you bill a “90806” to a third party payer after December 31st, the claim will be denied. And if you talk about having a “90806 appointment” with colleagues in 2013, they will roll their eyes at you because “Gosh Judy, you’re so last year!”
CPT codes are set by the American Medical Association (AMA), and are revised on an annual basis. This year, the revisions are substantial. Fortunately for counselors, many of the changes concern psychiatry, and not psychotherapy.
Major Psychiatric Revisions
The CPT revisions that effect psychiatrists are more complicated than those that effect counselors and psychologists. For those who run group practices, here are five major psychiatric CPT revisions:
- Evaluation and management (E&M) plus psychotherapy codes will be retired (including “90805” and “90807”)
- Codes for psychotherapy and E&M services are now differentiated
- The code “90801” will be replaced by “90792” for “a diagnostic evaluation with medical services”
- Pharmacologic management codes will be retired (providers are to use an E&M code)
- 2013 introduces “add-on” codes for psychiatry, which are services in addition to a primary service (not a stand-alone service)[i]
…and several other changes.
Major Psychotherapy Revisions
The CPT code revisions that effect counselors are simple and straightforward. Here is a list of psychotherapy CPT codes that will be retired, and their 2013 comparables:
- 90801 –> 90791 (diagnostic evaluation without medical services)
- 90804 –> 90832 (was 20-30 minutes psychotherapy, now 30 minutes)
- 90806 –> 90834 (was 45-50 minutes psychotherapy, now 45 minutes)
- 90808 –> 90837 (was 75-80 minutes psychotherapy, now 60 minutes)
Family therapy codes (90847 and 90846) will remain unchanged, as will codes for psychological testing.
A Note on Service Duration Changes:
As seen above, unlike existing codes that provide a service time range (i.e., 45-50 minutes), 2013 code descriptions list fixed times (i.e., 45 minutes). However, according to the 2013 CPT manual, providers still have flexibility. Respectively, 16-37 minutes for code “90832,” 38-52 minutes for code “90834,” and 53 minutes or more for code “90837.” When reporting a service, a provider should choose the code closest to the actual duration.[ii]
Will Reimbursement Rates Change?
It is unlikely that the 2013 CPT code revisions will affect reimbursement rates for counselors. That said, several large third party payers (including Medicare and Medicaid) are expected to announce their 2013 service rates in November.
Preparation
An experienced medical biller should be able to adjust to the 2013 CPT codes without much difficulty. Similarly, quality practice management software companies are already prepared for the code revisions, and are ready to apply them on 1/1/13. For most psychologists, social workers, and professional counselors, adopting the new CPT codes will be a simple administrative change that won’t affect their clinical workflows.
Need more? Continue reading about CPT Code Add-Ons For 2013
Author:
Dr. Anthony Centore is CEO of Thriveworks, is Private Practice Consultant for the American Counseling Association, and Author of “How to Thrive In Counseling Private Practice.” Learn more at https://twx.atlantacounseling.com/counseling-private-practice-book/
Looking for help starting or growing a private practice? We can help! Learn more at https://twx.atlantacounseling.com/private-practice
[i] Source: National Council for Community Behavioral Healthcare at www.TheNationalCouncil.org
[ii] www.apapracticecentral.org/update/2012/09-27/psychotherapy-codes.aspx. The 2013 AMA CPT Professional Edition Manual can be purchased on Amazon.com: www.amazon.com/Professional-Edition-Current-Procedural-Terminology/dp/1603596844
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Anthony Centore
Pardon me, but you are absolutely wrong that our reimbursement rates will not change. I just got a letter from Cigna today, stating that what used to be 90806, paid at $60/session, has now become 90834, paid at $42/session. It’s bad enough that we haven’t had a raise in over 20 years, now this!!!
Hi Roberta!
Thanks for your comment! I’m sorry to hear that your rates went down–ouch! I think in the video I was explaining that rates won’t go down because of the new codes, but rates will and do change all the time. In particular, every November many companies announce their rates for the following year. It’s likely that United/UBH’s rates are going down in response and preparation for the new healthcare reforms…but who knows, really….I agree that it completely sucks. I know some providers that are calling UBH and complaining. If enough providers refuse to accept the new rates, UBH’s customers (the clients) will begin complaining, as will their employers…all this will put pressure on United to raise their reimbursement rates. I hope this helps Roberta!
Hi Dr. Centore, I almost always see clients for 60 minutes (sometimes more) and was wondering how can I find out (without actually calling every insurance company) which insurance companies will require clinicians to get pre-authorizations to bill the 90837 code?
Sondra,
Thanks for your comment. I think that’s just something you’re going to need to call about.
If you find more information than we have, please let us know!
We are having a discussion now in our office on how to bill. Our typical sessions last 45-50 minutes and we did the required paperwork in the last 10 minutes from the (51-59 minute range). The typical remimbursment rate was $65 more or less.
Now the new code allowed for LPC’s is to replace a 90806 with a 90834 with a reimbursement rate of $50, a $15 paycut per client.
My question is can we bill for 90834 (38 minutes-up to 52 minutes). Could we see the client for 38 minutes and spend the rest doing paperwork? Here is the new definition regarding all the new codes. My question what constitures Time spent with the patient vs. face to face? If we saw clients as we previously had 45-50 minutes we would lose $150 a day or more.
Definition of new codes.
” THE TIME FOR EACH PSYCHOTHERAPY CODE IS NOW DESCRIBED AS BEING AS TIME SPENT WITH THE PATIENT AND/OR FAMILY MEMBER, A CHANGE FROM THE PREVIOUS PSYCHOTHERAPY CODE TIMES, WHICH DENOTED ONLY TIME SPENT FACE-TO-FACE WITH THE PATIENT. ”
Hope that makes sense. As we can’t bill 90837 a 60 minute session. I don’t believe we can add on time either say for example a 90832 and 90834.
Kim, We have been getting some follow up questions on this article. We added more detailed here: https://twx.atlantacounseling.com/blog/cpt-code-add-on-faq-2013-changes-for-mental-health/