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
I am a LPC-MHSP and a LSPE in my private practice in TN. I have been seeing a client through her Workers Compensation which is managed by Gallagher Bassett Services out of Florida where the robbery took place. I have not got paid for any 2013 claims because of a rejected procedure code. I initially billed for the new 90837 which replaced our old 75 minute code. when I got the denials I assumed that the Workmans Compensation denied because they would only accept the new 45 minute code, so I rebilled using the 90834. However, the claims were still rejected because of invalid cpt codes. When I called to speak with someone today at Gallagher Bassett/workmans compensation services, I was told that denial was for invalid code but that they were not billers so I would need to search acceptable cpt codes for Workman Compensation in Florida. Could there be a different set of cpt codes for Workman Compensation in Florida and if so I would someone suggest I find out what the accepted codes are? It just feels like I am getting the round around. Tammie Presley
I’ve received the same issue with TMHP (Texas Medicaid & Healthcare Partnership) and the 90791. I guess when they changed from 90801 they decided to change the underlying guidelines for reimbursement as well! Which is very frustrating. I’ve asked the reps at Medicaid and they are of no help. I’ve scoured the internet and this is the first article I have come across that has talked about the intake code issue with Medicaid.
For LPCs, we cannot be reimbursed for 90791 or 90792 or the interactive complexity add on 90785! I’m thinking about just sending in 90837 so we can at least get some sort of reimbursement for our time!
If anyone has found a different solution for this, please email me at amandaprokos@spiritreins.org. It would be greatly appreciated!
We are a billing company and for our therapist we have been using the 90837 for workers compensation patients and we are getting denied not a valid code. Please help me in determining the correct 2013 cpt code fo workers compensation claims in the state of Florida.
Without knowing what insurance company you are billing, it is hard to say. Sometimes workman’s comp companies do not use the specific codes and forms that you normally use; they may have their own method. It could also be that you do not have an authorization to bill for the 60 minute session. Some of our regular insurances will only allow up to 45 minutes. 90837 is a valid code but they may require different coding based on the particular insurance.
thanks!
Alicia
Medical Billing