Comments on: 2013 CPT Code Revisions: What the Changes Mean for Counselors

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By: Jean-Andre Constant

Jean-Andre Constant — Fri, 08 Sep 2017 16:41:31 +0000

Hello.
What is the current code for a psychosexual assessment?
Jean-Andre Constant,LCSW

By: Susan

Susan — Tue, 13 Sep 2016 01:46:50 +0000

Hi, I am an LCSW in Pennsylvania. Recently, Highmark Blue Shield denied and audited a case where I had used cpt code 90837 for a long term therapy case. I consistently provide a 55 minute plus session, and this had never been problematic until this case. Upon review of my additional information, Highmark paid the claim. However, within a few days I received a letter from a company called Change, stating they had monitored my provider billing patterns for Highmark, and informed me I was billing 90837 about 20% more than other similar professionals. They termed excessive use of this code “inappropriate”.
So I’m not sure how to proceed with future Highmark billing. If I change to 90834, how much revenue will I loose? If I continue billing 90837, do I risk my Highmark provider contract? If I bill some of each code, will this just appear erratic and trigger more audits? I have called Highmark. So far, I have not been able to get anyone there to talk to me.

By: Anthony Centore

Anthony Centore — Fri, 22 Jan 2016 20:51:28 +0000

In reply to James Ikonomopoulos.

90791 sounds right to me. I’ve never heard anything about LPCs not billing for diagnostic evaluations…

By: James Ikonomopoulos

James Ikonomopoulos — Fri, 22 Jan 2016 19:24:38 +0000

I am an LPC in Texas. If I am doing a diagnostic intake service, what code do I put? Do I put 90791? I heard LPC’s are not supposed to bill for intake services and we are supposed to put another code?

By: Anthony Centore

Anthony Centore — Wed, 29 Apr 2015 19:25:49 +0000

In reply to Dr Wu.

Dr Wu, definitely not in instance one. Regarding the co-leading of groups, you will want to look closely at your insurance contracts (or reach out to the payers directly).

By: Dr Wu

Dr Wu — Mon, 27 Apr 2015 10:54:48 +0000

I’m wondering can group psychotherapy be billed by me (MD provider) if rendered by a bachelors level counselor (non-licensed)? Will it be reimbursed? We are in Connecticut. Does it make a difference if I co-lead the group for part of the session? Is the proper modifier HN?

By: Christine

Christine — Sun, 26 Apr 2015 17:40:39 +0000

There seems to be little info on the internet–my question–as a new biller I don’t understand how to bill 12 units to medicaid for the same day. What medicaid codes are these, and how do I do it? My boss doesn’t know so I’m stuck figuring this out. Where can I reference this info? Many thanks for the assistance…

By: Phil Templeton, PhD/LMFT

Phil Templeton, PhD/LMFT — Thu, 02 Apr 2015 20:38:24 +0000

Do you have information for us about changes in billing codes with ICD-10, coming this year?

Thanks.

By: Courtney Putnam

Courtney Putnam — Thu, 15 Jan 2015 18:10:52 +0000

In Georgia, LPC’s are allowed to do psychological testing for which they have training and experience. The only codes I can find to bill for testing are for psychologists. Can you please advise as me as to what code would be appropriate for LPC’s?

By: Eileen

Eileen — Fri, 25 Jul 2014 17:10:09 +0000

I am in CO which does not require licensure for a psychotherapist. Can a bachelor’s level counselor bill CPT coding for individual and family psychotherapy services?

By: Anthony Centore

Anthony Centore — Mon, 27 Jan 2014 20:55:12 +0000

In reply to Dr. Felix.

Dr. Felix,

Here are the rates for BCBS – https://twx.atlantacounseling.com/blog/how-much-does-blue-cross-blue-shield-pay-counselors-and-psychologists/ – You can also search our site for other articles on reimbursement rates.

By: Dr. Felix

Dr. Felix — Mon, 27 Jan 2014 17:09:36 +0000

I was wondering if anyone can tell me the reimbursement rates for major insurance companies for the following codes: 90834 (45 minute outpatient psychotherapy session) and 90837 (60 minutes) for Master’s Level and Doctorate Level?

By: Tammie Presley

Tammie Presley — Tue, 13 Aug 2013 19:16:16 +0000

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

By: Amanda

Amanda — Fri, 19 Jul 2013 17:15:30 +0000

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!

By: Anthony Centore

Anthony Centore — Tue, 16 Jul 2013 18:46:17 +0000

In reply to Kathy.

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

By: Kathy

Kathy — Tue, 16 Jul 2013 17:04:46 +0000

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.

By: Sherri

Sherri — Tue, 09 Jul 2013 09:48:17 +0000

I have been having the same problem as Dawn stated above and TMHP told me the same thing today. So I was wondering if someone could please help me with this issue or had any other information regarding this. Thanks in advance.

By: Dawn

Dawn — Thu, 20 Jun 2013 20:55:59 +0000

I’ve been told by TMHP/Traditional Medicaid and
Community First.

By: Anthony Centore

Anthony Centore — Thu, 20 Jun 2013 12:44:23 +0000

In reply to Dawn.

Dawn,
I’m curious–who is telling you this? 90801 is now 90791, billable by LPCs

By: Dawn

Dawn — Wed, 19 Jun 2013 23:31:28 +0000

Hi, just wanted to know if anyone is getting denials for CPT code 90791 for a LPC. I’m being told this is not a covered service for a LPC only for a Psychiatrist.

By: Sylvia

Sylvia — Wed, 15 May 2013 22:29:12 +0000

its important that all therapists value their time and demand equitable payment. I for one will drop any insurance carrier who drops my reimbursement past $60.00. I’d rather get a part-time job and not have to deal with all the paperwork than take less money. By the time you look at the overhead what are you really making?

By: Sharon

Sharon — Mon, 29 Apr 2013 15:27:19 +0000

why are the RVU’s so much lower for 90853 for 2013?

By: Barbara

Barbara — Thu, 25 Apr 2013 01:07:06 +0000

I am in Ohio. I am cash only – out of network. I give superbills to pts so they can get reimbursement from their insurance companies. If State or Federal secrets were as closely guarded as the insurance companies are guarding their information about how to code in a way that they will accept then there would be no leaks of classified information. They will not disclose to me or my pts what codes they will accept other than to say many will not be accepted unless clinician is MD or PhD. I have not been able to find a replacement they will accept for 90 minutes. Has anyone been able to get reimbursement for 90 min?.

By: Elley1994

Elley1994 — Tue, 26 Feb 2013 15:18:07 +0000

I’m in Illinois and have not seen a rate change for bcbs. For a 45 min session the reimbursement rate is 88.20. This is the same rate as last year. Humana lowered their Rates last year to 43 for a standard 45 min session so I did not renew my contract with them. Cigna and Aetna have remained the same at 60. I’m out of network with united and usually get reimbursed around 70 something. I don’t know if illinois is different right now or if I’m not getting the updated reimbursement rates yet? I bill electronically and get my eob payments in about 3 weeks from bcbs and have been paid for 2013 sessions. As for a 60 min code…. Well alot of instance companies want you to get pre auth for it or you need to appeal the claim after it gets rejected submit your case notes to prove why that length of a session was medically necessary to justify that length of treatment. Family sessions are still being paid out as a 90847 with a higher rate of reimbursement vs a individual session through bcbs but Cigna and Aetna pay less for a family… Why? There’s no consistency with reimbursement claims when clearly a family session is more work! Seems only bcbs recognizes this. Also with the inter comp add on code I’ve been getting denied on that code from bcbs for several patients saying that their claim does not cover that code. So it seems that it depends on each individuals policy. When you call to verify benefits ask if the policy covers codes xx, xx, xx etc and see if pre auth is necessary for a 60 min session. What use to be a 90808…. Also I’ve experienced a rejected on a crisis code so I needed to submit notes to prove it was a crisis. Just a scam to get out of paying a higher reimbursement claim in my opinion.

Does anyone have info on a lpc being paid lower than a Lcpc for 2013? Or insurance companies now my allowing a lpc to get reimbursement from ? What insurance companies while billing under a group?

By: Anthony Centore

Anthony Centore — Mon, 25 Feb 2013 20:52:46 +0000

In reply to Karyn.

Karyn, Thanks for sharing! Which carrier are you referring to?

By: Karyn

Karyn — Mon, 25 Feb 2013 19:52:48 +0000

I can tell you from receiving my first out of network claim payment,one of the REAL Large carriers-NE is paying $40 less for the 90837 (and this is used in a private practice)than for the 90808. This is going to be a drastic assault on my relationship with my analyst (whom I meet with multiple times a week). Somebody needs to do something fast.

By: Anthony Centore

Anthony Centore — Tue, 19 Feb 2013 14:39:42 +0000

In reply to lynda holliday.

Yikes! I know that Harvard Pilgrim in MA also dropped their rates…

By: lynda holliday

lynda holliday — Sun, 17 Feb 2013 16:41:54 +0000

But the Rates DID get reduced and in MA, BCBS is ONLY reimbursing 90834 (formerly know as the 90806 — 50 min session f/u), at $50.51 (NOT the former $70.10/ 50 minute session). They are also DENYING 90837 codes — outright for private practitioners here. ( I am a LMHC ).I am in a small, private practice that is approx. 30-40% BCBS — this change represents a HUGE cut in revenue for me. What should I do? Any suggestions? I have several colleagues in the same situation altho it seems (some) other states are not having the same issue. Thanks for ANY help you can offer. ~ Best, Lynda
PS: no other rates or reimbursement seem to have been reduced EXCEPT the BCBS – why?

By: Anthony Centore

Anthony Centore — Fri, 08 Feb 2013 19:20:55 +0000

In reply to Roberta Rinaldi.

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!

By: Roberta Rinaldi

Roberta Rinaldi — Thu, 07 Feb 2013 23:59:31 +0000

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!!!

By: Anthony Centore

Anthony Centore — Thu, 31 Jan 2013 22:57:04 +0000

In reply to Sondra Brumett.

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!

By: Sondra Brumett

Sondra Brumett — Thu, 31 Jan 2013 22:55:17 +0000

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?

By: Anthony Centore

Anthony Centore — Wed, 09 Jan 2013 13:23:00 +0000

In reply to Kim.

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/

By: Kim

Kim — Tue, 08 Jan 2013 23:00:50 +0000

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.