American Mental Health Counselors Association
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Practice Update: Psychotherapy Billing Codes to Change in 2013 11/14/12


By Deb Legge, PhD CRC LMHC
DrLegge@InfluentialTherapist.com

Deb Legge, PhD CRC LMHC is a private practice mentor who helps counselors build successful and sustainable businesses. Deb has been in private practice for 20 years. She founded Influential Therapist as a way to share her experience and expertise in the business of private practice, with mental health professionals who are establishing, building, or revitalizing a private practice.

Whether or not you do your own billing, if you are in private practice YOU need to be in charge of your money. Knowing what has been billed and what has (or has not) been collected is just the tip of that iceberg.

In addition to having a good handle on your receivables, you need to know the rules. The insurance companies you bill generate some of those rules; things like authorization requirements, session limits, billing procedures, etc. Other rules have their roots in the CMS (Centers for Medicare & Medicaid Services) guidelines.

On January 1, 2013, the CMS is instituting a revision of the codes that mental health professionals use to bill for mental health services. Effective January 1, 2013, if you are still billing under the old CPT codes, your claims will likely be rejected and you will be required to resubmit your bills using the new CPT codes.

Here is a brief overview of the changes you'll see for the codes most commonly used by Counselors:
Service Old Code New Code
Psychiatric Diagnostic Evaluation
Outpatient Psychotherapy (45-50 min)
Outpatient Psychotherapy (75-80 min)
Group Psychotherapy
90801
90806
90808
90857
90791
90834 (45 min)
90837 (60 min)
90853

New to the CPT coding system in 2013 are the Crisis Code (90839 for 60 min and 90840 add-on for additional 30 minutes), and the interactive complexity add-on code (90785) for use when the delivery of services is more complex.

CMS should be releasing more information this fall. Remember that not all insurance companies reimburse all providers for all of the available codes. Therefore, you should always look to the insurance companies for which you are a provider for a complete listing of approved codes and new coding regulations. Information about these changes should be released by most insurance companies in late fall.
Click here to purchase a new CPT manual from the AMA.

Please note that this information is subject to change as more information is released about the new CPT procedure codes and regulations.

Stay informed; knowing the rules will help keep you in compliance, and will decrease rejected claims and unpaid invoices.

Deb Legge, PhD CRC LMHC
DrLegge@InfluentialTherapist.com

Private Practice can be an exciting and rewarding option for counselors. Getting the information and support you need regarding the business of private practice can help you to build a successful and sustainable business. Visit
http://www.InfluentialTherapist.com for more helpful information on starting and growing a private practice, and to submit your questions and ideas for future articles in the Advocate.