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The Business of Private Practice
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By Deb Legge, PhD, CRC, LMHC

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, including things such as authorization requirements, session limits, and billing procedures. Other rules have their roots in the Centers for Medicare & Medicaid Services (CMS) guidelines.

The CMS is instituting a revision of the codes that mental health professionals use to bill for mental health services. Effective Jan. 1, 2013, if you are still billing under the old CPT (Current Procedural Terminology) 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 clinical mental health counselors:

Psychiatric Diagnostic Evaluation

  • Old Code:     90801   
  • New Code:    90791

Outpatient Psychotherapy (45–50 min.)       

  • Old Code:      90806
  • New Code:    90834 (45 min.)

Outpatient Psychotherapy (75–80 min.)

  • Old Code:     90808
  • New Code:    90837 (60 min.)

Group Psychotherapy

  • Old Code:      90857
  • New Code:    90853

New to the CPT coding system in 2013 are the Crisis Code (90839 for 60 minutes 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.

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 was released by most insurance companies in late fall. 

Finally, you can purchase a new CPT manual from the American Medical Association. 

Please note that the information in this article 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.

The Business of Private Practice is a new Advocate department. For information about the author and private practice consultant, Deb Legge, see the article in this issue about her. 

Visit for more helpful information on starting and growing a private practice, and to submit your questions and ideas for future articles in The Advocate.