Can you bill 99417 with 90837?
Asked by: Prof. Arden Quitzon | Last update: March 1, 2025Score: 4.6/5 (21 votes)
Can I bill 90837 and 99417 together?
A new code was introduced, 99417, this can be used to bill for prolonged services, however, it cannot be used with psychotherapy codes 90837 or 90847. For sessions exceeding the typical timeframe but not reaching the extended service criteria, add-on codes exist.
What code can 99417 be billed with?
CPT Code 99417 Update – Prolonged Outpatient Evaluation and Management Services. This code may be billed with CPT Codes 99245, 99345 and 99350 effective Jan. 1, 2023.
What is the prolonged service code for 90837?
So are you out of luck and stuck with just billing 90837? Add-on CPT Code 99354 is defined as a prolonged services code and is defined as an extra 30-74 minutes of therapy. 99354 used to only be allowed by Medical Doctor's, but has since expanded and is applicable to 90837 and 90487.
Can 99417 be billed with telehealth?
CPT Code 99417
This code is used for prolonged office or other outpatient Evaluation and Management service(s) when conducted via telehealth. Key Components: Time: Beyond the typical time associated with the primary E/M service.
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What is the CPT code for telehealth prolonged services?
For CPT codes, use prolonged code 99417 for office services, consults, home and residence services and cognitive assessment; For hospital and nursing facility codes, use 99418.
What code should be billed for prolonged services with psychotherapy?
Psychologists who conduct sessions that require more than 60 minutes should report CPT® code 90837: Psychotherapy, 60 minutes with patient. Regardless of how long the session lasts, the psychologist's reimbursement will be based on the payment amount ultimately associated with 90837.
Does CPT code 90837 require a modifier?
So, you would use the CPT Code 90837 Modifier 95 for virtual sessions that are 53 minutes or longer. To further maximize your reimbursement, include the appropriate extender code if the session exceeds 53 minutes.
Can NP bill 90837?
One set is the set of codes to report psychotherapy only. (90832, 90834, 90837) While these are most frequently reported by social workers, psychologists and therapists, they can be reported by psychiatrists, psychiatric NPs and PAs if medication management is not performed at the same visit.
What are the CMS guidelines for prolonged services?
You can report prolonged services when you use time to select your visit level, and you exceed your total time for the highest-level visit by 15 or more minutes on medically necessary services. See Prolonged Services for detailed reporting instructions.
What is the mue for CPT 99417?
The Centers for Medicare & Medicaid Services (CMS) initially released a four-unit medically unlikely edit (MUE), or per day limit, on code 99417. That means a physician could report only four units of 99417 on a single date of service.
How to bill for telephone visits?
Billing and Coding
Use modifier -93 for the reporting of medical services that are provided via real-time interaction between the physician or other qualified health care professional (QHP) and a patient through audio-only technology.
What codes can 99417 be billed with?
What primary procedure codes can CPT code 99417 be billed with? CPT code 99417 can be billed with primary procedure codes such as 99245 (office consultation), 99345 (home visit for new patient), and 99350 (home visit for established patient).
How do I bill for longer therapy sessions?
While it may seem like the obvious thing to do, adding more units to your billing is not how to bill extended sessions. Rather, what is required to bill for 90 minutes is an add-on code on a new line in box 24 of your CMS1500 form. To bill an insurance claim for a 90 minute individual therapy session: bill 90837.
Can you bill 99214 and 99354 together?
Yes. To code 99354 with 99214, the total face-to-face time spent with the patient would need to be at least 30 minutes beyond the 25 minutes typically spent in a 99214 visit.
What is the add on code for 90837?
Start with CPT Code 90837 for a 60-minute individual psychotherapy session. If the session extends beyond 60 minutes but is still within the 134-minute range, use Add-on Code 99354. If the session exceeds 134 minutes, add Add-on Code 99355 for each additional 30-minute increment beyond 134 minutes.
What is the 59 modifier for therapy?
If a therapist bills a Current Procedural Terminology (CPT) code linked to one of these pairs, they are generally reimbursed for only one of the codes. In such scenarios, the modifier 59 can be employed to indicate that both services were provided independently, warranting separate payment.
How to justify 90837?
To bill 90837, you must have clear documentation showing the medical necessity for the extra time. Be sure to document things like: The start and end times of the actual session. The issues, topics, and goals addressed and discussed during the session.
How do I bill psychotherapy with E&M service?
CPT Codes 90832-90838 represent psychotherapy. Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837. Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838).
Can I bill 90837 for 50 minutes?
Therapists use CPT code 90837 to bill for psychotherapy sessions lasting 53-60 minutes. It replaced the previous code 90808 in 2013. This code applies to individual psychotherapy sessions that need more time than the standard 45 or 50-minute session (billed under CPT code 90834).
How to bill 75 minutes of psychotherapy?
90839 Psychotherapy for crisis (a crisis psychotherapy session requiring urgent assessment and history of crisis state mental status exam, and disposition), 60 minutes** 90840 Additional code for an additional 30 minutes (75 minutes and over with the client), used with 90839.
What is code 90837 for reimbursement?
The reimbursement rates for CPT Code 90837 vary depending on the year and insurance provider. As of 2023, the Medicare reimbursement rate for a 60-minute individual therapy session is $147.07. In previous years, the rates were $164.84 (2022), $152.48 (2021), and $141.47 (2020).
Can you bill 90837 without a patient present?
The patient must be present for all or some of the service. In reporting, choose the code closest to the actual time (i.e., 16-37 minutes for CPT codes 90832 and 90833, 38-52 minutes for CPT codes 90834 and 90836, and 53 or more minutes for CPT codes 90837 and 90838).
How to bill 90837 and 99354?
Let's say you had a 120-minute therapy session. The right way to bill this is to submit a claim for 90837 for the first hour then include the add-on CPT code, 99354 for the remaining time. However, if you only met with your client for 80 minutes, then you can only use 90837 to bill for the session.