How to bill 90837 and 99354?
Asked by: Dr. Leola Howell I | Last update: October 21, 2025Score: 4.1/5 (59 votes)
Can 90837 and 99354 be billed together?
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.
How do I bill my CPT code 99354?
CPT Code 99354 is a prolonged service CPT code add-on. It cannot be billed alone and must be billed with an appropriate procedure code. It fits into a sub-group of add-ons from 99354-99359 forming a subgroup of prolonged services codes.
Is 99354 no longer valid?
Deleted codes: Prolonged services codes 99354, 99355, 99356, and 99357 are no longer in use. In place of codes 99354 and 99355, use 99417. Code 99417 can be used to report prolonged services along with: 99245 (Office or other outpatient consultation for a new or established patient …)
How to bill for extended therapy sessions?
Billing Extended Sessions for Individual Therapy
It's important to note that if you are seeing a client for 60 minutes or under, make sure to bill using CPT codes 90832, 90834, or 90837 alone. Do not bill using add-on codes if sessions are not extended. Services performed outside of business hours.
Prolonged (Extended) Codes 99354 & 99355 DELETED!!
What is the CPT code 90837 for extended session?
CPT Code 90837 is a procedure code that describes a 60 minute individual psychotherapy session performed by a licensed mental health provider.
Can prolonged services be billed with psychotherapy?
2023: No longer a prolonged care code for use with psychotherapy services. Prolonged codes 99354, 99355 were deleted in 2023. The existing prolonged care CPT code for office visits, 99417, may not be used with psychotherapy codes 90837 or 90838. There is no way to report prolonged care with psychotherapy.
Can I bill 90837 for 50 minutes?
Time Requirements and Service Criteria for Billing 90837
Code 90837 is for 60-minute therapy sessions, defined as 53 minutes or longer. Anything less than 53 minutes would use code 90834 (45-minute session). For 90837, the actual session time must be documented in your notes. Rounding up or down is not allowed.
Can 99214 and 99354 be billed 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 CPT code for extended psychotherapy session 2024?
For a 2-hour therapy session, you can use 90837 CPT code for the first 60 minutes and 90838 CPT code for each additional 30 minutes.
Can 99354 be billed with 90791?
You can also use CPT Code 90791 with Code + 99354 Add-on if the session is between 90 and 120 minutes. Add-On CPT Code +99355 for an additional 45 minutes of time in the session. Use 90791 + 99354 + 99355 for long sessions of greater than 120 minutes.
Does 90837 require authorization?
CPT code 90837 represents a 60 minute individual therapy session and now requires authorization with UHC. UHC does not require authorization for CPT code 90834, a 45 – 55 minute individual therapy session. If you file to UHC with 90837 without authorization, your claim may be denied.
What does Medicare pay for CPT code 90837?
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).
How do I bill 99354?
Depending on the place of service, 99354 or 99356 is used to report the first hour of prolonged service on a given date. Either of these codes is used only once per date of service. To report either of these codes, the service must extend at least 30 minutes beyond the normal time of the E&M code.
How to justify 90837?
- Did the nature of the treatment justify the time length of the session? ...
- Does the nature of the treatment justify the frequency of treatment sessions? ...
- Was the treatment rendered medically necessary?
What is the modifier for 90837?
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.
What code replaced 99354?
Evaluation and Management (E/M) codes 99354, 99355 have been deleted. For prolonged evaluation and management services on the date of outpatient service, home or residence service, or cognitive assessment and care plan, you can use 99417.
What is the modifier for prolonged services?
A: According to CPT, modifier 25 may be appended to prolonged services codes if there is adequate supporting documentation that describes the service provided and indicates the service is significant and separately identifiable from another service or procedure on the same date of service.
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.
Why are therapy sessions usually only 45 or 50 minutes?
Most therapists offer 50-minute sessions. It allows enough time for the therapist and client to work toward the treatment goals while giving the client time to emotionally recover if the session is difficult. Fifty-minute sessions also give therapists the chance to take a break between clients.
What is the 8 minute therapy rule in billing?
Billing rules for the 8-minute rule. When Medicare reviews your claim, they will divide the total minutes for all timed services by 15. If the result of the equation leaves at least 8 minutes remaining before hitting another 15-minute increment, you can bill an extra unit.
What is the reimbursement rate for 90837?
2- CPT Code 90837 Reimbursement:
Therapists use this code when providing extended therapy services to their patients. Just like CPT Code 90834, the reimbursement rate for CPT Code 90837 may vary depending on the payer, location, like in New York the reimbursement rate for CPT code 90837 is $144.83.
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.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
What is the CPT time rule for psychotherapy?
Outpatient Mental Health CPT Codes:
90832 – Psychotherapy, 30 minutes (16-37 minutes). 90834 – Psychotherapy, 45 minutes (38-52 minutes). 90837 – Psychotherapy, 60 minutes (53 minutes and over). 90846 – Family or couples psychotherapy, without patient present.