In medical billing, CPT (Current Procedural Terminology) codes are crucial for accurately identifying and documenting services provided by healthcare professionals. One of these codes, 90833, is commonly used in the context of psychotherapy services. This blog will provide a comprehensive overview of the 90833 CPT code, explaining its significance, use, and role in therapy billing.

What is the 90833 CPT Code?

The CPT code 90833 is for psychotherapy, which is 30 minutes with a patient when done with an evaluation and management (E/M) service. This code is applied when a therapist performs psychotherapy on a patient for 30 minutes while also performing an associated evaluation and management service, such as a physical exam or mental status assessment.

This particular CPT code is commonly utilized by medical providers, including psychiatrists, psychologists, licensed clinical social workers (LCSWs), and other mental health professionals to bill for therapy sessions. It is part of the broader group of psychotherapy codes in the CPT system; however, it applies explicitly when therapy is coupled with an E/M service.

Key Features of 90833

The following are some key features of the 90833 CPT code:

The code is used when the therapist spends about 30 minutes in psychotherapy with the patient. If the session is longer or shorter, other CPT codes will be used.
The 90833 code is also billed along with an E/M service, usually including assessment, diagnosis, and treatment planning. This may be utilized, for instance, at a psychiatrist visit where psychotherapy and mental health evaluation are done.
The psychotherapy offered under 90833 is usually talk therapy, which may include several different therapeutic modalities, such as cognitive-behavioral therapy (CBT), psychodynamic therapy, or supportive therapy.
In contrast to codes for general medical treatments, 90833 is reserved for mental health services, which makes it necessary to bill for particular psychiatric or psychological interventions.

How Is 90833 Different from Other Psychotherapy CPT Codes?

Some other CPT codes in the 908xx series are frequently used for billing for psychotherapy services. Still, the critical difference between them and 90833 is whether an evaluation and management service exist and how long the therapy was.

Psychotherapy, 30 minutes (without E/M service).
Psychotherapy, 45 minutes (without E/M service).
Psychotherapy, 45 minutes with an E/M service.
Psychotherapy, 60 minutes (without an E/M service).

Notice that codes such as 90832 and 90834 are for therapy sessions without the added evaluation and management services, while 90833 and 90836 include both psychotherapy and an E/M service. Also, the time spent on the session (30 minutes for 90833 and 90836) comes into play in determining which code to use.

What Is an Evaluation and Management (E/M) Service?

To better comprehend application 90833, defining an E/M service is worth explaining. Evaluation and management service usually describes a range of clinical services that involve:

The process of evaluating the patient's medical history, present conditions, and any mental health issues.
The physician may diagnose or revise a prior diagnosis following their assessment of the patient's condition and symptoms.
The practitioner creates a plan for the patient's continuing treatment, which might involve medication prescriptions, types of therapy, and follow-up visits.

When used with psychotherapy, E/M services enable the practitioner to treat both the patient’s mental status and overall mental health management in the same visit.

When is 90833 Used?

The 90833 code can be used in the following circumstances:

A psychiatrist may perform an E/M service like a psychiatric evaluation or medication management and then perform a 30-minute psychotherapy session with the patient.
In case a patient is consulting a mental health care provider for medication management (e.g., an antidepressant) and psychotherapy, 90833 can be used if the session incorporates both.
If the treatment forms part of a complete care plan, a patient can have both a therapy session and an evaluation of the progress of the patient's mental health by a licensed therapist.

Billing and Reimbursement for 90833

The billing of CPT code 90833 is typically in the form of a claim submitted to insurers or payers. The reimbursement rate under this code might differ based on the insurance scheme, provider location, and individual patient’s policy. These are some salient facts about billing and payment:

Providers must properly document the actual length of the psychotherapy session, the evaluation and management services rendered, and the therapy type conducted. Failure to do so may result in the denial of reimbursement.
Insurance firms usually reimburse for 90833 at rates tied to the current value of the CPT code in their fee schedule. The insurers differ in the rates, but because the code includes both psychotherapy and an E/M service, it could have a higher reimbursement rate than isolated psychotherapy codes.
Depending on the circumstances, modifiers like -25 (reflecting that a substantial, separately identifiable E/M service was furnished) can be utilized when billing 90833 in conjunction with other services.

Benefits of Using 90833

Using the 90833 code enables therapists and psychiatrists to provide more holistic care that treats a patient's psychological and clinical aspects of health.
Using the code, providers can bill for psychotherapy and E/M services in one visit, which can streamline billing and offer higher overall reimbursement efficiency.
It ensures that providers are properly reimbursed for the combined services of therapy and assessment, which gives patients a complete treatment plan.

How Hello MDs Simplifies the 90833 CPT Code Billing Process

Hello MDs makes it easy to apply the 90833 CPT code by offering a comprehensive platform for healthcare providers to document and bill for integrated psychotherapy and evaluation and management (E/M) services in an easy way. Their intuitive platform accurately records therapy session durations and associated clinical evaluations, reducing errors and improving billing effectiveness. By removing manual recording and streamlining the claims process, Hello MDs allows providers to save time, get proper reimbursement, and focus more on patient care.

Conclusion

90833 CPT is a critical billing component in delivering psychotherapy services combined with an evaluation and management service. This code permits mental health providers to appropriately bill for a 30-minute session of psychotherapy being conducted as a service beyond intensive clinical assessment, e.g., medication management or psychiatric evaluation. Proper use of this code facilitates assurance that providers get appropriately reimbursed for time and knowledge devoted to treating patients’ mental ailments.

As with everything, following the correct documentation and billing procedures is necessary to avoid denial of claims and appropriate payment for services rendered.

Reference

https://en.wikipedia.org/wiki/Clinical_social_work