Current Procedural Terminology (CPT) codes provide healthcare professionals with a standardized language for documenting their services. This guide explains the importance of CPT codes and highlights some common ones you may encounter with a therapist or psychiatrist during your care journey.
Why do CPT codes matter?
In therapy and psychiatry, CPT codes ensure that each service (e.g., therapy sessions or psychiatric evaluations) is accurately categorized and billed. Understanding these codes can streamline the billing process and help ensure you receive the correct services.
CPT codes are also essential for insurance purposes. They allow insurance companies to verify coverage and enable providers to submit claims for reimbursement. Additionally, CPT codes can help providers maintain accurate record-keeping, which is vital for continuity of care.
How do CPT codes affect you?
As a client, you don’t usually need to worry about the technical details of CPT codes during sessions. However, understanding what these codes represent can help you:
✅ Verify coverage: Knowing the CPT codes for different services ensures you receive the coverage you're entitled to.
🔎 Track sessions: If you're trying to keep track of your therapy or psychiatric sessions for personal or financial reasons, understanding CPT codes can help you identify the type of service you received and the duration of each session.
💳 Prepare for billing: If you ever receive a bill from your therapist or psychiatrist that doesn’t match what you expected, you can refer to the CPT code to help clarify any confusion.
What are common CPT codes?
Here’s are some common CPT codes for therapy and psychiatry sessions:
For therapy sessions:
90791: Initial psychiatric evaluation or first therapy session
90832: Individual therapy session lasting 16 to 37 minutes
90834: Individual therapy session lasting 38 to 52 minutes
90837: Individual therapy session lasting 53 minutes or more
90846: Family or couples therapy session with the client not present
90847: Family or couples therapy session with the client present
For psychiatry sessions:
90792: Initial evaluation, similar to 90791, but includes additional medical services, such as prescribing medications
99202-99205: New client evaluation and management (E/M) codes, varying based on the complexity of the service provided
99212-99215: Established client E/M codes, varying based on the complexity of the service provided
90833: Therapy session lasting 16-30 minutes, with an additional E/M service
90836: Therapy session lasting 38-45 minutes, with an additional E/M service
90838: Therapy session lasting 53-60 minutes, with an additional E/M service
99212: Low-complexity E/M session lasting 10-19 minutes for an established client
Frequently Asked Questions
Why do I have two CPT codes listed on my bill?
Psychotherapy and medication management are considered separate components of care, so they are billed separately. One CPT code typically reflects the psychotherapy or therapy session with your provider, while the second code reflects the time spent evaluating, adjusting, and managing your medications.
Will my insurance cover telehealth sessions?
Coverage for telehealth sessions can vary depending on your insurance provider and plan. Generally, the same CPT codes used for in-person visits (e.g., 90834 for a 45-minute individual therapy session) apply to telehealth. However, some insurers may require a special telehealth modifier to indicate the service was provided remotely. It’s important to confirm with your insurance company whether telehealth services are covered under your plan.
Can CPT codes affect my out-of-pocket costs?
Yes, CPT codes can impact your out-of-pocket costs. The specific code used for a service determines your insurance company’s reimbursement rate, which in turn affects how much you are required to pay. Always verify your insurance coverage and confirm whether the provider is in-network before scheduling an appointment.
How do I address incorrect codes?
If you believe incorrect CPT codes have been used on your bill or insurance claim, it’s important to address the issue promptly to avoid unnecessary out-of-pocket costs or delayed reimbursement. Here’s what you can do:
Review your bill and the explanation of benefits (EOB) from your insurance company. Compare the CPT codes listed with the services you actually received.
Contact your provider if you notice an error. They may be able to correct the CPT code on the claim and resubmit it to the insurance company.
Contact your insurance company if your provider submitted the correct CPT code, but the company processed it incorrectly. Ask them to review the claim and correct any mistakes.
Follow up with your insurance company to ensure that the issue is resolved.