In psychotherapy, extended sessions beyond the standard 45- to 60-minute timeframe can be essential for certain clients, particularly those dealing with complex mental health conditions or trauma. Mental health providers need to use the appropriate Current Procedural Terminology (CPT) code for billing insurance and ensuring accurate reimbursement. This guide provides a detailed overview of the correct CPT code for a 90-minute psychotherapy session and how to use it effectively in clinical practice.
Understanding CPT Codes for Psychotherapy Sessions
CPT codes are standardized codes used for billing medical and mental health services. In psychotherapy, the length of the session determines which CPT code is used. The standard CPT codes for outpatient psychotherapy include:
- 90832 – 30-minute individual psychotherapy session.
- 90834 – 45-minute individual psychotherapy session.
- 90837 – 60-minute individual psychotherapy session.
However, for extended psychotherapy sessions lasting 90 minutes, an additional code must be used in combination with 90837.
CPT Code for a 90-Minute Psychotherapy Session
To bill for a 90-minute psychotherapy session, providers should use:
- 90837 (60-minute individual psychotherapy session)
- +99354 (Prolonged service, first 30-74 minutes beyond the typical service time)
Breakdown of the Codes:
- 90837 covers the first 60 minutes of the session.
- +99354 is an add-on code used to account for the additional time spent beyond 60 minutes, up to 90 minutes.
Key Notes:
- +99354 is an add-on code and must be billed alongside 90837; it cannot be used independently.
- The prolonged service code +99354 applies only when the total face-to-face psychotherapy session extends beyond 60 minutes but remains under 90 minutes.
- If the session extends beyond 90 minutes, additional prolonged service codes may be required.
Insurance Reimbursement Considerations
1. Checking Insurance Policies
- Not all insurance companies reimburse for prolonged service codes. It is important to verify with the specific insurer whether they cover +99354 in conjunction with 90837.
2. Medical Necessity
- Insurance providers may require justification for sessions longer than 60 minutes.
- Documenting the need for extended psychotherapy sessions is crucial to avoid claim denials.
3. Billing Accuracy
- Ensure that 90837 and +99354 are billed correctly, following insurance guidelines.
- If billing for Medicare, be aware of potential coverage restrictions for prolonged service codes.
Documentation Requirements
Proper documentation is critical when billing for a 90-minute psychotherapy session. The following details should be included in clinical notes:
- Start and end time of the session.
- Clinical justification for the extended session (e.g., severity of symptoms, need for intensive intervention).
- Therapeutic techniques used during the extended time.
- Progress made during the session.
- Any follow-up plans or recommendations.
When to Use 90-Minute Sessions
Extended psychotherapy sessions may be appropriate in the following situations:
- Trauma-Focused Therapy – Clients undergoing EMDR, exposure therapy, or other trauma-based interventions may require longer sessions.
- Severe Mental Health Conditions – Clients with PTSD, complex trauma, or severe anxiety may benefit from extended time.
- Crisis Intervention – When immediate intensive support is needed for crisis stabilization.
- Intensive Therapy Models – Some therapeutic models, such as DBT (Dialectical Behavior Therapy), incorporate longer sessions for skill-building and processing emotions.
Conclusion
Billing correctly for a 90-minute psychotherapy session requires using 90837 in combination with the prolonged service add-on code +99354. To ensure successful reimbursement, mental health providers must verify insurance coverage, document medical necessity, and follow correct coding practices. Extended therapy sessions can provide significant benefits for clients with complex mental health needs, making it essential for therapists to navigate the billing process effectively.