Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual

The American Medical Association revises coding manual for 2017.

Starting Jan. 1, 2017, multiple changes to the Current Procedural Terminology (CPT) codes related to mental and behavioral health services will take effect.

The American Medical Association’s (AMA) 2017 CPT code manual includes several clarifications on codes that apply to psychotherapy services and a new coding modifier for telemedicine services. These clarifications, recommended by the American Psychological Association and other mental and behavioral health societies, were in response to repeated questions from members, coders and payers.

The changes will provide psychologists with additional guidance on the codes, and how and when to use them. The additional modifier will set a coding standardization for telemedicine services that many psychologists have been seeking.

For psychotherapy services, the 2017 coding manual further explains that a code’s stated time for sessions only applies to face-to-face time with a patient who is present for all or most of their session.

The manual also clarifies which codes may involve informants for individual psychotherapy, which may be used for family sessions and which may be reported on the same day as other codes.

In addition, AMA revised the language for some psychotherapy code descriptors.

The new CPT modifier for “synchronous telemedicine” services is “95” and it indicates “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” As a coding example, when 45 minutes of psychotherapy is delivered via telemedicine, append the CPT code 90834 with modifier 95, and be sure to indicate the originating place of service code (typically “11” for practitioner’s office).

The codes designated for telemedicine were jointly selected by APA, representatives of other health care and medical societies, and payers as representations of services that are widely thought to be appropriate for telemedicine and for face-to-face service.

The Health Insurance Portability and Accountability Act requires all health insurance payers to recognize the changes and update their claims systems to reflect the new information.

Clarifications on psychotherapy codes

The 2017 CPT book clarifies that:

  • Individual psychotherapy (codes 90832, 90834, 90837) may involve informants (i.e., family members, caregivers).
  • A code’s stated time (e.g., 30 minutes) is relevant only for face-to-face time with the patient. No additional time is reported for time with the informant.
  • The patient must be present for all or a majority of the service.
  • Therapy using family psychotherapy techniques should be reported with either 90846 (without patient present) or 90847 (with patient present). 90846 and 90847 should not be reported for family therapy sessions shorter than 26 minutes.
  • Codes 90832, 90833, 90834, 90836, 90837, 90838 can be reported on the same-day as codes 90846 and 90847, provided that the services are separate and distinct. Be sure to include modifier 59 to emphasize that the services are separate and distinct. 
  • Do not report psychotherapy codes for sessions shorter than 16 minutes. 

AMA made no changes to the code numbers. 

Changes to code descriptors

Codes whose descriptors changed are marked with a triangle in the 2017 CPT book. The code language, or descriptor, for several codes was slightly revised to replace the phrase “with patient and/or family member” to “with patient.”

The descriptors for 90846 and 90847 now contain explicitly stated, face-to-face times. For valuation purposes, the times were implicit before and were factored into the payment levels. The CPT rule for estimating session times still applies (i.e., 16-37 minutes for 90832, 38-52 minutes for 90834, 53 minutes or longer for 90837, and 26 minutes or longer for 90846 and 90847):

  • 90832  psychotherapy, 30 minutes with patient.
  • 90834  psychotherapy, 45 minutes with patient.
  • 90837  psychotherapy, 60 minutes with patient.
  • 90846  family psychotherapy (without the patient present), 50 minutes.
  • 90847  family psychotherapy (with the patient present), 50 minutes

New telemedicine modifier and codes

In the 2017 CPT code manual, the telemedicine-appropriate codes are marked with a star. The complete list of telemedicine services and their CPT codes is listed in new CPT Appendix P. 

The psychotherapy services that CPT designates as appropriate for telemedicine are:

  • 90832  psychotherapy, 30 minutes with patient.
  • 90834  psychotherapy, 45 minutes with patient.
  • 90837  psychotherapy, 60 minutes with patient.
  • 90845  psychoanalysis.
  • 90846  family psychotherapy (without the patient present), 50 minutes.
  • 90847  family psychotherapy (with the patient present), 50 minutes 90863.