CMS alerts providers about accurate documentation of psychotherapy services

Independent contractor reviews found many improper payments involving claims where the psychotherapy codes were billed.

The Centers for Medicare and Medicaid Services (CMS) released a Medicare Learning Network (MLN) Matters article on March 18, 2014, alerting mental health professionals about the need to accurately document the time spent providing psychotherapy services. The MLN article discusses the 30-, 45- and 60-minute psychotherapy codes used by psychologists, including the flexibility allowed under the time ranges for each of the three codes. The article is available on the CMS website (PDF, 99KB). 

With its principal focus on billing for Evaluation and Management along with psychotherapy versus billing only the psychotherapy codes, much of the article is aimed at psychiatrists. The portion of interest to practicing psychologists underscores the importance of documenting the time spent on any psychotherapy session.  

Problems involving claims for psychotherapy services came to Medicare’s attention through a review program entitled Comprehensive Error Rate Testing (CERT). Under CERT, an independent review contractor examines a sample of Medicare claims to determine if they were reimbursed properly under Medicare’s rule on coverage, coding and billing. According to CMS, CERT reviews have found many improper payments involving claims where the psychotherapy family of codes were billed.  

Extensive guidance from the APA Practice Organization about billing the psychotherapy codes is available on the Billing and Coding page of our Practice Central website.