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EHR and practice management for mental / behavioral health

Change in CPT Codes, Part 2

Starting January 1, 2013, all mental health providers are required to utilize new CPT® codes for psychotherapy when billing insurance carriers, including Medicare.  However, the basic services provided by the new codes aren’t changing.  (CPT is the abbreviation for current procedural technology that was copy-righted by the American Medical Association, AMA, in 2011).

All mental health professionals including psychologists, psychiatrists, nurses and social workers providing psychotherapy services will use the same applicable codes for psychotherapy; while psychiatry providers will change how they bill for medical services.

We’ll be covering the changes and their nuances in more detail over the next month.  The 2013 Medicare reimbursement rates for these new codes will be released in early November when CMS publishes the final Medicare fee schedule for 2013.  For now, here are some key points to be aware of:

  • Use of a particular psychotherapy code and reimbursement for that service will not differ depending on whether the service is provided by a physician or a psychologist.
  • The code numbers and descriptions for psychoanalysis, family psychotherapy (with and without the patient), multi-family group psychotherapy, and group psychotherapy will not change in 2013.
  • Outpatient and inpatient psychotherapy codes will be replaced by a single set of codes that can be used in both settings.
  • The new codes will have specific times rather than ranges (for example, 30 minutes, not 20-30 minutes; 45 minutes, not 45-50 minutes; 60 minutes, not 75-80 minutes)
  • 3 new codes for 2013 are:
  • The currently used code for a psychiatric diagnostic interview, 90801, will be replaced by two separate codes: 90791 will be used for a diagnostic evaluation, and 90792 will be used for a diagnostic evaluation with medical services, such as a physical examination.
    • 90832 Psychotherapy, 30 minutes with patient and/or family member
    • 90834 Psychotherapy, 45 minutes with patient and/or family member (this replaces the currently used 90806, 45-50 minute psychotherapy)
    • 90837 Psychotherapy, 60 minutes with patient and/or family member

Check out the 2013 Psychotherapy CPT PDF for an overview of changes and our CPT Code Resource Center for more information.

(Sources: APA Practice Organization, National Council for Community Behavioral Healthcare)


Leigh-Ann Renz is the Marketing & Business Develoment Director of PIMSY mental health EHR.

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