Novitas, in collaboration with CMS, continues to focus on lowering Comprehensive Error Rate Testing (CERT) claims paid error rate. One area of concern identified in the CERT data is lack of documentation of face-to-face time to support the code billed.
The medical record must indicate length of time spent in the psychotherapy encounter.
Documentation requirements and detailed guidance are found in our LCD L35101 - Psychiatric Codes.
The following timed psychotherapy codes apply in all settings (e.g., office, outpatient, inpatient, etc.). Select the code that most closely matches the actual time spent.
90832: Psychotherapy, 30 minutes with patient (16 to 37 minutes)
90834: Psychotherapy, 45 minutes with patient (38 to 52 minutes)
90837: Psychotherapy, 60 minutes with patient (53 minutes or longer)
Note: Do not report psychotherapy codes for any session lasting less than 16 minutes.
E/M services performed on the same day as a psychotherapy service (same physician or other health care professional) must be significant and separately identifiable in order to bill both psychotherapy and E/M.
The following time-based psychotherapy codes are "add-on" codes to E/M services (99202 - 99255, 99304 - 99337, or 99341 - 99350). Select the psychotherapy code that most closely matches the actual time spent.
90833: Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (16 to 37 minutes)
90836: Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (38 to 52 minutes)
90838: Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (53 minutes or longer)
Note: Do not report psychotherapy codes for any session lasting less than 16 minutes.
Note: CPT 90832, 90833, 90834, 90836, 90837 and 90838 should not be reported with a unit of service greater than one except when performed in a Medicare partial hospitalization setting (POS 52). Effective July 1, services will be denied when reporting more than one unit of service (expect in POS 52).
CPT codes 90832-90838 include all psychotherapy provided to a patient with family members as informants, if present, for a single date of service. Family psychotherapy (e.g., CPT codes 90846, 90847) focused on the patient addressing interactions between the patient and family members may be reported separately with psychotherapy (CPT codes 90832-90838) on the same date of service if performed as a separate and distinct service during a separate time interval.
Psychotherapy (CPT codes 90832 - 90838) performed in a Medicare partial hospitalization setting (POS 52) may be reported with more than one unit of service to reflect the amount of psychotherapy provided during a single date of service.
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