90836 – Psychotherapy Service
CPT code 90836 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90836
?
90836 is a key CPT code utilized for billing individual psychotherapy services, specifically when combined with the provision of a focused or extended session. This document outlines the clinical rationale for using this code, essential documentation requirements, and considerations for payer compliance. Providers should ensure that clinical notes are meticulously aligned with evidence-based interventions, clearly articulating treatment objectives, the specific therapeutic techniques employed, and quantifiable progress made by the patient. In instances where billing is time-based, it is critical to document the exact start and stop times to substantiate the billed duration accurately.
Documentation Tips
When billing for time-based psychotherapy services under CPT code 90836, it is imperative to document detailed start and stop times. Additionally, clinicians should include the therapeutic modality employed, any standardized assessment instruments used, the clinical focus of the session, the patient’s response to interventions, and a comprehensive plan for follow-up. For sessions involving scored instruments, retain copies of completed tools as part of the patient’s record. In telehealth scenarios, it is essential to document patient consent and the platform utilized for the session. Adopting a consistent documentation structure, such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan), will facilitate audit readiness and ensure compliance with payer requirements.
At a Glance
- Service Type: Psychotherapy
- Use Case: Individual Therapy
- Typical Setting: Outpatient clinic or telehealth (determined by payer policies)
- Billing Unit: Per session / per instrument (varies by specific service)
- Common Pairings: 90791, 96127, various psychotherapy codes
Billing Examples
For instance, a clinician conducts a focused session employing Cognitive Behavioral Therapy (CBT) to address the patient’s panic symptoms. During the session, the clinician actively engages the patient in identifying triggers and developing coping strategies, meticulously documenting the interventions employed and the patient’s progress toward previously established treatment goals. If the session lasts for 75 minutes, the clinician would appropriately bill using the time-based code reflecting the actual duration of the face-to-face interaction, ensuring that all documentation aligns with the services rendered.
Compliance Guidelines
- Confirm payer coverage and authorization prerequisites before submitting claims for reimbursement.
- Thoroughly document medical necessity and ensure that services provided are directly linked to relevant ICD-10 diagnoses.
- Utilize appropriate modifiers (e.g., 95 for telehealth services) as required by specific payer guidelines.
- Avoid upcoding; select the code that accurately reflects the documented time and level of service provided.
- Conduct regular audits to identify and minimize claim denials, thereby enhancing documentation quality and compliance.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.0
- F41.1
- F33.1
- F43.10
- F41.9
- F34.1
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
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Q1: What is this code used for?
A: The CPT code 90836 is designated for use when the clinical activities performed during the session align with the code's definition. It is vital that the supporting documentation accurately reflects the services billed to avoid potential claim denials.
Q2: Can it be billed via telehealth?
A: Yes, many payers provide coverage for telehealth services under this code, provided that the service is synchronous and all necessary modifiers and patient consent documentation are in place. Always verify specific payer policies regarding telehealth billing.
Q3: What documentation will payers request?
A: Payers typically request documentation that includes the duration of the session, the therapeutic techniques or assessment instruments utilized, the patient’s responses to treatment, and the linkage of services to a covered ICD-10 diagnosis.
Q4: Can this be billed with other services?
A: When billing for multiple services, it is crucial to document the distinct time spent on each service and the rationale for their provision. Consider using add-on codes or following Evaluation and Management (E/M) separation rules as applicable to ensure compliance.
Q5: Common denial reasons?
A: Frequent reasons for claim denials include insufficient documentation of session times, lack of demonstrated medical necessity, incorrect use of modifiers, or billing for services that exceed frequency limits set by payers.
