90840 – Psychotherapy Service
CPT code 90840 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90840
?
90840 is a specific CPT code designated for psychotherapy services, particularly applicable to individual therapy sessions that extend beyond the standard duration. This entry provides a comprehensive overview of the clinical purpose of this code, the documentation required for compliance, and the payer considerations that clinicians and billing specialists must be aware of. It is essential for providers to ensure that their clinical documentation aligns with evidence-based practices. This includes recording treatment goals, detailing interventions utilized during the session, and noting measurable progress. When utilizing this time-based code, practitioners should meticulously document the start and stop times to substantiate the duration being billed, facilitating smoother claims processing and compliance with payer requirements.
Documentation Tips
When billing for time-based psychotherapy services under code 90840, it is crucial to document start and stop times accurately. Additionally, providers should indicate the therapeutic modality employed or any assessment instruments utilized, the clinical focus of the session, the patient's responses to the interventions, and a clear plan for follow-up. For any scored instruments used, maintain copies of the completed tools as part of the patient's record. In the case of telehealth sessions, it's important to document consent from the patient and the specific platform used for the session. To enhance audit readiness and ensure consistent documentation practices, consider using established frameworks such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan).
At a Glance
- Service Type: Psychotherapy
- Use Case: Individual Therapy
- Typical Setting: Outpatient clinic or telehealth (subject to payer policy)
- Billing Unit: Per session / per instrument (may vary depending on the specific code)
- Common Pairings: 90791, 96127, various psychotherapy codes
Billing Examples
A clinician conducts a focused therapy session utilizing Cognitive Behavioral Therapy (CBT) techniques to address a patient's chronic anxiety and panic symptoms. During the session, they document the specific interventions employed, such as cognitive restructuring and exposure exercises, along with measurable progress made by the patient towards their treatment goals. For sessions that deviate from the standard duration, the clinician should ensure they bill with the appropriate time-based psychotherapy code that accurately reflects the actual face-to-face time spent with the patient, thereby maintaining compliance and supporting proper reimbursement practices.
Compliance Guidelines
- Prior to billing, verify payer coverage and authorization requirements to ensure that the services rendered are eligible for reimbursement.
- Document medical necessity thoroughly, linking the services provided to relevant ICD-10 diagnoses to substantiate the treatment rendered.
- Apply correct modifiers as necessary (for instance, modifier 95 for telehealth services) to comply with payer guidelines.
- Avoid upcoding; always select the code that accurately reflects the documented time and level of service provided to ensure compliance with coding standards.
- Conduct periodic audits to minimize claim denials and enhance the quality of documentation, ensuring that it meets both clinical and administrative standards.
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: CPT code 90840 is utilized for psychotherapy sessions that meet the specific criteria outlined in the coding guidelines. It is essential to ensure that all documentation supports the billed service accurately.
Q2: Can it be billed via telehealth?
A: Many insurance payers will cover telehealth services when the therapy session is conducted synchronously, provided that appropriate modifiers and consent documentation are properly recorded. Always verify specific payer policies regarding telehealth coverage.
Q3: What documentation will payers request?
A: Payers may request detailed documentation that includes the time spent in the session, the therapeutic techniques or assessment instruments used, the patient's response to treatment, and a clear linkage to a covered ICD-10 diagnosis.
Q4: Can this be billed with other services?
A: Yes, when billing multiple services, it is important to document the distinct time spent on each service and provide a rationale for each. Utilize add-on codes or follow evaluation and management (E/M) separation rules where applicable to ensure compliance.
Q5: Common denial reasons?
A: Denials may occur due to missing documentation of time records, lack of medical necessity, incorrect use of modifiers, or billing for services beyond frequency limits established by the payer.
