Introduction
Wrapping your head around Current Procedural Terminology (CPT) codes is a complex but necessary component of working in healthcare. There is a lot of information that goes into understanding CPT codes (we’ll dive into this in just a moment), and we recognize how overwhelming it can quickly become. Sometimes, the best way to become an expert at knowing and using CPT codes is to understand the most commonly used codes in your industry. For this reason, we’ve conducted research and identified the CPT codes that are most frequently used by counselors – alongside some valuable tips and tricks on how you can optimize your coding practice. Let’s get started!
Overview on CPT® codes
First thing’s first: what exactly are CPT codes? As a healthcare practitioner, CPT codes dictate how you record the services you deliver, and as such, are critical for receiving reimbursement. Essentially, these codes are the standardized alphanumeric coding system that is managed by the American Medical Association (AMA). Each code refers to a specific service and/or action that a healthcare provider engaged in during an interaction with their client. CPT codes are used to standardize medical treatments, accurately describe services, and ensure that healthcare practices receive the necessary reimbursement. They are used by federal insurance programs (including Medicare and Medicaid), as well as private insurance providers.
CPT codes are reviewed and updated by the AMA annually, a necessary process that does, however, make it difficult for practitioners to stay on top of their knowledge of the codes. For this reason, it can be especially useful for healthcare providers to have a solid understanding of their own industry, whether this relates to the top CPT codes for therapy, counseling, psychiatry, dentistry, or occupational therapy.
Why are CPT codes essential for private practitioners?
As we mentioned briefly, CPT codes determine whether or not a healthcare practice receives reimbursement for services that they deliver to patients. The medical coding and billing process is highly complex, and we won’t get into all of the details, but in order to understand our guide to using CPT codes, you first need to know how this system works.
Essentially, after a healthcare practitioner has treated a patient, a claim is submitted to the patient’s insurance provider. This claim must contain detailed and accurate codes pertaining to the specific treatment that the client received during the relevant session. After this information has been documented, the claim is submitted to the insurance provider, who vets the details. Only if the claim is accurate will the healthcare practice receive reimbursement for their services. As you can see, this process is highly dependent on the accuracy of the original claim – which requires accurate CPT codes.
A healthcare practice’s financial stability, reputation, and general growth are thus highly dependent on the accuracy of the claims that they submit. Given the importance of this process, it is evident how necessary it is for healthcare businesses to prioritize developing their understanding of CPT codes, especially those that are relevant to their industry.
Just as a quick head’s up, we want to reiterate that this summary of the medical billing process is just that – a summary. The actual system involves further complexities, and we definitely recommend having a look into them so you can deepen your understanding of medical coding!
Most common counseling CPT codes for private practitioners
Now that we’ve gone over all of that, let’s take a look at some of the most commonly used CPT codes in counseling. Knowing these codes will systematize and organize the coding process at your healthcare practice. It can also be useful to have an understanding of different healthcare field codes as well, for example, CPT codes for family therapy billing and CPT codes for occupational therapy evaluation. This information will make your coding process much easier, especially when you take into consideration how interrelated healthcare services can be.
Common Counseling Codes:
Diagnostics:
- 90791: Psychiatric Diagnostic Evaluation
- 90792: Psychiatric Diagnostic Evaluation with medical services
Therapy:
- 90832: 30-min Psychotherapy
- 90834: 45-min Psychotherapy
- 90837: 60-min Psychotherapy
- 90846: Family or Couples Therapy, without the patient present
- 90847: Family or Couples Therapy, with the patient present
- 90853: Group Psychotherapy (not a family session)
- 98968: Telehealth session
- 90839: 60-min Psychotherapy for crisis
Assessments:
- 96101: Psychological testing, interpretation, and reporting by a psychologist
- 96105: Assessment of Aphasia
- 96125: Standardized Cognitive Performance Testing
- 96110: Developmental Screening
- 96112: Developmental Test Administration
- 96127: Brief Emotional/Behavioral Assessment
Psychological Testing:
- 96116: Neurobehavioral Status Exam, first hour
- 96130: Psychological Testing Evaluation by a physician, first hour
If you’re reading this list and feeling somewhat overwhelmed, that’s totally okay. There are quite a large number of different CPT codes and it can be difficult to remember the specific codes relevant to your work. It is important to note, however, that CPT codes change rarely, so as soon as you have a good understanding of how they apply to your services, the coding process will be much easier!
Add-on CPT codes for mental health billing
In addition to the commonly used base CPT codes for mental health services, there is a range of add-on codes. These CPT codes must be used in conjunction with other relevant codes, and help to explain specific details of a session or demonstrate complexities. Add-on codes can be specific to different primary codes – for example, there are add-on codes applicable to CPT psychological testing and evaluation codes that may differ from those applicable to diagnostic CPT codes.
Here are some of the most commonly used add-on CPT codes for mental health billing:
- 90785: Interactive Complexity (this code demonstrates that the treatment has complexities)
- 90863: Pharmacological Management
- 99050: Services provided at times when the practice is usually closed
- 99354: Additional time after the additional 74 minutes (adds another 30 minutes)
- 99355: Additional time after first 60 minutes
- 90840: 30 additional minutes of psychotherapy for crisis
- 90833: Psychotherapy 30-minute additional time
- 90835: Psychotherapy 45-minute additional time
Final thoughts
These are essentially all of the commonly used CPT codes for mental health therapists. We understand that medical coding can be highly complex, but hopefully, this guide has highlighted some of the key codes relevant to your industry. While wrapping your head around CPT codes is important – it’s only step one. It will also benefit you greatly to have a good understanding of ICD codes, and the differences between CPT codes and HCPCS – equipped with this knowledge, you’ll be an expert in no time.
Another fantastic way to optimize the medical coding process at your counseling practice is to invest in practice management software. These systems are integrated with sophisticated tools that can assess and organize your codes to ensure that the claims you submit are accurate. Carepatron is a practice management solution that aims to streamline the medical coding and billing process, enabling improved accuracy and a much faster reimbursement rate. Get in touch to find out more about our free, customer-focused, healthcare solution.
Further Reading:
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