How to Navigate Billing for Extended Sessions

Therapists who offer extended sessions (longer than 60 minutes) were left high and dry in 2013 when the AMA overhauled the CPT codes and deleted codes for these services.  There now are only three, timed, individual psychotherapy codes, the longest one being 90837 for 60 minutes. With instructions to use the 90837 CPT code for 60 minute psychotherapy for any session over 53 minutes, there was no way to distinguish a 60 minute session from longer sessions, thus insurance reimbursement was based on the 60 minute rate.

However, don’t always expect to get paid more for the 60 minute code.  While many plans do allow ongoing, routine 60 minute sessions, and pay for more than the 45 minute session (CPT code 90834), other plans reimburse at the same rate. Worse yet, at least one insurance plan won’t process a 90837 code without preauthorization (UBH/UHC/Optum — they will sometimes grant a few preauthorized sessions for EMDR or other special circumstances).  As always, it’s a good idea to contact the plan to check their policy on coverage of 90837 sessions.

If the session meets the criteria for a crisis session, you might use these codes: 90839 for the first 60 minutes of a crisis session, 90840 as the add-on for each 30 minutes of additional time after the 60 minutes.

Another possibility is to bill one 45 or 60 minute session to insurance and contract privately with the client to pay any additional time out of pocket.  This is not a violation of your contract, as a client is always able to contract for additional services that are not covered by their insurance.  If you are a network provider I would charge the client your usual network rate for the additional time (ex.  if your usual network rate is $75 for 45 minutes and you do a 90 minute session, I would charge the client $75 for the second half of the session plus his/her copayment or deductible for the first half of the session).  I would also have them sign a written Private Pay Agreement stating they understand that this additional time will be their responsibility to pay, and how much they will be paying (a sample Agreement is in the back of my book).

It is not recommended that you break the session into two parts and bill for each.  For example, if you did a 90 minute session, it is not recommended that you bill for two 45 minute sessions on the same day, unless the plan tells you to do so, as many plans only allow one hour of therapy per day.

A final billing possibility for extended therapy sessions emerged in 2016 when the AMA allowed add-on codes for Prolonged Services, 99354 and 99355, to be used with 90837 sessions for sessions at least 90 minutes in length.  These codes were formerly allowed for doctors, physician’s assistants, and nurses only.  So, will insurance plans reimburse therapists for these Prolonged Service codes?  Or only when medical personnel uses them?  

If you want to try billing for an extended session using the Prolonged Services codes, it requires the use of multiple CPT codes and thus multiple lines for the same date of service. When using these codes it’s recommended that you verify the usage with each insurance payer.  Here are some examples:

 

Some therapists who have used these codes have been reimbursed for the extra time, yet others only got paid for the first 60 minutes.  So while it isn’t a sure thing you’ll be reimbursed, there doesn’t seem to be a risk: I have not heard of entire claims being denied.

One final note: What about extended family or couples therapy sessions? The AMA clarified in 2016 that if you are billing for ongoing family or couples therapy, you should be using CPT code 90847 or 90846 instead — you can’t use timed individual therapy codes like 90837 or Prolonged Service codes with these sessions.  You can use individual codes for a couples or family session only if a family member comes into a session where ongoing individual therapy has been or will be taking place, and the family member acts as an occasional or one-time informant.  The individual client must be present for at least part of the session.  For more info on family and couples billing, see my article on the CPT code updates, or stay tuned for my article on Billing for Couples and Family Therapy later this month.

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