Understanding when to use CPT vs. HCPCS codes is important for mental health practitioners who accept insurance.
This guide provides a comprehensive overview of psychotherapy billing codes and a handy list of CPT codes and CPT code examples.
We’ll explain the differences between a CPT code vs. HCPCS code, how to use each, and when to apply one over the other.
This can help you feel confident knowing when to use CPT vs HCPCS codes.
Are HCPCS and CPT codes the same?
To understand when to use a CPT code vs HCPCS code, you’ll first need to have a grasp of the terminology and how it is used operationally.
What are CPT codes?
CPT, which stands for Current Procedural Terminology®, is a medical nomenclature created by the American Medical Association (AMA) to describe healthcare procedures, surgical procedures, diagnostic services, and more.
Providers in healthcare professions across the globe use these codes to ensure standardized language, which can improve accuracy, streamline reporting, and allow for tracking of healthcare trends.
Mental health clinicians who accept insurance use CPT codes for insurance reimbursement. In cases where a provider does not accept the client’s insurance, they may also provide the client with a superbill so that the client can submit the claim to their insurance. In these cases, CPT codes would be used on the superbill.
The AMA defines CPT codes by three distinct categories:
CPT code structure:
- Category I codes describe common medical procedures or services.
- Category II codes are used to record performance and quality, and are optional.
- Category III codes track procedures, services, and emerging technologies that are not widely used.
What are HCPCS codes?
Like CPT codes, HCPCS codes—which stands for Healthcare Common Procedure Coding System—are used as a standardized reporting language relating to medical procedures and services.
HCPCS codes were created by the Centers for Medicare & Medicaid Services. Both sets of codes have a numbered coding structure, however, the descriptions for CPT vs. HCPCS codes differ.
HCPCS code structure:
- Level I codes, also known as CPT 4 codes, include all levels of CPT codes to describe services performed by physicians in hospitals.
- Level II codes are used to denote services, products, and supplies not otherwise described in CPT codes, such as medical equipment and supplies, ambulatory services, and prosthetics.
- Level III are locally used codes. National usage ceased in 2003.
CPT code vs. HCPCS code
There are some key differences between CPT vs. HCPCS codes.
HCPCS codes classify medical and diagnostic procedures and services to Medicare and Medicaid (and some other insurance providers). They are also used to bill for the use of products, supplies, and services not included in CPT codes.
Meanwhile, CPT codes describe healthcare procedures, surgery, and diagnostic services—and are more commonly used by healthcare providers for billing both private and public health insurance plans.
Here are some other important differences between CPT and HCPCS codes:
- HCPCS codes are:
- Used commonly by hospitals and physicians to report supplies, equipment, and services
- Developed and maintained by the Centers for Medicare & Medicaid Services, however, they are in the public domain
- Alphanumeric codes beginning with the letters H, J, K, L, Y, Z
- CPT codes are:
- Used universally for billing purposes
- 5-digit codes
- Copyrighted by the AMA
List of CPT codes
The following is a list of CPT code examples used by mental health clinicians:
- 30-minute psychotherapy session: 90832
- 60-minute psychotherapy session: 90837
- 45-minute psychotherapy session: 90834
- 50-minute family therapy session: (without client present) 90846
- 60-minute family therapy session (with client present): 90847
- 60-minute psychotherapy with E/M service (therapy session which includes an evaluation and management): 90838
- Psychiatric evaluation: 90791
- 60-minute crisis psychotherapy: 90839
- Group psychotherapy (not time-based): 90853
- Interactive group psychotherapy: 90857
- Other psychiatric services or procedures: 90875
- 60-minute preventive medicine, individual counseling services: 99404
Clinicians may also add a CPT code modifier, which provides additional information, such as:
- Modifier UT: Describes attending to a patient in crisis.
- Modifier GT: Defines a telehealth session using audio and video.
- Modifier 25: Used to describe a separate evaluation and management service.
- NOTE: You can only attach modifier 25 to codes 99201 to 99215 and 99341 to 99350.
- Modifier 59: Denotes another service completed with the client on the same day (excludes evaluation and management).
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