Accurate billing keeps a therapy practice ethical and financially sustainable. While many CPT codes are straightforward, some can be complex and often misunderstood. One such code is 90833, which proves useful for certain clinical situations.

In this article, we'll clarify CPT code 90833 and explain when, how, and if you should  use it. This will help you feel confident in applying this code appropriately in your practice. Let's look into the details of 90833.

What is CPT Code 90833?

CPT code 90833 applies to 16-37 minutes of psychotherapy with a patient when performed alongside an Evaluation and Management (E/M) service by the same provider on the same day. Psychiatrists or other prescribing providers often bill this code during a medical management visit that also includes therapy. Non-prescribing providers generally do not use 90833 unless they work within a multidisciplinary team.

When to Use 90833: Clinical Criteria and Examples

Use CPT code 90833 when you, as the provider, offer both medication management (E/M service) and a separate, billable psychotherapy session lasting between 16-37 minutes with the same patient on the same day. Here are a couple of clinical examples to illustrate:

• Psychiatrist adjusting medication and providing therapy: Imagine you're a psychiatrist treating a patient with severe depression. During the visit, you adjust their antidepressant dosage (an E/M service) and then transition into providing cognitive behavioral therapy techniques to help manage their symptoms. As long as the psychotherapy portion lasts between 16-37 minutes, you can bill this visit using 90833 along with the appropriate E/M code.
• Psychiatric NP conducting medical management and brief therapy: Consider a psychiatric nurse practitioner conducting a medication management visit for a patient with bipolar disorder. In addition to assessing the patient's response to their current mood stabilizer (E/M service), the NP also provides brief supportive therapy to help the patient cope with a recent stressor. Again, if the therapy portion takes 16-37 minutes, this visit qualifies for 90833 billing.

Both components, medical management and psychotherapy, must be significant, distinct, and well-documented to justify using 90833. Psychotherapy should stand as a billable service on its own, with a clear therapeutic focus and interventions separate from the medical management.

Billing Requirements and Documentation Tips

To bill 90833 correctly, your documentation must clearly separate the psychotherapy portion from the E/M service. This distinction shows that the psychotherapy service warrants its own billing code as a significant, separately identifiable service. Here's what you should include:

• Time breakdown: Indicate the time spent on the E/M portion and the psychotherapy portion separately. Remember, the psychotherapy must last between 16-37 minutes to qualify for 90833.
• Therapeutic modalities: Specify the therapeutic approaches used during the psychotherapy, such as cognitive behavioral therapy (CBT), supportive therapy, or interpersonal therapy (IPT). This helps justify psychotherapy as a distinct service.
• Goals addressed: Connect the psychotherapy interventions to the patient's treatment goals. This could include reducing symptoms, improving coping skills, or addressing specific stressors. Documenting the therapeutic focus shows the medical necessity of the service.
• Modifier 25: When billing 90833 alongside an E/M code, add modifier 25 to the E/M code to indicate that it was a significant, separately identifiable service. This informs payers that the psychotherapy was a distinct service, not just an extension of the E/M visit.

Proper documentation helps prevent claim denials and ensures compliance with payer requirements. Regularly review and update your documentation templates to align with the latest billing guidelines. If you collaborate with a quality assurance specialist, work with them to ensure your documentation meets all necessary criteria for 90833 and other psychotherapy codes

Common Errors and How to Avoid Them

Even with a good grasp of CPT code 90833, mistakes can happen when billing. Here are some common errors to watch out for:

• Misusing 90833 without a concurrent E/M code: Remember, 90833 is an add-on code and must be used with an appropriate E/M service. Using 90833 by itself will lead to claim denials.
• Lack of documentation to justify separate billing: Your session notes must clearly distinguish the E/M service from the psychotherapy service. Inadequate documentation can result in denials or audits.
• Billing 90833 for sessions lasting less than 16 minutes of psychotherapy: The psychotherapy portion must be at least 16 minutes long to qualify for 90833. Shorter sessions are typically not billed, as there is no code to document this service under 16 minutes. 
• Using vague or incomplete session notes: Be specific in your documentation. Include details about the therapeutic interventions used, the patient's response, and the progress made toward treatment goals. Avoid generic phrases like "provided therapy" or "discussed issues."
• Failing to check payer requirements and bundling rules: Insurance companies may have specific guidelines for using 90833, such as requiring certain modifiers or limiting the frequency of use. It's important to be familiar with each payer's policies to ensure compliance and avoid denials.

To minimize these errors, consider these tips:

1. Use templates or checklists: Develop standardized documentation templates that prompt you to include all necessary information for 90833 billing. This helps ensure consistency and completeness.
2. Double-check your coding: Before submitting claims, review your codes to make sure they accurately reflect the services provided. Pay close attention to the E/M code and any required modifiers.
3. Stay updated on billing guidelines: Regularly review payer policies and attend coding workshops to stay current with the latest requirements for 90833 and other psychotherapy codes.
4. Conduct self-audits: Periodically review a sample of your claims to identify any patterns of errors or areas for improvement. This proactive approach can help you catch and correct mistakes before they lead to denials or audits.

Paying attention to these common pitfalls and using preventive strategies can reduce billing errors and ensure you receive proper reimbursement for your services.

Reimbursement Considerations and Payer Variations

It's important to note that CPT code 90833 often receives lower reimbursement compared to standalone therapy codes like 90832 (30 minutes) or 90834 (45 minutes). This occurs because 90833 serves as an add-on code, with the main reimbursement coming from the accompanying E/M service code. However, using 90833 can still boost overall reimbursement for a visit that includes both medical management and psychotherapy.

When billing 90833, be aware that some insurance plans may deny reimbursement if the documentation or modifiers are incorrect. To avoid denials and ensure proper payment, keep the following in mind:

• Check preauthorization requirements: Some payers may require preauthorization for 90833, especially if it's frequently used or combined with specific E/M codes. Review each payer's policies and obtain preauthorization when needed.
• Verify coverage for your provider type: Not all payers reimburse 90833 for every type of mental health provider. Check with each insurance company to confirm they cover 90833 for your specific license type and specialty.
• Use modifiers correctly: As mentioned earlier, add modifier 25 to the E/M code when billing 90833 to indicate a significant, separately identifiable service. Double-check that you're using the correct modifier to avoid denials.
• Monitor changes in payer policies: Insurance companies may update their reimbursement policies for 90833 over time. Stay informed about any changes that could impact your billing, such as new documentation requirements or limitations on frequency of use.

If you encounter denials or lower-than-expected reimbursement for 90833, reach out to the payer for clarification. In some cases, providing additional documentation or adjusting your billing practices can resolve the issue. If you consistently face challenges with a particular payer, consider advocating for better reimbursement rates or exploring alternative payment arrangements.

Scope of Practice Considerations for Therapists

When using CPT code 90833, it's important to know which mental health professionals typically bill for this service. While 90833 is a useful code for many providers, it doesn't apply to all therapists in every setting. Here's a breakdown of who commonly uses 90833:

• Psychiatrists: As medical doctors specializing in mental health, psychiatrists often bill 90833 when they provide both medication management and psychotherapy in the same visit. Their wide scope allows them to offer treatment that combines medication and therapeutic interventions.
• Psychiatric Nurse Practitioners (NPs): Like psychiatrists, psychiatric NPs can prescribe medications and provide psychotherapy. They frequently use 90833 to bill for visits that include both medication management and therapy services. Psychiatric NPs collaborate with other mental health professionals to deliver integrated care.
• Physicians: Some primary care physicians and other medical specialists also provide mental health services. When these providers conduct an E/M service and psychotherapy in the same visit, they can bill using 90833. However, physicians not specializing in mental health or trained in psychotherapy may not be able to use this code.

On the other hand, licensed therapists, such as Licensed Clinical Social Workers (LCSWs), Licensed Marriage and Family Therapists (LMFTs), and Licensed Professional Clinical Counselors (LPCCs) usually do not bill using 90833. These providers focus on psychotherapy services and do not hold prescribing privileges. 

As a therapist, it's important to understand your scope of practice and how it relates to billing codes like 90833. If you're unsure whether you can use this code in your practice, consult with your supervisor, a billing specialist, or your professional organization for guidance. Staying within your scope ensures ethical and compliant billing practices while providing the best possible care to your clients.

Conclusion: Making Informed Decisions About 90833

CPT code 90833 can be very useful for mental health providers who offer both medical management and psychotherapy services. However, it's important to use this code correctly to ensure proper reimbursement and compliance with billing regulations. Here are some key points to remember:

1. Know the requirements: To bill 90833, you must provide between 16-37 minutes of psychotherapy along with a significant, separately identifiable E/M service on the same day.
2. Document thoroughly: Clearly separate the psychotherapy service from the E/M portion in your session notes, including the time spent on each, therapeutic interventions used, and patient response.
3. Know your scope of practice: 90833 is primarily used by psychiatrists, psychiatric NPs, and other prescribing providers. 
4. Stay updated on billing guidelines: Regularly review payer policies and attend billing trainings to ensure you're using 90833 correctly and avoiding common errors.

For therapists working in interdisciplinary settings, collaborating closely with medical providers is key for accurate billing and documentation. This teamwork enhances patient outcomes, improves communication, and makes the best use of resources. Some key benefits of interdisciplinary collaboration include:

• Enhanced patient safety: Bringing together diverse expertise reduces risks of medical errors and adverse events.
• Holistic, personalized care: Addressing physical, psychological, and social aspects of a patient's condition leads to more comprehensive treatment plans.
• Increased patient engagement: Coordinated care supports stronger therapeutic alliances and treatment adherence.

Ongoing education on CPT coding is an important part of professional development and compliance for all mental health providers. Workshops, webinars, and self-study resources can help you stay current with the latest billing guidelines and payer requirements. Understanding codes like 90833 ultimately supports the financial health of your practice and your ability to deliver high-quality patient care.