Full Answer
How to apply for a new CPT code?
- Submission of a current, complete and materially compliant application form and all other necessary supporting documents
- Adherence to all posted deadlines
- Full cooperation with requests from CPT staff and/or Editorial Panel members for clarification and information
What is the CPT code for substance abuse treatment?
Code. Description. Fee Schedule. Commercial Insurance. CPT 99408. Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes. $33.41. CPT 99409. Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes. $65.51. Medicare. G0396
What is the CPT code for treatment?
What is CPT ®?
- Recognizing CPT ® Codes. CPT ® codes consist of 5 characters.
- Understanding the Types of CPT ® Codes. ...
- Learning How to Use CPT ® Codes. ...
- Building Confidence with CPT ® Coding Guidelines. ...
- Appending Modifiers to CPT ® Codes. ...
- Relating CPT ® to Other Codes Sets. ...
- Establishing Medical Necessity. ...
- Preparing for a Career in Medical Coding. ...
What is the CPT code for individual therapy?
CPT Code 90837 is a procedure code that describes a 60 minute individual psychotherapy session performed by a licensed mental health provider. 90837 is considered a routine outpatient CPT Code and is one of the most common CPT codes used in mental health insurance claims coding and billing.
What is the CPT code for addiction counseling?
Addiction Treatment Billing CPT Code #3: 96164HF The CPT code here is “96164” and the modifier being used is, again, “HF.” The CPT code, 96164, represents face-to-face (in-person) group counseling.
What is the CPT code for substance abuse?
The two new codes, 99408 and 99409, will standardize and streamline reporting and reimbursement for physicians who perform alcohol or non-tobacco substance abuse SBI. Sample questions from the drug abuse screening test include: Can you get through the week without using drugs?
What is CPT code H0001?
Alcohol and/or drug assessmentH0001 Alcohol and/or drug assessment – means the evaluation of an individual by a clinician to determine the presence, nature, and extent of substance use disorder with the goal of formulating a plan for services (if such services are offered) and treating the client in the most appropriate treatment environment.
What is CPT H2036?
HCPCS code H2036 for Alcohol and/or other drug treatment program, per diem as maintained by CMS falls under Other Mental Health and Community Support Services .
What is CPT code H0049?
H0049 is a valid 2022 HCPCS code for Alcohol and/or drug screening or just “Alcohol/drug screening” for short, used in Other medical items or services.
What is CPT code G0396?
G0396 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes.
What is CPT code H0006?
HCPCS code H0006 for Alcohol and/or drug services; case management as maintained by CMS falls under Drug, Alcohol, and Behavioral Health Services .
What is CPT code H2019?
HCPCS code H2019 for Therapeutic behavioral services, per 15 minutes as maintained by CMS falls under Other Mental Health and Community Support Services .
What is CPT code H0015?
H0015- Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education.
What is CPT H2035?
HCPCS code H2035 for Alcohol and/or other drug treatment program, per hour as maintained by CMS falls under Other Mental Health and Community Support Services .
What is CPT H0010?
HCPCS code H0010 for Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) as maintained by CMS falls under Drug, Alcohol, and Behavioral Health Services .
What is CPT code H0035?
H0035 – Mental health partial hospitalization, treatment, less than 24 hours.
When was CPT code developed?
The American Medical Association (AMA) developed the Current Procedural Terminology (CPT) code system in 1966. CPT codes standardize medical billing across disciplines and practice types, allowing a wide range of health care professionals, including mental health workers, to be reimbursed for their services.
What are add on codes?
Add-on codes are codes that are always billed along with another code, called a primary code. The Centers for Medicare and Medicaid Services breaks these add-on codes into three categories: 1 Type I codes are eligible for reimbursement only if submitted with an appropriate primary code for the same practitioner and client for services rendered on the same date. The only exception to this rule is if a client receives care from two practitioners in the same specialty, in the same practice, and on the same date. 2 Type II codes are not associated with a specific list of primary codes. Instead, these codes are eligible for reimbursement if a practitioner bills an acceptable primary code along with the add-on code for the same day of service. 3 Type III codes are those for which a practitioner may bill along with an approved code listed in the CPT manual or if the provider offers medical justification for billing the add-on with another primary code.
What is the CPT type 3 code?
Type III codes are those for which a practitioner may bill along with an approved code listed in the CPT manual or if the provider offers medical justification for billing the add-on with another primary code. A common mental health add-on code is 90785, which denotes interactive complexity services.
What is duplicate billing?
Duplicate billing, such as billing the same code twice or billing different codes for a single service. A basic familiarity with common billing codes can make it easier to quickly generate bills. Many psychotherapists only bill a few CPT codes.
What is the code for mental health?
A common mental health add-on code is 90785, which denotes interactive complexity services. A practitioner usually reports it along with 90837, 90834, 90791, or 90832. 90785 indicates that there is a communication factor that complicates mental health services.
Does evaluation count toward psychotherapy?
Likewise, evaluation and management time cannot count toward the time spent on a psychotherapy session. Overbilling can increase the risk of a costly audit. Mental health providers who seek reimbursement for their services must master efficient CPT billing.
Can I get reimbursement for a type I code?
Type I codes are eligible for reimbursement only if submitted with an appropriate primary code for the same practitioner and client for services rendered on the same date. The only exception to this rule is if a client receives care from two practitioners in the same specialty, in the same practice, and on the same date.
What is a CPT code?
The final piece in the coding puzzle is a Current Procedural Terminology (or CPT) code. CPT codes describe the treatment you’ve provided to the patient based on their diagnosis. The CPT code is always informed by the ICD code you choose. The CPT code should always represent a treatment that your patient's insurance company will agree is warranted and “necessary” given the patient’s diagnosis. Knowing what treatments are allowable for each insurance company is critical when you’re choosing a CPT code. It’s so important that you—or your billing service—complete a thorough verification of benefits and a rock-solid utilization review before your staff starts choosing CPT codes.
What happens if you choose the wrong ICD-10 code?
Choosing the wrong ICD-10 code sets up your entire claim for failure. If there were just one ICD-10 code for substance use disorder, then it would be easy to always choose the correct code, but it’s just not that simple. To make matters even more complicated, each insurance company will have different rules and expectations based on different ICD-10 codes. Learning what to expect from each insurance company when you bill for each code can feel like a process of trial and error, especially when you are first starting out.
What is a CPT code?
CPT codes are five digit numeric codes describing everything from surgery to radiology to psychotherapy. CPT Codes are different from Diagnosis Codes or ICD10 F-Codes for billing and coding your insurance claims. Here’s our mental health diagnosis code list if you need to look one up.
How many CPT codes are there for psychotherapy?
CPT coding for psychotherapy doesn’t have to be difficult! There are an overwhelming amount of total CPT Codes (~8,000), however only 24 are specifically designated for psychotherapy and other mental health services.
How long is a 90837 session?
Adding another 30 minutes. (Only use if the duration of your session is at least 90 minutes for 90837 or 80 minutes for 90847). Add-On CPT Code 99355 – Additional time after first 60 minutes. First additional 30 to 74 minutes. Add-On CPT Code 90840 – 30 additional minutes of psychotherapy for crisis.
When did the CPT change?
CPT is a large and dynamic code set that changes year to year, but the psychotherapy codes seldom change. The most recent change for psychotherapy codes took place in 2019, then 2013, and previously 1998.
What does it mean to downcode a claim?
Downcoding (including less services on the claim than actually provided) will usually mean you get paid less, while upcoding (including more services on the claim than actually provided) can get you in trouble with your managed care panels.
What is psychometric testing?
Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member (s) or caregiver (s), when performed; first hour
What is standardized cognitive performance testing?
Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
