Top 2024 CPT Codes | How Do Health Care Workers Use Therapy Billing Codes?
Understanding CPT Codes for Psychotherapy, Counseling, Group Therapy & More
Tracking services and billing by code can be time-consuming, which is why it’s helpful to use counseling, psychotherapy, and social work software that has these codes built into the system. Psychotherapists, counselors, and Social workers may use everything from a family therapy CPT code to psychotherapy codes to a CPT code for alcohol counseling.
If they want to get paid, then they must have diagnosis and treatment services categorized correctly for insurance companies and government healthcare reimbursement programs.
In this article, we’ll take a deep dive into CPT codes for psychotherapy, counseling, social work billing, and other mental health services. You may find it handy to bookmark this page as a quick reference for mental health worker, counselor, therapist, and social worker billing codes.
CPT Codes for Mental Health
Clinical social workers and therapists provide vital mental health services. These services are often covered by public and private insurance, thus it’s important for practitioners to know how to use CPT codes for mental health, as well as therapy CPT codes.
CPT codes are the language of insurance billing. Being able to bill insurance for services increases the income potential of social work agencies and therapists. For example, certified therapist or licensed clinical social workers that diagnose and treat mental, emotional, and behavioral illnesses can bill Medicare for reimbursement for approved services.
See Also: What Are the Best Screening Tools for Depression and Anxiety?
Table of Contents: Psychotherapy, Counselling, and Social Work Codes for Billing
Keep on scrolling down this page to read each section or click any link below to go directly to that section.
- What Does CPT Code Mean?
- Types of CPT Codes for Mental Health & Medical Services
- What Are HCPCS Codes for Mental Health Services?
- Categorized List of the Most Common CPT Codes for Mental Health
- CPT Code Update Questions
- Common Errors When Using Social Work & Psychotherapy Billing Codes
- Conclusion | Social Work Billing and How to Use CPT Codes for Mental Health
- FAQ | Social Work & Therapy CPT Codes
Don’t Miss: Anxiety and Depression Questionnaire Screening Guide
What Does CPT Code Mean? Why is it Important?
CPT codes were created by and are maintained by the American Medical Association (AMA). CPT is an acronym for Current Procedural Terminology. These codes provide a common language for health care and mental health care providers for various services and procedures.
Counseling CPT codes, psychology CPT codes, therapy procedure codes, and others are used to annotate the specific services provided to a client. These are widely used in the medical and mental health communities and are generally required for billing services to public and private insurance.
Some of the things that Psychiatrists, Counselors, and Social Workers use a CPT code for family therapy or behavioral health CPT codes for are as follows:
- Reporting
- To improve records accuracy
- Developing medical care review guidelines
- Insurance claims processing
CPT codes are designated as a national coding standard for physicians and other healthcare professional services and procedures in the Health Insurance Portability and Accountability Act (HIPAA).
So, it’s important for social workers and everyone in the mental health services community including mental health counselors and therapists to become familiar with these CPT codes, psychotherapy uses, therapy billing codes, and other codes pertinent to mental health services.
Related: Survey for Depression to Detect Signs in Adults, Children, and Elderly
Do you have feedback about the CPT codes therapy providers use at your organization? Or have questions about CPT psychotherapy codes, or the group therapy CPT code? If so, contact the Social Work Portal Team.
Types of CPT Codes for Mental Health & Medical Services
CPT codes are five digits long and can include both numeric and alphanumeric characters. These codes are separated into four types.
- Category I: The health and therapy CPT codes in this category will have numbers between 00100 to 99499. They are based on the procedure or service type as well as anatomy. (This is where most of the CPT codes for psychotherapy and social work services will be.)
- Category II: These are optional codes that are used for performance measurement.
- Category III: The CPT codes in this category are temporary and used for new and developing technology, procedures, and services. You can think of this as a “catchall” for services and procedures that don’t fit into any criteria for a code in Category I.
- Proprietary Laboratory Analyses (PLA) codes: These are used to describe proprietary clinical laboratory analyses.
Popular Article: How Does the PHQ 9 Depression Scale Work?
What Are HCPCS Codes for Mental Health Services?
Another type of code set that is used for counseling billing codes, and other types of social worker billing codes is the Healthcare Common Procedures Coding System (HCPCS).
Medical and mental health HCPCS codes are administered by the Centers for Medicare and Medicaid Services (CMS). It has two levels or types, which are:
- HCPCS Level I: The CPT coding system.
- HCPCS Level II: Commonly referred to as “HCPCS codes” are mainly used to identify services, products, and supplies not included in the CPT codes. These medical billing codes include a letter followed by four numeric digits.
Read More: Understanding the GAD 7 Scale for Anxiety Screening
Do you have any questions about the CPT code for couples therapy, the CPT code for group therapy, or the CPT code for counseling? If so, contact the Social Work Portal Team.
Categorized List of the Most Common CPT Codes for Mental Health
Below is a list of the most common CPT codes family practice, social workers, therapists, and other mental health professionals use. You’ll find a variety of insurance billing codes, such as the CPT code for individual therapy, the CPT code for psychiatric evaluation, the CPT group therapy code, and many others.
Note that the AMA updates these CPT codes for mental health and medical services regularly, so be sure to check the official website for the latest updates.
CPT Codes for Psychotherapy
In this group of CPT codes for psychotherapy, you’ll find the individual therapy CPT code, the CPT code for psychiatric evaluation, CPT code for psychological evaluation, and other commonly used CPT codes therapy practices use.
90791: Psychiatric diagnostic evaluation
90792: Psychiatric diagnostic evaluation with medical services
90832: Psychotherapy, 30 minutes with patient
90833: E/M (evaluation & management) code for 30 minutes of psychiatry (used with 90832)
90834: Psychotherapy, 45 minutes with patient
90836: E/M code for 45 minutes of psychiatry (used with 90834)
90837: Psychotherapy, 60 minutes with patient
90838: E/M code for 60 minutes of psychiatry (used with 90834)
90839: Psychotherapy for a crisis, first 60 minutes
90840: Add-on code for psychotherapy, each additional 30 minutes (used with 90839)
90845: Psychoanalysis
90863: Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
90876: Individual psychophysiological therapy, incorporating biofeedback training by any modality (face-to-face with patient), with psychotherapy, 45 minutes
Family, Couples & Group Therapy CPT Codes
This set of MSW CPT Code options includes the code for family therapy without patient present, the group counseling CPT code, the family therapy code, and others.
90846: Family or couples psychotherapy, without patient present, 50 minutes
90847: Family or couples psychotherapy, with patient present, 50 minutes
90849: Multiple-family group psychotherapy
90853: Group Psychotherapy, other than a multi-family group
Related: What You Need to Know about GAD 2 Questions & Scoring
Do you have any questions about CPT family therapy codes, a family counseling CPT code, a group therapy billing code, or group counseling CPT code? If so, contact the Social Work Portal Team.
Psychological Testing Social Work Codes
The next set of CPT codes includes the code for psychiatric evaluation of testing results, the initial psychiatric evaluation CPT code for tests administered through electronic means, and the CPT code for psychoanalysis testing.
96127 – Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument
96130 – Psychological testing, interpretation, and reporting by a psychologist (first hour)
96131 – Add-0n code to 96130, Psychological testing, interpretation, and reporting by a psychologist (per additional hour)
96146 – Single automated psychological or neuropsychological test administered via an electronic platform.
Online & Telehealth Clinical Social Worker CPT Codes
Telehealth (also called telemental health) has grown tremendously since the COVID-19 pandemic. The CPT codes for psychotherapy and mental health services below include mental health counseling CPT codes for telehealth interactions.
98968 – Telephone therapy (non-psychiatrist) – limit 3 units/hours per application
99421 – Online digital E/M service conducted via a patient portal for an established patient, five to 10 minutes of cumulative time over seven days
99422 – Online digital E/M service conducted via a patient portal for an established patient, 11 to 20 minutes of cumulative time over seven days
99423 – Online digital E/M service conducted via a patient portal for an established patient, 21 or more minutes of cumulative time over seven days
99443 – Telephone therapy (psychiatrist) – limit 3 units/hours per application
Don’t Miss: PHQ-2 Scoring and Assessment Guide
Do you have any questions about a family therapy billing code or individual therapy code? Do you have feedback about the initial psychiatric evaluation CPT code being used by your organization? If so, contact the Social Work Portal Team.
Substance Abuse Counseling CPT Codes
Below, are two behavioral health CPT codes for alcohol and/or substance abuse services.
99408 – Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
99409 – Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
Additional Social Work CPT Codes
The social work and counseling CPT codes below are additional codes that may be used by social workers in various areas of service.
90404: Cigna / MHN EAP sessions
90785: Interactive Complexity add-on code (Used in conjunction with CPT codes 90791, 90832, 90834, 90837, or 90853)
90887: Consultation with Family. Family feedback/education. Explanation of results of examination, procedures, data, to family or other responsible person.
97535 – Self-care management training
97537 – Community/work reintegration
CPT Code Update Questions
How Do I Use CPT Code 99417 Since Its Update?
CPT codes get deleted, added, and updated from time to time. This can cause confusion and interfere with a billing process that used to run smoothly. It’s important to keep up to date on any changes, by checking for updates at the AMA’s website.
One code change that we’ve been asked about is the revision of Prolonged Services E/M code 99417 and guidelines. This change became effective on January 1, 2023.
If you are looking for more information on how and when you can use CPT code 99417, we’ve located some resources that you can review for further information. Below, we’ve included links to the resources and a small excerpt of pertinent information from the page. Please visit the links to read the guidance from those sites in more detail.
Reference 1: CodingIntel
Excerpt:
“Per CPT, use 99417 for office visits, outpatient consults, home and residence services and cognitive assessment planning.
Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)
(Use 99417 in conjunction with 99205, 99215, 99245, 99345, 99350, 99483)
(Do not report 99417 on the same date of service as 90833, 90836, 90938, 99358, 99359, 99415, 99416)
(Do not report 99417 for any time unit less than 15 minutes)”
Reference 2: Codify by AAPC
“For 2023, CPT® removes the words “beyond the minimum required time” from the descriptor for +99417, which now reads (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)).
Fortunately, the guidelines for using the code remain the same.”
Reference 3: Medical Billers and Coders
“Medicare has assigned a status indicator of invalid to code 99417 and developed an HCPCS code to replace it, G2212.”
Reference 4: Noridian Healthcare Solutions
“CPT codes 99358, 99359 or 99417 are not valid for Medicare with status indicator “I” on the physician fee schedule.”
Popular Article: Mental Health Questionnaire Assessment Tools
If you have any questions about the CPT code for family therapy, the group therapy CPT code, the CPT code for couples therapy, or any other CPT code for counseling just contact the Social Work Portal Team.
Common Errors When Using Social Work & Psychotherapy Billing Codes
Working with mental health and behavioral health CPT codes for billing can be complicated. It’s not unusual for mistakes to happen. But when they do, it can mean getting an insurance claim denied or facing a penalty.
You want to reduce billing mistakes and ensure that you’re using the right CPT codes therapy services required for acceptance by insurance carriers and government programs.
Here are some of the most common CPT billing errors to avoid.
Missing Therapy Codes Billing Information
Missing information can cause a claim to get bounced. For example, if you’re not connecting the right CPT code to a service or you leave digits off the CPT code. Missing form information can also include leaving off important patient information on your billing submission.
Using software that will insert CPT codes for mental health services and patient data from your CRM can help you avoid missing information.
Duplicate Billing Especially for CPT Psychotherapy
This can happen if you don’t have a good tracking system for billing and payments. Duplicate billing is when a patient is billed more than one time for the same service that was provided just once.
Using the Wrong Social Work CPT Codes
If you use the CPT code group therapy entry when you should have used the CPT code for individual therapy, it can cause delays in getting paid by a patient’s insurance carrier.
Using the wrong CPT code for a mental health service is an easy mistake to make, but it can be costly. It’s important to understand how each of these CPT codes for psychotherapy and social work services are used and ensure you keep track of them appropriately in patient records as the services are provided.
Upcoding
Upcoding can be a serious problem and get you into trouble. It’s when a billing code is used for a more expensive service than was actually given.
You want to make sure you’re always using accurate billing codes that match the CPT code described with the service provided to the patient.
See Also: Social Work Case Notes Formats (SOAP, BIRP, GIRP, and DAP Notes Examples)
Do you have any questions about family therapy CPT code practices, CPT codes psychotherapy uses, or Individual therapy CPT codes? Click here to contact the Social Work Portal Team.
Conclusion | Social Work Billing and How to Use CPT Codes for Mental Health
No matter what area of social work or mental health you work in, you’ll likely be billing an insurance company at some point. To ensure you’re doing it right, you need to become very familiar with CPT codes for psychotherapy and CPT codes for mental health services in other areas of social work.
CPT codes are also a requirement of HIPAA, which is another reason to brush up on them. And even if you’re not using these codes for billing purposes, CPT codes are used through the medical and mental health communities for a variety of purposes.
Knowing the “language” of procedure and service coding improves records consistency and integration with other health and mental health providers.
Don’t Miss: What Social Worker Intake Form Types Are Used the Most by Social Workers?
FAQ | Social Work & Therapy CPT Codes
What are the CPT codes for mental health counseling?
CPT codes were created by and are maintained by the American Medical Association (AMA). CPT is an acronym for Current Procedural Terminology. These codes provide a common language for health care and mental health care providers for various services and procedures.
What is the difference between CPT code 90791 and 90792?
CPT code 90791 is for a psychiatric diagnostic evaluation.
CPT code 90792 is for a psychiatric diagnostic evaluation that includes medical services.
What are the CPT codes for psychotherapy?
There are several CPT codes for psychotherapy. A few of the most common are:
•90791: Psychiatric diagnostic evaluation
•90792: Psychiatric diagnostic evaluation with medical services
•90832: Psychotherapy, 30 minutes with patient
•90834: Psychotherapy, 45 minutes with patient
•90837: Psychotherapy, 60 minutes with patient
•90839: Psychotherapy for a crisis, first 60 minutes
What are Mental Health HCPCS Codes?
Another type of code set that is used for counseling billing codes, and other types of social worker billing codes is the Healthcare Common Procedures Coding System (HCPCS).
Medical and mental health HCPCS codes are administered by the Centers for Medicare and Medicaid Services (CMS). CPT codes are included in Level I of the HCPCS codes.
Note: Content on Social Works socialworkportal.com website is copyrighted.
Social Work Portal Disclaimer:
Social Work Portal is not a social work agency and we do not refer social workers. This web site is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with ...
Read our full disclaimer here: Social Work Portal Disclaimer.
Image sources: Stock.adobe.com