CPT Codes for Mental Health Professionals

CPT (or current procedural terminology) codes are used by healthcare providers to tell insurance companies what they’ve done for their patients. Needless to say, understanding the correct CPT codes are essential for insurance billing procedures. 

Despite this fact, therapists often get confused about these codes, probably due to the wealth of complex information available on the internet. 

In this article, we will discuss common codes that therapists use in mental health services, as well as a step-by-step guide to navigating the world of CPT codes. 

Are CPT Codes Really That Important? 

Before we move on to the guide, however, let’s talk a bit about the importance of CPT codes.

It feels like it’s an unnecessary hassle to translate our services into ‘codes’ for insurance. After all, why not just write down the entire thing in words? 

That seems like a logical argument, until you remember that insurance companies deal with thousands of bills each day—and for them, the CPT codes are a way to streamline and standardise their procedure. 

This is beneficial for healthcare providers as well. 

Why? Because if the insurance companies have proper control over their billing process, mental health professionals are at lower risk of being reimbursed the wrong amount.

CPT codes also ensure that communication with insurance companies remains smooth. Instead of arguing over the intricacies of the provided services, healthcare providers and companies can simply resolve their issues by referring to the CPT handbook. 

Furthermore, CPT codes can help you keep track of the kind of services you are providing and can be beneficial for data analysis. 

All in all, while CPT codes appear to be tricky and overwhelming, they are truly a blessing in disguise. 

Most Common CPT Codes Used by Therapists 

Having a strong grasp of what CPT codes are and how they are used is important, but there is some preliminary information that you just can’t do without. 

That is, you should have at least the most common codes on your fingertips. 

These mental health visits cover everything from assessments and psychological testing to individual and group therapy . Each visit and procedure requires a unique CPT code. It's crucial for mental health professionals to stay current on CPT code updates.

To help you out, we’ve compiled the common CPT codes used by therapists in the USA. For your own country specific codes, please take a look at your local CPT handbook. Psychotherapy Evaluation 

These codes inform the insurance company of the duration of each session. The longer the session, the higher the code number will be. 

• 90832: Psychotherapy, 30 minutes

• 90834: Psychotherapy, 45 minutes

• 90837: Psychotherapy, 60 minutes 

E/M Codes 

These are used for initial and follow-up visits. Just like the aforementioned codes, they are used to inform the insurance company of the duration of the session.

• 99201: New patient office visit, 10-15 minutes

• 99203: New patient office visit, 20-29 minutes

Diagnostic Service Codes

These are used to inform the company that you’ve conducted a psychological test on the patient. 

The main code used for testing is ‘90785’ which includes clinical interviews, examination, and reports, alongside psychological testing and evaluation. 

Remember that the above list is not exhaustive and there might be some more common codes that you need to know. In our opinion, however, these are the ones that you need immediately after setting up your business and filing for your first insurance claim.

Now let’s take a look at how you can go about researching and figuring out the rest of the required codes. 

Tips for Effectively Using CPT Codes 

Tip 1: Understand CPT Code Basics Before Code Selection 

When you open up the CPT handbook, you are bound to get overwhelmed. 

The handbook is full to the brim with numbers that may seem foreign to unfamiliar persons—but there is a rhyme and reason to the CPT madness too. 

CPT codes have categories, structures, and modifiers that make them easier to navigate. To understand them, you first need to look at your country-specific guidelines. 

In short—do not skip the instruction manual for CPT codes. That is perhaps the most important part of this whole process.

After you’re done going over the rules, take some time to identify the different categories of the CPT codes and mark the ones that are the most relevant to you. 

The CPT handbook will typically contain several categories like interpersonal therapy, family therapy, diagnostic evaluation, and so on. Based on the services you offer, some will apply to your business while others won’t. 

Remember that there are divisions within each category too—so reading the heading only isn’t enough. 

Codes are differentiated according to durations, as well as mediums. Face-to-face therapy has a different code in each instance than online therapy. Similarly, codes will differ for 45-minute and 60-minute sessions. 

For the first few months, you might have to carefully look at each code and then document it for insurance billing. 

But as you gain mastery over the CPT game, you’ll realise that there are certain modifiers to each code that make the process so much easier.

These modifiers basically make the codes more specific. One example of a modifier is ‘GT’ which is used for group therapy. Another common one is ‘51’ which is used to indicate that multiple sessions have been conducted. 

To speed up the process, you can look at some of the relevant modifiers beforehand. 

Our suggestion is that you don’t leave things to trial-and-error in the CPT process—because that could mean lost money or tussles with the insurance company. 

In short: Do your research. You can’t go wrong if you know all the guidelines beforehand. 

Step 2: Master Time-Based Codes 

As already mentioned, codes vary according to the duration of each session. 

This seems simple enough to understand—but the problem arises when you as a therapist don’t keep track of your session duration. 

To bill for insurance, you cannot make do with ‘estimated’ times. You need to have a proper procedure to keep track of the duration and your client needs to be aware of it. 

Why? Because if you and your client disagree about the duration, then a) you will have no proof of the allotted time and b) you will lose the trust of your client.

Since trust is the foundation upon which a therapist-client relationship is built, you cannot compromise on this part of the process. 

That’s not to mention that you might have to face accusations of ethical violation and that your licence might be threatened in the process. 

Step 3: Stay Informed About Coding Updates 

Just like the DSM gets updated, unfortunately, sometimes, the codes get updated too. 

And if you miss out on important updates—then, that might mean more administrative work, as well as loss of time and money. 

Our advice is that you subscribe to coding newsletters or regularly check online resources to stay informed about any such changes. 

You can also sign up for coding workshops and seminars at different intervals, just to survey what has changed and what has stayed the same. 

If you already have a good professional network, however, you don’t need to worry that much. You can cut a deal with fellow therapists to share any coding updates, in case any one of them gets wind of them. 

This is especially helpful if you know of therapists working with organisations. Private therapists might have a harder time staying updated, but those working under a company name are usually updated by the staff within the organisation itself. 

Step 4: Navigate Coding with Software 

As a licensed professional counselors, you probably want to invest all your energy in your clients. CPT codes, then, might serve as unnecessary distractions to your actual job. 

That is why it’s a good idea to enlist the help of software. 

Coding software can help you find the right CPT codes, check code compliance, and reduce the number of coding errors. 

They can also save you from the vicious cycle of going over the CPT handbook again and again, and will automatically give you updates when required. 

If you have the money—it’s a good investment.

If you don’t have the money, it’s a good idea to save up for it. This is because in the long run, doing the admin work yourself is a waste of time, energy, and money. In that time, you can deal with one more client if you wish. 

However, before you make the decision to buy software, it’s best to take the following things into account: 

• How much does the software cost? 

• Are there any additional training costs for the software? 

• How much time does it take to familiarise yourself with the software? 

• Is the interface of the software user-friendly? 

• Is the software actually saving time? 

As long as your software fits all your requirements, you’ll be able to handle CPT codes like a pro, without even having to consult the CPT handbook five times a day yourself. 

Conclusion

CPT codes might be an administrative challenge, but they prove to be immensely useful in streamlining the insurance billing process. What’s more, you can easily get around the tedious CPT procedures by delegating the task to an efficient software. 

In any case, if you are worried, now should be the time to take a deep breath and relax—because as far as we can tell, the whole process is not that bad at all!