CPT Code 90404 is an oddity in the collection of regularly billed CPT codes. Cigna created this procedure code to describe EAP sessions taking place through their billing system.
CPT Code 90404 Description
90404 is defined as Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual.
This isn’t the most descriptive CPT code and beyond the routine procedure codes (90834/90837) 90404 is one of the most frequently billed CPT codes.
CPT Code 90404: Cigna EAP
Employee Assistance Program (EAP) visits are typically billed with the HJ modifier with a routine procedure code, i.e. 90837 or 90834. This is how companies like Anthem, Aetna, and United Healthcare ask their claims to be billed. But Cigna has a different requirement.
90404 Billing Modifier
Cigna asks that you do not use the HJ modifier and instead bill EAP with a different procedure code, 90404. Just like other EAP visits, Cigna also requires that an authorization number is included. If 90837 + HJ session is billed to Cigna, they may process it as a normal mental health claim!
This also means there is no time descriptor for Cigna EAP claims. While most smaller insurers follow the standard protocol, a few like MHN may ask you to file with 90404. Not sure if this includes your specific situation with an insurer? This is an area where a professional billing service, such as TheraThink can help.
If you are also not sure if your Cigna client has EAP benefits, we recommend calling the insurance ahead of time to ensure that you should be billing EAP or for a routine mental health service.
How Do I Bill 90404?
Just like other CPT codes, it should go in the 24(c) location of a CMS 1500. Be sure to also include the authorization in box 23.
CPT Code 90404 Reimbursement Rate
Reimbursement for 90404 by Cigna tends to be similar to routine sessions, like 90834 or 90837. Because all sessions billed as 90404 are EAP, they should not have any patient responsibility.
If you’re struggling to get your Cigna EAP claims paid, consider reaching out to TheraThink’s mental health billing service. We successfully bill 90404 everyday of the week.