CPT Code 99354 for Mental Health Therapists

CPT Code 99354 is a prolonged service CPT code add-on. It cannot be billed alone and must be billed with an appropriate procedure code. It fits into a sub-group of add-ons from 99354-99359 forming a subgroup of prolonged services codes. Up until recently, only medical doctors could bill this code with E/M codes but in the last few years many insurance companies have begun to reimburse for it with routine service codes. This means many Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Marriage Family Therapist (LMFT), clinical psychologists and psychiatrists can get reimbursed with 99354. It is still not commonly known and isn’t billed very frequently, but is a great way to be compensated for extended psychotherapy sessions.

CPT Code 99354 Definition

99354 is described as an additional 30-74 minutes beyond the other CPT code. This means there is no preset time that you can bill 99354 for. So, the time of the original procedure code is important + a minimum of 30 minutes. See the 99354 time requirements section for further clarification.

99354 Time Requirements

For mental health professionals, the 99354 is almost always billed with 90837 or 90847. 90837 is defined as 60 minutes, whereas 90847 is defined as 50 minutes. Since 99354 needs to be at least an additional 30 minutes, sessions need to be at least 30 minutes longer beyond the other procedure code.

Individual Psychotherapy

  • 53-89 minute session – 90837.
  • 90-134 minute session – 90837 + 99354.

Group Psychotherapy w/Patient Present

  • 26-79 minute session – 90847.
  • 80-124 minute session – 90847 + 99354.

99354 vs. 99355 & Even Longer Sessions

What about individual psychotherapy sessions even longer than 134 minutes or group psychotherapy that’s longer than 124 minutes. Are you required to underbill insurance in these cases?Billing CPT Code 99354

Not necessarily. 99355 belongs in the same subgroup of procedure codes as 99354 and can be used in tandem with 99354 for sessions that are another 30 minutes. 99355 cannot be billed without 99354. In the case of even longer extended sessions, you would bill 99355 as well.

 

99354 Restrictions

Even though 99354 can now be billed by non-medical personnel it does not mean it is universally accepted. Different insurance companies may reimburse for it while others may not. Others may also require authorization. If you bill with us, we can call on your behalf to find out before you have an extended session.

Even though the family psychotherapy 90847 often allows 99354, 90846 is rarely allowed to be billed with 99354.

How Do I Bill 99354?

Just like other CPT codes, the procedure code 99354 should go in the 24(c) location of a CMS 1500. Since it must be billed with 90837 or 90847 make sure you include those procedure codes on a separate line in section 24.CMS 1500 99354 Claim

 

99354 Reimbursement

99354 is not universally reimbursed and depends heavily on the insurance company. The fee schedule often allows for reimbursement along the lines of 90837 when it is. Billing 99354 is a great way to be fairly compensated if you end up seeing clients for a much longer session. It is always best to call the insurance ahead of time to make sure it is covered. Our billing service can do this for you.