Extended Sessions Billing Guide for Mental Health Providers [2024]
PLEASE NOTE: As of 2023, these codes have been removed by CMS and the AMA.
Learning how to bill extended therapy sessions for mental health insurance claims can be a paid but our extended sessions billing guide will help cut down your learning curve.
If you’d rather leave it up to the professionals, consider hiring out your insurance billing to a service like TheraThink. Otherwise grit your teeth and read on.
You’ll learn how to bill extended sessions for psychotherapy (90837), couples and family therapy (90847), and your diagnostic evaluations (90791).
We’ll also show you the 2020 Medicare extended session reimbursement rates for these add-on CPT codes.
- Individual Therapy Over 60 Minutes
- Reimbursement Rates
- Couples Therapy Extended Time Guide
- E/M Guide
- Video Guide
Billing Extended Sessions for Individual Therapy
It’s important to note that if you are seeing a client for 60 minutes or under, make sure to bill using CPT codes 90832, 90834, or 90837 alone.
Do not bill using add-on codes if sessions are not extended.
| Individual Therapy CPT Code | Add-On CPT Code for Extended Session | Length of Session | Services Rendered |
|---|---|---|---|
| 90832 | 16-37 minutes | Psychotherapy, 30 minutes | |
| 90834 | 38-52 minutes | Psychotherapy, 45 minutes | |
| 90837 | 53 - 89 minutes | Psychotherapy, 60 minutes | |
| 90837 | 99354 | 90-134 minutes | Psychotherapy, 1:30 hrs - 2:14 hrs |
| 90837 | 99354 99355 | 135-164 minutes | Psychotherapy, 2:15 hrs - 2:44 hrs |
| 90837 | 99354 99355 99355 | 165-194 minutes | Psychotherapy, 2:45 hrs - 3:14 hrs |
| 90832 90834 90837 | 99050 | N/a | Services performed outside of business hours. |
| 90832 90834 90837 | 99051 | N/a | Planned services performed in the evening, weekend, or during a holiday. |
Learn more about billing CPT Code 90837 for individual therapy sessions or review our quick guide on how to bill 90 minute therapy sessions.
Extended Sessions Billing Guide for Couples and Family Therapy
| Couples or Family Therapy CPT Code | Add-On CPT Code for Extended Session | Length of Session | Services Rendered |
|---|---|---|---|
| 90846 90847 | 99354 | 80-124 minutes | Couples or Family Therapy, Extended Session, 1:20 hrs - 2:04 hrs |
| 90846 90847 | 99354 99355 | 125-154 minutes | Couples or Family Therapy, Extended Session, 2:05 hrs - 3:34 hrs |
| 90846 90847 | 99354 99355 99355 | 155-184 minutes | Couples or Family Therapy, Extended Session, 3:35 hrs - 4:06 hrs |
| 90846 90847 | 99050 | N/a | Services performed outside of business hours. |
| 90846 90847 | 99051 | N/a | Planned services performed in the evening, weekend, or during a holiday. |
Review our extensive billing guide on CPT Code 90847 for couples and family therapy billing for more information or consider hiring out this painful drudgery.
Extended Sessions for a Diagnostic Evaluation & E/M Codes
To ensure you can bill these extended session add-on codes, make sure you’re licensed and eligible to provide evaluation and management services as per your insurance panel contract.
The first two codes (CPT codes 90833 or 90836) describe conducting therapy after providing evaluation and management services, in this example in conjunction with a diagnostic evaluation (90791).
The second two codes, CPT Codes 99415 and 99416, are used to describe extended sessions for evaluation and management (E/M).
If you are billing with CPT Code 99416, you must use CPT Code 99415.
| E/M CPT Code | Add-On CPT Code | Medicare 2020 CPT Code Reimbursement: | Description of Services |
|---|---|---|---|
| 90791 | 90833 | $72.90 | 30 minutes, Psychotherapy provided alongside evaluation and management services. |
| 90791 | 90836 | $92.39 | 45 minutes, Psychotherapy provided alongside evaluation and management services. |
| 99205 99215 | 99415 | $10.11 | 45-74 minutes, evaluation and management services |
| 99205 99215 | 99415 99416 | $4.33 | 75-104 minutes, evaluation and management services |
Video Guide!
Extended Sessions Reimbursement Rates
You can conduct an eligibility and benefits verification call to your client’s insurance company and ask specifically about coverage for those CPT codes used in conjunction with the primary code (90837 or 90847 or 90791).
At TheraThink, we do this as part of our mental health insurance billing service for free (because, as you can tell, it’s a best practice).
There is no guarantee that these extended session CPT codes will be covered. It’s best to call and ask for each client and obtain a reference ID as proof of that quote if problems come up in billing.
When using mental health add-on codes for services rendered after business hours or during evening, weekend, or holiday hours, call ahead to find out how your client’s insurance policy will approve the use of these procedure codes.
| Add-On CPT Code | Medicare 2020 CPT Code Reimbursement Rate | Medicare 2022 CPT Code Reimbursement Rate | Services Description |
|---|---|---|---|
| 99354 | $132.09 | $140.26 | Prolonged psychotherapy or evaluation and management, out-patient |
| 99355 | $100.33 | $101.32 | Prolonged psychotherapy or evaluation and management, out-patient |
| 90840 | $70.74 | $78.64 | Crisis therapy, each additional 30 minutes |
| 90833 | $72.90 | $77.88 | 30 minutes, Psychotherapy provided alongside evaluation and management services. |
| 90836 | $92.39 | $98.30 | 45 minutes, Psychotherapy provided alongside evaluation and management services. |
| 99415 | $10.11 | $11.34 | 45-74 minutes, evaluation and management services |
| 99416 | $4.33 | $6.43 | Each additional 30 minutes for prolonged evaluation and management services |
| 99050 | Not covered | Not covered | Services performed outside of business hours. |
| 99051 | Not covered | Not covered | Planned services performed in the evening, weekend, or during a holiday. |
CPT Add-On Code +99354 Reimbursement Rate (2022): $140.26
— Additional time up to 1 hour and 45 minutes for a diagnostic interview
CPT Add-On Code +99354 Reimbursement Rate (2020): $132.09
CPT Add-On Code +99354 Reimbursement Rate (2021): $129.10
CPT Add-On Code +99355 Reimbursement Rate (2022): $101.32
— Additional time up to three hours for a diagnostic interview (must be used with +99354)
CPT Add-On Code +99355 Reimbursement Rate (2020): $100.33
CPT Add-On Code +99355 Reimbursement Rate (2021): $96.31
(Source)
Example CMS 1500 Form Coding for Extended Sessions
Please note you will need to make sure to fill in your own NPI in box 24J on the CMS-1500 form, in this example.
Final Billing Suggestions
Consider all your services you provide (and at what times) when billing extended sessions. Make sure you’re asking about the right CPT codes when you’re doing your eligibility and benefits verification. Make sure to code your claims correctly for submission using the right add-on codes.
Ensure your EHR or claims management system is capable of billing these scenarios without interruption. Or look to hire out it all out.
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