Extended Sessions Billing Guide for Mental Health Providers

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).

extended sessions billing guide

We’ll also show you the 2020 Medicare extended session reimbursement rates for these add-on CPT codes.

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 CodeAdd-On CPT Code for Extended SessionLength of SessionServices Rendered
9083216-37 minutesPsychotherapy, 30 minutes
9083438-52 minutesPsychotherapy, 45 minutes
9083753 - 89 minutesPsychotherapy, 60 minutes
908379935490-134 minutesPsychotherapy, 1:30 hrs - 2:14 hrs
9083799354
99355
135-164 minutesPsychotherapy, 2:15 hrs - 2:44 hrs
9083799354
99355
99355
165-194 minutesPsychotherapy, 2:45 hrs - 3:14 hrs
90832
90834
90837
99050N/aServices performed outside of business hours.
90832
90834
90837
99051N/aPlanned 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 CodeAdd-On CPT Code for Extended SessionLength of SessionServices Rendered
90836
90847
9935480-124 minutesCouples or Family Therapy, Extended Session, 1:20 hrs - 2:04 hrs
90836
90847
99354
99355
125-154 minutesCouples or Family Therapy, Extended Session, 2:05 hrs - 3:34 hrs
90836
90847
99354
99355
99355
155-184 minutesCouples or Family Therapy, Extended Session, 3:35 hrs - 4:06 hrs
90836
90847
99050N/aServices performed outside of business hours.
90836
90847
99051N/aPlanned 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 CodeAdd-On CPT CodeMedicare 2020 CPT Code Reimbursement:Description of Services
9079190833$72.9030 minutes, Psychotherapy provided alongside evaluation and management services.
9079190836$92.3945 minutes, Psychotherapy provided alongside evaluation and management services.
99205
99215
99415$10.1145-74 minutes, evaluation and management services
99205
99215
99415
99416
$4.3375-104 minutes, evaluation and management services

(Source) (Source)

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.

extended sessions reimbursement rates

 

Add-On CPT CodeMedicare 2020 CPT Code Reimbursement RateServices Description
99354$132.09Prolonged psychotherapy or evaluation and management, out-patient
99355$100.33Prolonged psychotherapy or evaluation and management, out-patient
90840$70.74Crisis therapy, each additional 30 minutes
90833$72.90 30 minutes, Psychotherapy provided alongside evaluation and management services.
90836$92.3945 minutes, Psychotherapy provided alongside evaluation and management services.
99415$10.1145-74 minutes, evaluation and management services
99416$4.33Each additional 30 minutes for prolonged evaluation and management services
99050Not coveredServices performed outside of business hours.
99051Not coveredPlanned services performed in the evening, weekend, or during a holiday.

(Source) (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.

extended sessions billing cms 1500 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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