Physician Assistants and Billing for CPT Code 90833

Using CPT Code 90833: You’re already Doing Psychotherapy! (Whether You Know It or Not!)

Let’s talk reimbursement!  I know its important that the time spent with patients is reimbursed!  This helps your practice, and your RVU, and you’re able to spend more QT with your patients!  The time spent on psychotherapy is never wasted!  

What even is Psychotherapy in Primary Care?

To review: psychotherapy doesn’t have to be profound, “I was traumatized as a child…”  When we think of psychotherapy think: 

1. Identifying and changing negative thought patterns and beliefs that contribute to depression or anxiety
2. Developing coping skills to manage stress, anger, or other difficult emotions
3. Improving communication skills to address relationship issues or social anxiety
4. Learning to set boundaries and assert oneself in relationships or work situations
5. Developing healthy habits such as exercise, sleep, and self-care
6. Increasing self-awareness and self-esteem
7. Addressing past trauma or grief and coping with its impact on one’s life
8. Learning to manage symptoms of mental health disorders, such as panic attacks, obsessive-compulsive behaviors, or phobias.

CPT code 90833 refers to a psychotherapy session that lasts for 16 – 30 minutes. To use this code, you need to follow these steps:

1. Determine if the service provided is eligible for reimbursement under CPT code 90833. 
2. Ensure that you have the appropriate documentation to support the use of this code. This may include the patient’s medical record, a treatment plan, progress notes, and any other relevant documentation.
3. Enter the CPT code 90833 on the claim form, along with any other codes that may be necessary to describe the services provided.

It’s important to note that the specific requirements for using CPT code 90833 may vary depending on the insurance company and the specific circumstances of the services provided. It’s always a good idea to consult with the insurance company and/or a billing specialist to ensure that you are using the correct codes and following the appropriate guidelines for reimbursement.

How Much Can My Practice Be Reimbursed When I Add This Code To an Office VIsit?

Wondering how much the CPT code reimbursement is? It’ll depend on several factors, such as the specific insurance plan, geographic location, and the provider’s specialty.  In general, the national Medicare reimbursement rate for CPT code 90833 in 2021 is $71.79. However, private insurance companies may have different rates or negotiate rates with individual providers or provider groups.

Remember CPT 90833 is an Add-On Code for Office Visit!

Keep in mind that CPT 90833 is an add-on code!  This means an office visit (99214 usually) has to be billed and then 90833 is additional.  Both services SHOULD be provided during the same visit.  An example might be: a patient with uncontrolled anxiety, presenting with catastrophic thinking.  You’ll review any medication (likely adding or increasing dose) and then review of systems (GI, thyroid concerns, sleep, recent infections, derm for skin picking, general ROS and so on) and  possibly physical exam.  That meets criteria for 99214.  Then 16 or more minutes spent reframing catastrophic thoughts.  “Let’s talk about triggers that make you think about car accidents.  Have you ever witnessed or seen an accident like this?  Reframing would be crucial here! 

It is essential, actually vital, to ensure that the documentation supports the medical necessity for both services and that the billing is done correctly to avoid any potential billing errors or denials.  You’ll want to note, “spent >16 minutes discussing anxiety provoking thoughts, impact on daily living and reframes.”  Psychotherapy focuses on changing behaviors, thoughts, and emotions contributing to mental health issues.

PA-C Ability to Bill for CPT 90833:

Can a PA-C bill for this code? Well, this answer is as clear as mud.  It will depend on a few things:

• Does your state require extra paperwork to add 90833 as “additional/extra procedures.”  This is a matter of paperwork filled out by you and collaborating MD….its annoying but easy. 
• Sometimes insurances have extra barriers in place.  I have heard of cases where the state allows billing for 90833 but insurance will only reimburse if provider has CAQ in psychiatry.  This is unfortunate, but learning what insurances do/don’t reimburse could mean a significant change in revenue.  

The Centers for Medicare and Medicaid Services (CMS) recognizes PAs as “non-physician practitioners” who are eligible to provide certain medical services, including psychotherapy services, under the supervision of a physician or other qualified healthcare professional.

Don’t wait, add CPT 90833 to bills: it benefits you, the practice and of course…The patient!