+90836 CPT Code: Know Your Codes
There are two sets of psychotherapy codes. One set is the set of codes to report psychotherapy only i.e., CPT 90832- 30 minutes; CPT 90834-45 minutes; and CPT 90837- 60 minutes. While these are most frequently reported by social workers, psychologists and therapists, they can be reported by psychiatrists, psychiatric NPs, and PAs if medication management’s not performed at the same visit. These are time-based codes and do not differentiate by the type of psychotherapy or the location of the therapy. The second set of individual psychotherapy codes set are add-on codes i.e. CPT code 90833, CPT code 90836, and CPT code 90838.
When psychotherapy is done in the same encounter as an E/M service, there are add-on codes for psychotherapy that are to be used by psychiatrists to indicate both services were provided i.e., 90833 -30 minutes, 90836 – 45 minutes, 90838 – 60 minutes. Add-on codes are indicated by a plus sign. An add-on code is a CPT code that describes a service always performed in conjunction with the primary CPT code. For example, +90833 CPT code is used with the primary CPT code 90832, +90836 with 90834, and +90838 with 90837. These are billed by psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants.
+90836 CPT Code Description
+90836: Use add-on code for Individual psychotherapy, insight-oriented, behavior modifying and/or supportive, 45 minutes with the patient and/or family member (time range 38-52 minutes) when performed with an evaluation and management service. As mentioned above add-on code 90836 can be used with primary CPT code 90834 (i.e., psychotherapy, 45 minutes with the patient).
Key Points for Accurate Coding
- Psychotherapy with medical evaluation and management services (formerly reported as 90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827, 90829) are now reported with codes for E/M services plus a psychotherapy add-on code, +90833, +90836, and +90838.
- Code ‘exact’ time (in minutes) Actual Time Range (in minutes) 90832, +90833 30 16-37 90834, +90836 45 38-52 90837, +90838 60 At least 53
- Psychotherapy times are for face-to-face services with the patient and/or family member. The patient must be present for all or some of the service. In reporting, choose the code closest to the actual time (i.e., 16-37 minutes for 90832 and 90833, 38-52 minutes for 90834 and 90836, and 53 or more minutes for 90837 and 90838). Do not report psychotherapy of less than 16 minutes duration.
- If a patient is unable to communicate by any means, the interactive complexity codes should not be billed. This service is used in conjunction with codes for diagnostic psychiatric evaluation (90791, 90792), psychotherapy (90832, 90834, 90837), psychotherapy when performed with an evaluation and management service (90833, 90836, 90838, 99201-99255, 99304-99337, 99341-99350), and group psychotherapy (90853).
- Procedure codes 90832-90838 (psychotherapy for 30 to 60 minutes) – report the code closest to the actual time (i.e., 16-37 minutes for 90832 and 90833, 38-52 minutes for 90834 and 90836, and 53 or more minutes for 90837 and 90838. Procedure codes 90833, 90836 and 90838 are add on codes that should be used in conjunction with evaluation and management (E/M) codes 99201-99239, 99304-99337, 99341-99350.
Billing Examples for +90836 CPT Code
To get a clear idea of the accurate use of the +90836 CPT code, we shared a couple of billing examples from the APA website.
Q: I am a solo practitioner and generally see my patients for both E/M and psychotherapy on a weekly basis. Does the E/M code I bill limit the psychotherapy code I can bill?
A: No. The two services are separate. You code and document for whatever level of E/M is warranted by the patient’s presenting problem that day and select the add-on psychotherapy code based on the length of time of the psychotherapy provided. (The add-on psychotherapy codes are 90833 for 30 minutes, 90836 for 45 minutes, and 90838 for 60 minutes.) Since the current psychotherapy codes are not for a range of time, like the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used. For up to 37 minutes you would use the 30-minute code; for 38 to 52 minutes, you would use the 45-minute code, 90834; and for 53 minutes and beyond, you would use 90837, the 60-minute code.
Q: I take no insurance in my practice, but give my patients invoices for my services, which they submit to their insurance companies for reimbursement. I see my patient regularly for psychotherapy along with medical evaluation, and in the past always coded for the visit with 90807. Under the new coding format, the patient is required to submit a bill with the new codes. I will code using 99212 (since almost all my patients are stable and just require minimal E/M) and 90836, the add-on psychotherapy code for 45 minutes of psychotherapy. My question is, with the current CPT codes, am I required to apportion my fee between these two codes? If so, is there a reasonable way to do this?
A: Most insurers do require you to apportion your fee between the two codes. A reasonable way to do this may be to base how you apportion the fee on the relative value units that Medicare assigns to each of the codes. You can find these RVUs on the APA’s website here under the heading “RVUs.” If you take the total of the RVUs for the two codes you bill and divide that into your total fee, that will give you what your practice’s fee is for 1 RVU. Multiplying this by the RVUs assigned to each code will give you a fee for each code. Many payers base their fee schedules on the RVUs Medicare assigns, so the insurer should have no trouble accepting this approach.
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