nswers to Psychologists’ Questions about the 2013 Psychotherapy Codes QA
When do I use the new psychotherapy codes?
You will use the 2013 psychotherapy codes for
billing clients and filing health insurance claims
with third-party payers, including Medicare,
Medicaid and private health insurance carriers,
for psychotherapy services provided on or after
Jan. 1, 2013.
What if a psychotherapy session is shorter or
longer than the time specified in the code
All individual psychotherapy will be captured
through one of three new codes. (See page 1.)
Unlike the codes in existence through 2012, the
new code descriptions in the 2013 CPT® manual
list specific times (for example, 45 minutes)
rather than a range ( 45-50 minutes).
Although the time for each code is specific, the
manual allows for some flexibility. When reporting
a psychotherapy service, the provider may choose
the code closest to the actual time of the session.
The examples provided in the manual are 16-37
minutes for code 90832, 38-52 minutes for 90834
and 53 minutes or more for 90837.
What happens if I bill using the old psychotherapy
codes for services provided on Jan. 1, 2013, or later?
Effective Jan. 1, psychologists should assume that
their Medicare carrier will reject any claims
containing codes that have been deleted from
CPT and that these claims will require refiling.
We expect that private managed care and other
insurance companies are also likely to reject claims
filed using the 2012 psychotherapy codes.
What was psychology’s role in the psychotherapy
codes review process?
Revisions to the family of psychotherapy codes for
2013 resulted from the Five Year Review, the process
by which the Centers for Medicare and Medicaid
Services (CMS) periodically reviews all codes.
National associations representing psychology,
psychiatry, child and adolescent psychiatry, social
work and nursing participated in a confidential
CPT coding workgroup process overseen by the
American Medical Association (AMA). The multi-specialty workgroup evaluated the definitions
of services under the existing psychotherapy
family of codes and recommended work relative
value units (RVUs) for the new psychotherapy
codes. Along with other associations involved in
the workgroup, the APA Practice Organization
conducted a member survey during the spring
of 2012 as part of the process of determining
recommended work RVUs. The RVUs ultimately
adopted by CMS are applied to the formula used
by the federal agency in determining Medicare
apapracticecentral.org/codes for additional
answers to frequently asked questions and more
information about the 2013 psychotherapy codes.
APA members who are licensed by a state board of
psychology can renew their membership in the APA
Practice Organization for 2013 online at
Log in using your APA user ID and password, click
on “Renew Your Membership for 2013” and pay your
2013 Practice Assessment. You can also call APA
Membership Services at 1-800-374-2721.
Putting Your Practice Assessment to Work