In behavioral health, medical billing is a crucial aspect of providing services to patients. The billing ensures that healthcare providers receive proper payment for the services they provide, and it helps patients understand the costs associated with their care.
As the healthcare industry continues to evolve, it is important for behavioral health providers to understand the billing process and the specific CPT Codes that are commonly used in their field. The codes help healthcare providers communicate with insurance companies and ensure that they receive proper reimbursement for the services they provide.
Below, we provide an overview of the most commonly used CPT Codes in behavioral health billing. We will explain what each code means, when it is used, and provide examples of situations where it might be applicable.
What are CPT Codes?
CPT Codes are a standardized set of codes used to describe medical procedures and services provided by healthcare providers. CPT-10 stands for Current Procedural Terminology, 10th edition. These codes are used by healthcare providers to communicate with insurance companies and ensure that they are properly reimbursed for the services they provide.
Understanding Behavioral Health Billing
In behavioral health, billing is slightly different than in other areas of healthcare. For example, behavioral health providers often provide psychotherapy and other mental health services that are not typically provided by other healthcare providers. As a result, they use different CPT Codes than other healthcare providers might use.
In general, billing in behavioral health involves submitting claims to insurance companies for services provided. These claims typically include information about the patient, the services provided, and the cost of those services. Insurance companies use this information to determine how much they will pay for the services provided.
CPT Codes Used in Behavioral Health
The Most Commonly Used CPT Codes in Behavioral Health:
90834 – Psychotherapy
This code is used for individual psychotherapy sessions lasting 45-50 minutes. It is typically used for patients who are experiencing mental health issues such as anxiety, depression, or post-traumatic stress disorder (PTSD).
90837 – Psychotherapy
This code is used for individual psychotherapy sessions lasting 60 minutes. It is also typically used for patients who are experiencing mental health issues such as anxiety, depression, or PTSD.
90846 – Family Psychotherapy without the Patient Present
This code is used for family psychotherapy sessions that do not involve the patient. It is typically used when the therapist is working with the family to help them understand and cope with a loved one’s mental health issues.
90847 – Family Psychotherapy with the Patient Present
This code is used for family psychotherapy sessions that involve the patient. It is typically used when the therapist is working with the family to help them understand and cope with the patient’s mental health issues.
90853 – Group Psychotherapy
This code is used for group psychotherapy sessions. It is typically used for patients who are experiencing mental health issues that can benefit from group therapy, such as substance abuse or eating disorders.
90791 – Psychiatric Diagnostic Evaluation
This code is used for initial evaluations of patients who are seeking mental health treatment. It is typically used to determine a diagnosis and create a treatment plan.
90832 – Psychotherapy
This code is used for individual psychotherapy sessions lasting 30 minutes. It is typically used for patients who are experiencing mental health issues but do not require a longer session.
96127 – Brief Emotional / Behavioral Assessment
This code is used for brief emotional or behavioral assessments. It is typically used to assess a patient’s mental health and determine whether they need further treatment.
H0004 – Behavioral Health Counseling and Therapy, per 15 minutes
This code is used for behavioral health counseling and therapy sessions that last 15 minutes. It is typically used for patients who require shorter sessions or frequent check-ins.
H0031 – Alcohol and/or Drug Services; Brief Intervention, per 15 minutes
This code is used for brief interventions related to alcohol and drug services. It is typically used to provide education and counseling to patients who are struggling with substance abuse.
H0036 – Mental Health Services; Community Psychiatric Support and Treatment (CPST)
This code is used for community psychiatric support and treatment services. It is typically used to provide support to patients who are receiving treatment for mental health issues.
H2019 – Therapeutic Behavioral Services
This code is used for therapeutic behavioral services. It is typically used to provide support to patients who are experiencing behavioral issues that impact their mental health.
H0038 – Behavioral Health Nursing Visit
This code is used for nursing visits related to behavioral health. It is typically used to provide support to patients who are receiving treatment for mental health issues.
H2036 – Community-Based Psychiatric Rehabilitation and Support
This code is used for community-based psychiatric rehabilitation and support services. It is typically used to provide support to patients who are recovering from mental health issues and need help reintegrating into their community.
Summary
Understanding the most commonly used CPT Codes in behavioral health billing is essential for both providers, plus the billing and coding staff. By using the correct codes for each service performed, providers can ensure accurate and timely payment for their services, while also avoiding potential penalties or compliance issues. Navigating the complexities in behavioral health billing becomes second nature.
While the CPT coding system can be complex and challenging to navigate, providers can improve their knowledge and efficiency by staying up-to-date on the latest guidelines and regulations, as well as by consulting with expert billing and coding professionals when needed.
Ultimately, by prioritizing accurate and efficient billing, behavioral health providers can focus on what matters most – providing high-quality care to their patients.
Behavioral Health CPT Code FAQs
- What are some of the most common behavioral health CPT Codes?
Some of the most common behavioral health CPT Codes include 90791 for diagnostic evaluations, 90834 for psychotherapy sessions lasting 45-50 minutes, and 90847 for family or couples therapy sessions. - How can behavioral health providers ensure they are using the correct CPT Codes for billing?
It’s important for behavioral health providers to stay up-to-date on the latest coding guidelines and regulations, as well as to consult with their billing and coding staff or a professional medical billing company to ensure they are using the correct codes for each specific service. - What is the difference between a CPT-10 Code and an ICD-10 code?
While both CPT-10 and ICD-10 codes are used for medical billing and coding, CPT Codes specifically describe the services provided, while ICD-10 codes describe the diagnosis or reason for the service. - Can the same CPT Code be used for different types of behavioral health services?
Some CPT Codes can be used for multiple types of behavioral health services, but it’s important to ensure that the code accurately reflects the specific service provided and that any necessary modifiers are used to clarify the service type. - How can behavioral health providers track their billing using CPT Codes?
Behavioral health providers can use electronic health records (EHRs) or billing software to track their CPT Codes. These tools can help providers ensure accuracy and efficiency in their billing processes.
