Having the right psychotherapy CPT codes is significant in the descriptions of mental health care procedures. These codes help providers in finding the type of service and duration. One such code that is used frequently is CPT 90838.
90838 is an add-on code that is used for a psychotherapy session that lasts for 60 minutes, which also includes some medical evaluation and prescribing medication, making the E/M component primary.
Understanding all related codes is very important. Having the correct code influences compensation payment. Coding mistakes can result in claim denial, reduced revenue, or billing audits.
This article will address CPT code 90838, stating the details of its application, comparing it with related codes, and most importantly, highlighting some problems associated with this code and their solutions.
Code 90838 Description
CPT code 90838 describes a psychotherapy session lasting one hour with evaluation and management (E/M) services incorporated in the session. This is mainly for psychiatrists or other physicians who are able to prescribe medicine and also oversee the physical or mental health of the patient.
90838 CPT Code Description
· 90838 used for a psychotherapy session, which lasts for an hour and also includes an E/M component.
· Such includes both therapeutic conversation and medical treatment.
· Staff to patient contact time must be no less than 53 minutes.
Who Can Bill 90838 on CPT?
One of the most frequently asked questions is, can psychologists bill 90838?
The answer lies within a psychologist’s license and scope of practice. Ordinarily, most psychologists and licensed therapists do not bill 90838 because it has E/M and includes things such as prescribing medications or looking over lab results. These activities are usually done by:
· Psychiatrist
· Nurse Practitioners Specializing in Psychiatry
· Mental Health Trained Primary Care Physicians
· Non-prescribing therapists should utilize codes that do not comprise E/M elements.
Differences between 90838 vs 99205
Most providers will mistake CPT 90838 as 99205 and vice versa, but these two codes have completely different uses.
· Ongoing psychotherapy sessions with E/M attached to them are billed under 90838.
· Conversely, 99205 is a new patient evaluation code. This is used for in-depth assessment where there is a greater level of complicated decision-making.
99205 should be used for the initial visit, during the period where history taking, reviewing old records, in addition to developing a treatment plan, is in progress, while 90838 CPT code should be used in subsequent visits where the patient is receiving therapy and medical supervision.
Key Differences
| Code | Description | Use Case |
| 90838 | Psychotherapy + E/M, 60 mins | Ongoing therapy |
| 99205 | Initial patient visit, E/M only | First appointment |
Additional Relevant Psychotherapy Codes
Knowing associated codes together with related ones allows providers to properly identify the ideal one for each session. Below are some frequently used psychotherapy codes alongside 90838 that may differ from it.
90836
· Is to be used for 45-minute psychotherapy with E/M
· Time range: 38 to 52 minutes
· Except for 90838, the same purpose is attached to 90836, but for a shorter time of session time
CPT Code for 1 hour therapy without medical assistance
If the therapy session continues for 53 minutes but without any medical assistance, then CPT code 90837 is a good choice
Therapists and non-prescribers can use this code, which cannot offer any medicines along with therapy
Other Useful Codes
| Code | Description | Time |
| 90833 | 30-minute psychotherapy + E/M | 16–37 mins |
| 90834 | Psychotherapy (no E/M) | 38–52 mins |
| 90836 | Psychotherapy + E/M | 38–52 mins |
| 90838 | Psychotherapy + E/M | 53+ mins |
If your services include substance abuse evaluations instead of psychotherapy sessions, it’s essential to understand the proper use of H0001 CPT Code for billing those assessments correctly.
Use CPT Code 90838 When
CPT 90838 is applicable only if the session includes the following:
1 hour-long (60 minutes) psychotherapy session
The E/M component included
Such as in the case of:
· Monitoring side effects
· Reviewing diagnostic tests
· Medication review or adjustment
If both time and services fulfill the requirements, then use this code; otherwise, switch to another code.
Billing Tips for CPT 90838
As for the billing rules for CPT 90838, here are some notes:
Session Duration
· Time and face-to-face interaction must in total at least 53 minutes.
· Sessions shorter than that cannot have time rounded up.
Document Clearly
· During therapy sessions, patients must be shown what happens
· Capture subsidiary time with each component.
· Include a description of therapy techniques and E/M activities in the documentation.
Don’t Use If No E/M Is Provided
· Should only therapy be provided, bill as 90837. Claiming 90838 without E/M will most likely have the claim denied.
· Don’t bill if no elements of E/M are incorporated.
Use Modifiers if Needed
If you use another code, like 99214, along with 90838, apply modifier 25 to highlight other services on the same day.
Reimbursement for CPT 90838
The reimbursement amount remains largely dependent on:
· Contracted rates
· Location
· Payer (Medicare vs private insurance)
For 2024, Medicare is expected to reimburse an average of $140−$160 for 90838. This amount might be higher for private insurers, particularly for in-network providers.
To ensure accurate payment:
· Use designated codes and modifiers without deviation. Follow all policy documentation mandates.
Common Mistakes to Avoid
- Billing 90838 when no E/M Services provided
- Without the prior evaluation and management services (E/M), medication management will be performed without billing or non-billable services, which outcomes in claim denial.
Inadequate Minimum Time Threshold
Alternately, if the session is longer than the minimum required time, ensure it does not end prematurely. If it is shorter than the required duration (which is 90836 or 90833), then select a lower billing code.
Invalid Code Bundles
Do not bill 90838 and 99205 in conjunction for same day/same sitting. These codes are not interchangeable.
Conclusion
Comprehending and accurately leveraging CPT 90838 is essential for mental health care reimbursement accuracy. This code must not be applied for anything less than a full hour (60 minutes) pre-medical evaluation and management sessions, which also requires associated full hour pre-medical evaluation and management sessions.
As a golden rule, providers need to ensure the code corresponds with what occurred during the session, including the duration and nature of services provided. Understanding the distinction between CPT 90838 vs 99205, and other related codes reduces precision-deficient and reimbursement-maximizing errors. Partnering with an experienced billing company aids you in understanding these codes and get your payment without any refusals.
