You’ve got to know this if you want to get paid

It’s funny how you stumble on things, right?  Lot’s of times you just think:  hmmmm… that’s interesting.  Other times, you think:  wow, I’m going to try to remember that.  Well (a while ago) when I stumbled up upon what I’m about to share with you, all I could think was:  holy crap — wasn’t anybody going to tell me about this?

Anyway, I thought that you might live in the same cave I apparently do — so I decided to write this post to give you a heads up about something that could affect your bottom line.

Apparently, January 1st 2013, the CMS (Centers for Medicare and Medicaid Services) is going to revise the list of CPT codes that we use to bill insurance and describe the “type of service” we provide our clients on a given day.  You might think that this will only affect you if you are a provider for Medicare of Medicaid — but that would be wrong!

You see, CPT codes are CPT codes.  They are what we use when we bill insurance companies; they are what we put on our “Super Bills” so clients can submit for reimbursement.

This is information you need.  Submitting claims with the wrong CPT codes can cause rejections and a delay in your reimbursement.

Although the specific information I’m about to share with you is subject to change, here’s an overview of what I’ve heard to date.  I’m thinking (hoping) that as we come closer to Jan 1, 2013, we will all hear a lot more about this news.


Psychiatric Diagnostic Evaluation                Current:  90801               Proposed:  90791

Outpatient Psychotherapy (45-50 min)        Current:  90806               Proposed:  90834 (45 min)

Outpatient Psychotherapy (75-80 min)        Current:  90808               Proposed:  90837 (60 min)

Group Psychotherapy                                  Current:  90857               Proposed:  90853

In addition, there are (at least) a couple of new codes: the Crisis Code (90839 for 60 minutes and 90840 for additional 30 minutes); and the Interactive Complexity add-on code (90785) for use when the delivery is more complex.

Here are a few things to keep in mind as you read this post:

  • The proposed changes are not limited to these specific service codes
  • This information is subject to change as CMS chisels out the details
  • You should get the specifics about how this affects you, directly from the insurance companies for which your are a provider (hopefully they will let you know more as we get closer to the first of the year)
  • You can purchase a 2013 CPT manual from the AMA at:

Be informed — Take action — GET PAID!

Leave A Comment!



  1. Maureen Shea /Reply

    While I wait for the “storm of the century” to hit the Connecticut coastline, I’m reading emails. I must be in the same cave as you are. I didn’t know the CPT codes were changing. I wonder how many professionals do know that. I will do what I can to spread the word because evidently CMS isn’t going to!

    1. Deborah Legge PhD CRC LMHC /Reply

      @Maureen – Well, at least we know our Influential Therapist community knows to look out for change in 2013! Thanks Maureen. Stay safe in the storm!

  2. Michele Mester, LMHC /Reply

    Can you please provide the new code for 90847 (family session)?
    Your information is very appreciated!

    1. Deborah Legge PhD CRC LMHC /Reply

      @Michele: I believe 90847 will be the same. I just started getting some notifications from insurance companies for which I’m a provider. We should se more specifics as we get closer to 2013. I was surprised that some of the largest insurance companies in our area (including Blue Cross Blue Shield) knew nothing of the changes until I asked and they did some digging. As we get closer to 2013, I’ll bet you can google “2013 CPT codes” and get a list. Or, you can purchase the book.

  3. Janette Miller LMFT LMHC /Reply

    Does anyone know anything about the new 90785 and if an MFT or LMHC can bill for that code?

  4. Kay Louise /Reply

    Have any of your readers reported problems with billing 90853 with 90785 to Medicare? If yes, any suggestions on how to get past it?

    1. Deborah Legge PhD CRC LMHC /Reply

      @Kay – I’ve not heard that yet. Anybody out there experience this yet?

  5. Robina Choudhry /Reply

    I am doing masters in mental health counseling. Can a LMHC bill medicare and medicade? Some one told me they can not do that.

    1. Deborah Legge PhD CRC LMHC /Reply

      @ Robina: If you work with an agency, they can bill Medicaid for you. I’m not sure about Medicare. We are not yet reimbursed in private practice for (straight) Medicaid or Medicare. Some managed medicaid companies credential LPCs. Hopefully the legislation will change so Medicare will no longer be an issue. As far as private practice goes — you’ll want to look at the reimbursement rates before you sign any contracts with Medicaid or Medicare.

Leave a Reply

Your email address will not be published. Required fields are marked *