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90834 vs 90837

Marilyn Posted Tue 26th of February, 2019 15:11:06 PM
***Would this article be for all states?........90834 vs 90837 State of New York If an insurance company pays for 90837 only with prior authorization, please be advised they are only giving 90837 authorizations for cases they consider severe, and then only for a few visits. They expect the 90837 code to be used in extreme cases to help a patient for a few visits and then go back to using 90834 with that patient. Below is a list of insurance companies specifying whether they pay for 90837, do not pay for 90837, or require prior authorization before they will pay for 90837. If you submit claims using the 90837 codes without proper authorization or to an insurance company not allowing 90837, they will deny the claim and you will not get paid. The following insurance companies are not paying for 90837: -Magellan -Freelancers -Beacon The following insurance companies will only pay for 90837 with prior authorization: -UBH -Oxford -Empire Plan The following insurance companies are paying for 90837: -Medicare -CDPHP -BCBS-*Some BCBS claims that use 90837 are denying but those that pay are paying the same rate as 90834 -ValueOptions *Just as BC/BS, some 90837 are denying but those that pay are paying the same rate as 90834 -Fidelis -Cigna -Aetna-*Allowing 90837 but paying the same rate as 90834
SuperCoder Answered Wed 27th of February, 2019 06:51:58 AM

Thank you for your Question.

CMS states Psychotherapy services are not considered to be medically reasonable and necessary when they are rendered to a patient who has a medical/neurological condition such as dementia, delirium or other psychiatric conditions, which have produced a severe enough cognitive deficit to prevent effective communication with interaction of sufficient quality to allow insight oriented therapy (i.e. behavioral modification techniques, interpersonal psychotherapy techniques, supportive therapy or cognitive/behavioral techniques). In these cases, evaluation and management or pharmacological codes should be used.

Psychotherapy times are for face-to-face services with the patient. 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.

Both 90834 and 90837 are designed to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes.

Some psychiatric patients receive a medical evaluation and management service on the same day as a psychotherapy service by the same physician or other qualified health care professional. These services to be medically necessary should be significantly different and separately identifiable.

For services requiring authorization, authorizations provided for a higher-level code may be applied to the claim submitted by that provider with a lower level code, rather than denying the lower level code for no authorization. For example, in the event an authorization is given for a more involved visit, i.e., 90837, but in turn, a claim is submitted with CPT code 90832 or 90834, the claim would be paid on the 90837 authorization rather than denied for no authorization.

The above-mentioned article is from a Non-Federal publication. Hence, we can’t provide any confirm coding statement regarding the use of CPT codes 90834 & 90837 basis the article.

 

Check your contract with the payer to ensure that 90837 is available for reimbursement and verify that your client is covered for that service. Often, their plan may have limits or require preauthorization for 90837. The coverage for these codes may differ from state to state and one payer to another payer.

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33252

Hope this Helps!

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