Ahhh the ole’ 90837. If you have worked with billing codes for insurance, you know how common this one is. The 90837 code tells insurance companies that a therapist saw a client for a 53 minute or longer psychotherapy session. However, insurance companies have pushed back in recent years, sometimes sending letters telling therapists they overuse the code.
The 90837 code is one of the most common codes used by mental health providers. It allows therapists to bill a maximum amount for therapy services within a clocked hour. Therapists typically block an hour per client and hold sessions that last 50–60 minutes.
In recent years, many therapists began receiving letters from insurance companies claiming they use the at a high rate. These letters may either remind clients therapist of the existence of the 90834 code or imply some kind of threatened recourse. This has created a lot of confusion for therapists. Some fear insurance audits or even removal from insurance panels.
It is unclear whether insurance companies have actual data showing this code is being overused. Perhaps they have actionable reasons to believe therapists are overusing the code. They may just be trying to prevent fraudulent billing. Or perhaps they don’t want to cover the coveted between-session bathroom break every therapist strives to catch.
However, many therapists assert that insurance companies are using this as another cost-cutting tactic. Afterall, insurance pays out more for a 90837 (53+ minutes) than a 90834 code (38-52 minutes) or a 90832 (16-37 minutes). Many have expressed that insurance companies are simply using this tactic to intimidate therapists into using a billing code with lower pay-out.
So what are therapists to do? Some trade organizations propose simply using the billing code that is accurate to the amount of time that therapy occurred. Then being sure to document services and time-spent well in treatment notes. Good notation is always a good and ethical practice. And it allows therapists to stand their ground and be justified for their use in the case of insurance billing codes.
Every therapist who bills insurance should learn each individual insurance company’s description of what specific services might be billed for which specific codes. For example, some insurance companies say that clinicians should use the 90837 only for procedures that require extra effort or specialized care. They also require the session to exceed a certain number of minutes.
If a therapist gets one of these letters, some recommend replying after receiving a second letter from them. A therapist can then compose a return later that simply states when they bill for which codes. This letter also explicitly asserts that the therapist intentionally sticks to billing code guidelines. However, it remains unclear whether the letter will have the desired effect. But the idea is that every therapist document and addresses this with an insurance company directly.
Letters from insurance companies that claim overuse of the 90837 code can be unnerving, anxiety provoking, or just plain confusing for therapists. However, using the codes correctly, documenting thoroughly, and responding diplomatically to insurance inquiries may do the trick.
