If you are hesitant to bill CPT (CPT copyright 2020 American Medical Association. All rights reserved)* 90837 rather than 90834 read this blog. You will find out how often other therapists use this code, how much insurance companies pay, and how often they deny. We will also provide payer-specific data on denials and reimbursement.
In 2013, the traditional CPT code used for psychotherapy sessions, “the fifty-minute hour,” was retired and replaced by two new codes, 90834 for sessions of 37-52 minutes, and 90847 for sessions or 53 minutes or longer.
How Much More Money?
Most payers reimburse more for 90837 than for 90834. The chart below shows data for over a million claims submitted to the CarePaths EHR since 2013.
The payment advantage of 90837 has increased since 2013 and is now over $29/session more than 90834.
What About Claims Denials and Reimbursements?
Denial rates are low for both 90834 and 90837. In 2019 denial rate for 90834 was 0.7% and 1.8% for 90837. But the variation in denial rates between payers is significant.
Also significant is variation in reimbursement between payers.
If you’d like to see how your payers stack up in denial rates and reimbursement, you can view our entire data set by clicking here. Search either by “Payer ID” or “Payer Name.”
*CPT copyright 2020 American Medical Association. All rights reserved.