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When the CPT* codes for psychotherapy were revised in 2013, 90837 became available for longer therapy sessions. 90837 had two advantages over the previous code for longer sessions. First, it only required a therapy session of 53 minutes which is in line with how many clinicians practice; and second payers would pay for it.
How much better paying? Based on claims submitted through CarePaths, mean payment for 90837 was $81.25 (allowable $111.50) compared to $54.60 (allowable $78.81) for 90834.
Many clinicians have grasped the economics of 90837, using it for 30.6% of all billings in 2013 and 40.6% today.
Initially some payers were reluctant to pay for 90837. BCBS and commercial payer denial rates were in the 3 to 4 % range between 2013 and 2015 but have dropped dramatically since then. In 2017, the BCBS the denial rate for 90837 is 1.29% and for 90834, .45%; for commercials the rates are 1.14% (90837) and .89% (90834). Denial rates for Medicaid and Medicare are higher but have also come down. Currently the denial rate for Medicaid is 5.9% and for Medicare 4.12%.
The upshot from our data is that clinicians can earn reliably higher reimbursement from commercial and Blue Cross payers by using 90837 without undue concern about having their claims denied. Medicaid and Medicare are different stories, but even here there have been a dramatic lowering of denial rates.
*CPT copyright 2017 American Medical Association. All rights reserved.
