Navigating Novel Codes for Extended Therapy Sessions

Introduction to New Challenges in Therapy Billing

In January 2023, the American Medical Association (AMA) made a significant change that impacted therapists and their clients deeply by removing two critical CPT codes: 99354 and 99355. These codes were pivotal for therapists because they allowed for maximum or additional coverage for individual and family therapy sessions exceeding 90 and 80 minutes, respectively. Designed to accommodate longer session times necessary for certain complex cases, these codes enabled therapists to claim higher reimbursements, reflecting the extended care provided.

The removal of these codes has posed substantial challenges for mental health professionals across the country. Without the ability to bill for extended time, therapists are finding themselves constrained financially, which in turn can impact the quality and depth of care they are able to offer. Extended therapy sessions are often crucial for dealing with severe mental health issues, including major depressive disorders, trauma, and family therapy interventions, where more time is required to effectively manage and treat patients.

The sudden elimination of these codes has not only reduced the potential for adequate reimbursement but has also placed therapists in a difficult position: they must either absorb the cost of longer sessions or potentially shorten their sessions, potentially undermining therapeutic outcomes for clients who require more intensive intervention. This change thereby threatens the sustainability of practices that cater to high-need populations and challenges the overall delivery of comprehensive mental health services.

Amidst this backdrop of growing concern, a collaborative effort between the Centers for Medicare and Medicaid Services (CMS), the National Association of Social Workers (NASW), and other third-party payers has begun to explore alternative billing methods to address these issues. This evolving scenario underscores the dynamic nature of healthcare billing and the need for practices to stay informed and agile to navigate these changes effectively.

The Proposal for Extended Therapy Session Billing: How to Apply the Two Units of Code 90834

Amid this crisis, a ray of hope emerged in the guise of collaboration between the Centers for Medicare and Medicaid Services, the National Association of Social Workers, and other third-party payers. They all came together to propose a potential solution to this uncertainty. The proposal included billing two units of code 90834 for individual therapy sessions that exceed 90 minutes and the same for family therapy sessions that exceed over 80 minutes. This innovative approach exhibited a promising nature for most therapists. However, this brought about a layer of complexity to the billing infrastructure due to the variance in acceptance of the proposal across different states.

Understanding the New Billing Proposal

Several therapists reported that the enactment of this new medical billing system brought in mixed outcomes. Some insurance providers approved two units of code 90834. On the other side, other insurance providers either imposed restrictions on reimbursements or denied the claims. They also highlighted the significance of in-depth research and careful deliberation before going ahead with billing for extended sessions. To boot, attaining preauthorization from insurance providers can aid in alleviating potential risks and assure seamless reimbursement processes.

Documentation Strategies for Extended Sessions

On top of the billing concerns, documentation remains a crucial aspect in justifying the need for exceeded sessions/services. For a comprehensive documentation process, progress notes should thoroughly mention the clinical rationale backing extended therapy sessions, especially in cases that involve trauma-related treatments and complex clinical presentations. By delivering articulate documentation, therapists can reinforce their reimbursement case and showcase the value of their exceeded therapy sessions in resolving clients’ requirements successfully.

Exploring Alternative Billing Options

However, even with the prospective billing system proposed by the collaboration, therapists are suggested to navigate other billing options to explore reimbursement concerns efficiently. Some viable alternatives include Private Pay Agreements, Crisis Session Codes, and Private Contracting for Additional Time. These options also have the advantage of aligning with contractual obligations and regulatory needs. Nevertheless, it is imperative to practice extreme caution and ensure compliance with relevant policies when considering new billing options.

Staying Informed and Proactive

Despite the ever-changing ecosystem of insurance billing, therapists are encouraged to stay proactive while rendering the therapeutic requirements of their clients. The industry trends may support shorter treatment periods, but it is pivotal to understand the role of therapists in delivering extensive client care aimed to result with positive outcomes. By navigating effective and innovative medical billing strategies, staying on top of the billing policy changes, code changes, and deletions, and staying abreast of policies and regulations, therapists can seamlessly overcome the complexities associated with reimbursement with confidence. This will also nudge them to deliver high-quality client care at all times.

Conclusion: Embracing New Billing Strategies with Practolytics

Are you on board to significantly transform your billing strategy and optimize reimbursement? Unleash the unparalleled abilities of Practolytics as your trusted Revenue Cycle Management (RCM) partner. By utilizing leading-edge technology and remarkable expertise, Practolytics empowers your practice to explore billing constraints with complete ease, assuring optimum reimbursements and streamlined finances. Take control of your revenue cycle today and unveil new levels of efficacy and profitability with Practolytics’ aid.

ALSO READ – Importance of Medical Documentation and Diagnosis Coding in Mental Health Billing