PracticePerspectives

Most Frequently Used CPT* Codes by Clinical Social Workers

WinterI S S U E

2 0 1 7

Clinical social workers who seekindependent reimbursement use CurrentProcedural Terminology (CPT) codes toidentify procedures they perform whenproviding psychotherapy services. TheHealth Insurance Portability andAccountability Act (HIPAA) has designatedCPT as the national coding standard forreporting procedures for health careprofessionals such as clinical socialworkers. CPT provides a uniformlanguage to describe psychotherapyand other health services.

Since 1994, NASW has provided tworepresentatives to the American MedicalAssociation, Current Procedural TerminologyEditorial Panel, Health Care ProfessionalAdvisory Committee (AMA/CPT/HCPAC) wherecodes are developed, maintained, and revised.The two representatives provide a nationalvoice for clinical social workers in the creation,revision, and maintenance of the CPT codes.

The most frequently used CPT codes by clinicalsocial workers are listed in this document. Healthinsurance companies can individually decidewhich CPT codes they will reimburse clinical

social workers for. Thus, clinical social workersshould acquire a list of the CPT codes that theywill be reimbursed for from each health insurancecompany in which they have a contractualagreement with. Doing so may prevent claimdenials and overpayment requests.

Since 2013, clinical social workers haveused the following CPT codes most frequentlyto report psychotherapy services rendered toan individual, family or group.

90791The psychiatric diagnostic evaluation is anintegrated biopsychosocial assessment whichincludes a history, mental status, andrecommendation. It may include communicationwith family and other sources who areconsidered informants. 90791 does notinclude psychotherapeutic services and canonly be reported once per day per patient.This code may be used for a reassessment orit can be used more than once for an initialassessment if more time is required. There isno time range for this code.

90832, 90834, and 9083790832, 90834, and 90837 describeindividual psychotherapy services for thepatient and may include an informant. The

Mirean Coleman,LICSW, CT

Cl in ica l Manager

mco leman.nasw@soc ia lworkers .org

750 First Street NE, Suite 800Washington, DC 20002-4241SocialWorkers.org

The NationalAssociation ofSocial Workers

750 First Street NE

Suite 800

Washington, DC 20002-4241

SocialWorkers.org

©2017 National Association ofSocial Workers. All Rights Reserved.

Practice Perspectives Winter 2017

*CPT copyright 2016. American Medical Association. All rights reserved. CPT is a registered trademarkof the American Medical Association.

patient is required to be present for all or most ofthe service. The codes include an ongoingassessment and adjustment of treatmentinterventions. The times for these codes are:

• 90832 – Psychotherapy 30 minutes. Time range: 16 to 37 minutes

• 90834 – Psychotherapy 45 minutes. Time range: 38 to 52 minutes

• 90837 – Psychotherapy 60 minutes. Time range: 53 minutes or more

Some health insurance companies may consider90834 as the standard psychotherapy session.In such cases when reporting 90837, it wouldbe beneficial to document in the clinical recordwhy the longer service was warranted ratherthan the shorter service.

9078590785 is an add-on code used to reportinteractive complexity services. It is reported inconjunction with 90791, 90832, 90834, and90837. Interactive complexity is a specialcommunication factor that complicates the deliveryof psychotherapy services. It is commonly usedwhen delivering services to children and verballyundeveloped or impaired patients. These patientsusually have third parties such as parents,guardians, interpreters, schools, and court officers.

90839 and 9084090839 and 90840 are codes used to reportpsychotherapy for crises. These codes report anurgent assessment which includes a history of acrisis state, a mental status exam, and adisposition. Treatment includes:

• Psychotherapy• Mobilization of resources to defuse the crisis

and restore safety• Provision of psychotherapeutic intervention to

minimize emotional trauma

For 90839 and 90840, the presenting problemis life threating or complex, and requiresimmediate attention to a patient in high distress.Clinical social workers must devote their fullattention to the patient, and cannot provideservices to another patient during the same timeperiod. The times for these codes are:

• 90839 – Psychotherapy for crisis, the first60 minutes. The time range is 30-74minutes.

• 90840 – Psychotherapy for crisis, eachadditional 30 minutes. Report additionalblocks of time up to 30 minutes eachbeyond 74 minutes.

9084590845 is used to identify psychoanalysisservices. There is no time range for this code.

9084690846 identifies family psychotherapy serviceswithout the patient present. This code may beused on the same day as an individualpsychotherapy service is provided when theservices are separate and distinct for the patient.The session is for 50 minutes and the time rangeis 26 minutes or more.

9084790847 is family psychotherapy with the patientpresent. This is also referred to as conjointpsychotherapy. This code may also be used onthe same day as an individual psychotherapyservice is provided as long as the services areseparate and distinct for the patient. The time isa 50 minute session and the time range is 26minutes or more.

9085390853 is for group psychotherapy. Whenappropriate, the add-on code for interactivecomplexity, 90785, may be used with this code.There is no time specification for this code.

Using the CPT Codes on theCMS-1500 FormWhen submitting a claim, a CPT code must be usedin order to receive payment. The code is listedon line 24 D under CPT/HCPCS. An add-oncodes is also listed under this heading, but on theline following the listing of the primary CPT code.

NASW is committed to advocating for itsmembers in the coding process through theAmerican Medical Association CPT EditorialPanel and will keep its members abreast of anycoding changes.

ReferencesAmerican Medical Association. 2016. CPT 2017Professional. Chicago IL: Author.

The Health Insurance

Portability and

Accountability Act

(HIPAA) has

designated CPT

as the national

coding standard

for reporting

procedures for

health care

professionals such

as clinical social

workers. CPT

provides a uniform

language to describe

psychotherapy and

other health services.

2

PracticePerspectives

Most Frequently Used CPT* Codes by Clinical Social Workers

WinterI S S U E

2 0 1 7

Clinical social workers who seekindependent reimbursement use CurrentProcedural Terminology (CPT) codes toidentify procedures they perform whenproviding psychotherapy services. TheHealth Insurance Portability andAccountability Act (HIPAA) has designatedCPT as the national coding standard forreporting procedures for health careprofessionals such as clinical socialworkers. CPT provides a uniformlanguage to describe psychotherapyand other health services.

Since 1994, NASW has provided tworepresentatives to the American MedicalAssociation, Current Procedural Editorial Panel,Health Care Professional Advisory Committee(AMA/CPT/HCPAC) where codes aredeveloped, maintained, and revised. The tworepresentatives provide a national voice forclinical social workers in the creation, revision,and maintenance of the CPT codes.

The most frequently used CPT codes by clinicalsocial workers are listed in this document. Healthinsurance companies can individually decidewhich CPT codes they will reimburse clinical

social workers for. Thus, clinical social workersshould acquire a list of the CPT codes that theywill be reimbursed for from each health insurancecompany in which they have a contractualagreement with. Doing so may prevent claimdenials and overpayment requests.

Since 2013, clinical social workers haveused the following CPT codes most frequentlyto report psychotherapy services rendered toan individual, family or group.

90791The psychiatric diagnostic evaluation is anintegrated biopsychosocial assessment whichincludes a history, mental status, andrecommendation. It may include communicationwith family and other sources who areconsidered informants. 90791 does notinclude psychotherapeutic services and canonly be reported once per day per patient.This code may be used for a reassessment orit can be used more than once for an initialassessment if more time is required. There isno time range for this code.

90832, 90834, and 9083790832, 90834, and 90837 describeindividual psychotherapy services for thepatient and may include an informant. The

Mirean Coleman,LICSW, CT

Cl in ica l Manager

mco leman.nasw@soc ia lworkers .org

750 First Street NE, Suite 800Washington, DC 20002-4241SocialWorkers.org

The NationalAssociation ofSocial Workers

750 First Street NE

Suite 800

Washington, DC 20002-4241

SocialWorkers.org

©2017 National Association ofSocial Workers. All Rights Reserved.

Practice Perspectives Winter 2017

*CPT copyright 2016. American Medical Association. All rights reserved. CPT is a registered trademarkof the American Medical Association.