How to Bill for Longer Couples and Family Therapy Sessions using Add-on Codes
Introduction
A question that a lot of providers have is how to bill for longer couple and family therapy sessions. Sometimes these sessions run long and it is normal to desire to get paid for the extended time that you spend seeing these clients. In this guide, we will walk you through the codes that are used, how to use add-on codes, verification of benefits, and reimbursement expectations. Our goal with this guide is to help reduce the learning curve when billing extended sessions and to give you a process to use in your office when you have to run longer sessions.
Codes Used in Extended Therapy Sessions
The first area that a therapist has to start with when billing extended therapy sessions for couples and family therapy is what codes are used. Below is a helpful chart that you can use as a cheat sheet when approaching extended therapy sessions:
Base CPT Code | Add-on Code | Session Length |
90846 (53-89 minute session) 90847 (53-89 minute session) | +99354 | 80-124 minutes |
90846 (53-89 minute session) 90847 (53-89 minute session) | +99354 +99355 | 125-154 minutes |
90846 (53-89 minute session) 90847 (53-89 minute session) | +99354 +99355 +99355 | 155-184 minutes |
In this graph you have all of the codes that you will need to use in order to bill longer couples and family therapy sessions. We would recommend that you post this graph somewhere where you can easily access it or where your staff can see it and review the codes for coding accuracy.
How to Use Add-On Codes for Extended Therapy Sessions
Now that you know the codes that are used in longer marriage and family therapy sessions, we will now go through how you can use these codes in your practice.
When you have a marriage or family therapy session completed there is always a base CPT code. This is the first code that you will use to document how much time you spent in the session with the couple or family. For those codes, you have a range of 53-89 minutes spent with the couple or family. You cannot use an add-on code if you are within this range.
However, when the session starts to go longer than the allowed time, then you start to add CPT codes to document how much additional time you spent with the client.
For the next 1-60 extra minutes you will add CPT code 99354. This communicates that you spent the first 53-89 minutes with the client plus extra time.
For every additional 30 minutes after you will add CPT code 99355. This communicates that you spent the first 53-89 minutes plus an additional 60 minutes plus an additional 30 minutes.
For every 30 minutes after that, you will continue to add CPT code 99355.
Within your EHR system, you will be able to add codes to the base code that you have used to document the session. We recommend that you research how to effectively carry out this task and commit that process to memory or document it within your practice with a workflow or regular training.
Verification Of Benefits of Extended Therapy Sessions
With any session that is outside the normal session you will want to conduct a verification of benefits and an eligibility check for your clients. This part of the revenue cycle is a time consuming process but it is critical to the cash flow of your practice.
If you have not outsourced your billing and you have to conduct eligibility of benefits and verifications within your practice here are a few tips that we can give you that will help the process go a little smoother.
Always obtain a copy of the patient’s insurance card, front and back
Call the number on the back of the card for mental health benefits
Tell the representative on the phone that you want to check to see if extended sessions are covered and give them the specific codes that you want checked
Make sure that you clarify that the codes are covered for in-office and telehealth sessions
The more detailed your verification of benefits the better the billing will go, so take your time and make sure that you have all the information that you need when completing verification of benefits and eligibility checks.
Reimbursement Expectations for Extended Therapy Sessions
When you call the insurance to verify your client’s benefits they will preface every call by stating that you are receiving a quote of benefits and payment is not guaranteed. We will give you the same disclaimer on this section as well. Just because we have the ability to code a certain procedure does not mean that payment is guaranteed. You will want to document what session you completed but that doesn’t hold the insurance financially responsible.
With that said, Medicare has laid out some standard reimbursement rates that you can review in the event the insurance companies decide to pay for extended services. The rates for Medicare are public knowledge, and we have published them in the table below. The rates for private insurance companies are not public information, so we are not allowed to disclose those rates.
Add-On CPT Code | Medicare 2020 CPT Code Reimbursement Rate | Medicare 2022 CPT Code Reimbursement Rate | Rate Services Description |
99354 | $132.09 | $140.26 | Prolonged psychotherapy or evaluation and management, outpatient |
99355 | $100.33 | $101.32 | Prolonged psychotherapy or evaluation and management, outpatient |
Conclusion
As you decide to bill extended therapy sessions for marriage or family clients, be sure that you are aware of your fee schedule and do everything that you can to ensure that the codes are covered. If you have to get prior authorization for the codes, then make sure you are following the process that the insurance company lays out for you. We want to see you reimbursed for the work that you are doing which means that we need the best systems that exist to ensure payment. If you have any questions or concerns please don’t hesitate to reach out to us and we would be glad to help you in any way that we can.
