How to Handle Longer Sessions for Provider Pay Patients

According to Barbara Griswold, LMFT, a go-to person for all things Insurance-related, the trend for insurance reimbursement for mental-health services is “toward encouraging briefer treatment, and disincentivizing longer sessions.” 

For TEAM-CBT therapists, the opposite is true: longer sessions = briefer treatment.

Since Insurance Providers view effectiveness differently than most of us who practice TEAM-CBT, it is important to make sure you are billing the right code. In addition, the patient must be educated on what is covered by the insurance provider in the Super Bill. 

Therapist Steps to Educate Patient

Prior to beginning a session, explain to each patient that the therapist will have to bill CPT Code 90837 if the session runs longer than 53 minutes. Remind the patient to check with their insurance to verify if the provider will reimburse for longer sessions, referencing CPT Code 90837. 

Facilitate a conversation with the patient regarding how long the session will be and the established rate. A 90-minute session would normally be billed time and a half; a two-hour session double the normal rate, etc. Some insurances do not allow 90837, whereas other plans do cover longer sessions. These plans require a pre-authorization in order for the clinician to bill this code. 

Be sure to clarify that the patient is responsible for any portion of the rate that the insurance provider does not cover. 

TEAM-CBT and CPT Codes at Cross Purposes

In the TEAM-CBT community, we recognize that longer sessions (90 minutes plus) tend to be economically and clinically better for our patients. Therapeutic momentum is gained in longer sessions, as opposed to starting and stopping at 45 minutes and resuming the following week.

The common reasons for longer sessions are to get a thorough intake, aid patients who travel longer distances, better serve those patients who aren’t able to attend weekly, and accomplish more overall. 

More alarmingly, extended sessions CPT Codes 90837 and 90847 for individual or family therapy will be taken away effective 1/1/2023, according to Barbara Griswold, LMFT. For more information about correctly billing extended-length sessions using CPT Codes, please see this link. According to this article, additional codes are used for extended services, such as 99354 and 99355, used for each additional 30 minutes of session time. 

I will post another blog in the New Year to see how the TEAM-CBT community is handling the deletion of the extended time CPT Codes (90837 and 90847) with tips for clinicians to continue to provide longer sessions successfully. 

- Michael Mikulski, LMFT is Pre-Licensed Program Manager at Feeling Good Institute