The December 1997 issue of the Practice Directorate newsletter, Practitioner Update, advised readers of 24 new Current Procedural Terminology (CPT) psychotherapy codes that became effective January 1, 1998. APA members have made numerous inquiries about these new codes. Several of the most common questions and their answers follow.

Q. Do the CPT code changes apply to initial evaluations, psychological assessments, family or group psychotherapy?

A. No, CPT code numbers for the above services have not changed. The 24 new codes apply only to individual psychotherapy services. The three prior CPT codes for individual, insight-oriented psychotherapy each have been replaced with four new CPT codes. And the one interactive psychotherapy code used primarily for services provided to young children has been superseded by 12 new CPT codes.

Q. What does the term 'interactive psychotherapy' mean?

A. This type of psychotherapy incorporates the use of physical aids to overcome barriers to therapeutic treatment. It is used with patients who have lost or have not developed the expressive language communication skills to explain their symptoms or who lack the receptive skills needed to understand the therapist. One example of this type of psychotherapy involves the use of dolls or puppets when working with young children.

Q. Why can the Practice Directorate only publish 12 of the new CPT psychotherapy codes?

A. Due to copyright laws and conditions of an APA agreement with the American Medical Association (AMA), the directorate could only publish 12 of the 24 new individual psychotherapy codes and their descriptors. A complete listing of all CPT codes appears in the 1998 CPT Coding Manual, available for purchase from the AMA by calling toll-free, 1-800-621-8335.

Q. Are the new individual psychotherapy codes only for use on Medicare claims?

A. No, a psychologist who submits these CPT codes on any claim, including private insurance, should use the new codes.

Q. What happened to the 'G' codes?

A. The 'G' codes, mandated by the Health Care Financing Administration for use in submitting claims for Medicare beneficiary services during 1997, were replaced by the new CPT codes for individual psychotherapy that became effective January 1, 1998.

Q. Is there a grace period for using the new CPT codes?

A. Medicare typically allows a 90-day grace period whenever codes are discontinued and replaced with new codes. Medicare providers may use either the old 'G' codes or the new CPT codes until the end of March. All Medicare providers must use the new individual psychotherapy CPT codes on claims submitted April 1, 1998 or later. Beginning in April, Medicare claims may be denied for not containing the new codes.

Q. How should I code an individual psychotherapy service that was delivered in 1997 but not billed until 1998?

A. You should use the code that was applicable when the service was rendered in 1997. The new CPT codes should not be applied to individual psychotherapy services delivered before January 1, 1998.

Q. How do I bill for individual psychotherapy sessions that last for a time period not specifically reflected in the new codes? For example, I have 60-minute client sessions, yet the psychotherapy codes descriptors specify that sessions last approximately 45-50 minutes or 75-80 minutes.

A. Providers may use 'modifiers' to indicate a more extensive (09922 modifier) or reduced (09952 modifier) service in terms of duration. For example, the code '90806' (used for 45-50 minutes of office-based outpatient psychotherapy; see chart on page 9) may be used with a '09922' modifier on the HCFA 1500 claim form to denote a 60-minute office-based outpatient session. Note that there is a separate column for a modifier right alongside the column for listing the CPT code on the HCFA claim form.

Be advised that using a modifier might trigger a request for documentation to support the modifier's use.

There is no guarantee that a payor will recognize the use of a modifier or reimburse an amount that differs from the amount pertaining to the 5-digit CPT code alone, i.e., without any modifier.

The former CPT code 90841, related to individual psychotherapy of unspecified duration, has been deleted from the 1998 CPT Coding Manual.

Q. Do managed care and other private insurance companies know about the CPT coding changes?

A. All payors that utilize CPT codes should be aware of the psychotherapy code changes, though some companies are slow to update their claims processing systems.

Laurie Badanes Prather, the directorate's federal and regulatory affairs officer, may be reached at 202-336-5889 with any APA member questions regarding these coding-related developments.

The following 12 codes are for individual psychotherapy that is insight oriented, behavior modifying and/or supportive. Time listed is approximated and indicates face-to-face time with the patient. Place of service is also listed.

*CPT Only © 1997 American Medical Association. All Rights Reserved.