CPT Code 90833: Psychotherapy Add-on (30 minutes)

What is CPT code 90833?

CPT code 90833 is a specific code for psychotherapy services provided in conjunction with an evaluation and management (E/M) service. This unique CPT code describes a 30-minute psychotherapy add-on service performed by the same qualified health care professional who also provides the primary E/M service during the same encounter. This code was designed to accurately capture the delivery of integrated medical services and psychiatric diagnostic evaluation and care.

The 90833 CPT code is essential for mental health providers, particularly psychiatrists, clinical nurse specialists, and physician assistants who commonly deliver both medical evaluation and mental health services during psychotherapy sessions. This add-on code allows for appropriate reimbursement of the full scope of services provided to patients with mental health conditions.

As defined, the key features of CPT code 90833 for mental health billing include:

• It represents 30 minutes of psychotherapy.
• It must be used in addition to a primary E/M service.
• The same provider must perform both services.
• It applies to individual psychotherapy only.
• The time spent on psychotherapy must be separate from the time spent on the E/M service.

It notes that the 30-minute duration specified in code 90833 refers to face-to-face time with the patient, time spent in providing interactive complexity services, and this time for mental health treatment must be devoted primarily to psychotherapy that is distinct from the medical evaluation and management service.

CPT code 90833 documentation requirements

Thorough documentation is essential for supporting medical billing claims using both E/M codes and the 90833 psychotherapy add-on code. Documentation guidelines for services reported with 90833 should include:

For the E/M portion:

• Chief complaint or reason for encounter
• Relevant history, examination findings
• Medical decision making or time spent
• Medication management discussions
• Medical diagnoses addressed

For the psychotherapy portion:

• Therapeutic modality used
• Topics/issues addressed in therapy
• Patient's response to treatment
• Progress toward treatment goals
• Plan for future therapy sessions
• Separate time spent on psychotherapy

Medical necessity documentation

Documentation must also clearly establish medical necessity for both the E/M service and the psychotherapy:

• The documented diagnoses should support the need for both services
• The clinical rationale for providing psychotherapy should be clear
• The documentation should reflect how the therapeutic interventions address the patient's mental health condition
• Progress notes should demonstrate the patient's response to treatment

CPT code 90833 billing guidelines

Proper billing and use of CPT code 90833 requires adherence to specific guidelines to ensure appropriate reimbursement and compliance with payer requirements.

To correctly bill for the 90833 add-on code, healthcare providers must:

• Always report it in conjunction with an E/M code
• List the E/M code first, followed by the 90833 code
• Do not use modifier 25 with the add-on code (it's unnecessary for add-on codes)
• Ensure the same provider performed both services
• Verify that the documentation supports both services

Time considerations

The time component of CPT code 90833 is crucial for proper billing:

1. The 30-minute duration refers to face-to-face time delivering psychotherapy
2. This time must be separate from time spent on the E/M service
3. Minor variations in time are acceptable (typically 16-37 minutes for 30-minute codes)
4. Documentation should clearly indicate the time spent on psychotherapy

Other relevant codes

When providing mental health services, several related CPT codes may be relevant depending on the specific circumstances of the encounter:

• 90832: Psychotherapy, 30 minutes (standalone code without E/M)
• 90834: Psychotherapy, 45 minutes (standalone code without E/M)
• 90837: Psychotherapy, 60 minutes (standalone code without E/M)
• 90836: Psychotherapy, 45 minutes with E/M service (add-on code)
• 90838: Psychotherapy, 60 minutes with E/M service (add-on code)

This part is essential in the billing process to ensure proper documentation and avoid reimbursement delays.