In support of our whole-person approach to care, Point32Health provides insurance coverage for psychotherapy services in accordance with members’ benefits. If you provide outpatient psychotherapy to members of the plans noted above, when billing for these services please be sure to use the procedure code most closely reflective of the duration of time spent with the patient during the session.
For example, Current Procedural Terminology (CPT) code 90837 denotes 60 minutes spent with the patient and would not be appropriate to bill for a session lasting 45 minutes, for which CPT code 90834 would be more appropriate.
Because a psychotherapy session may not last for exactly the length of time specified by a given code, providers can defer to the CPT “time rule,” which dictates that you choose the code closest to the actual time of the session. In keeping with the CPT time rule, a session ranging anywhere from 38-52 minutes would most appropriately be reported using CPT code 90834 (45 minutes), whereas it would be appropriate to bill CPT code 90837 for a session lasting 53 or more minutes.
Neither prior authorization nor notification are required for outpatient psychotherapy. Additional information on reimbursement guidelines — including documentation requirements — is available in the Harvard Pilgrim Health Care and Tufts Health Plan Commercial, Tufts Health Public Plans, and Tufts Health Plan Senior Products Behavioral Health and Substance Use Payment Policies.