Maximizing Reimbursement: Navigating Insurance Billing For Emdr Therapy

Billing insurance for EMDR therapy can be a complex process. EMDR, or Eye Movement Desensitization and Reprocessing, is a type of therapy used to treat trauma and distressing life experiences. While most insurance companies do not distinguish between EMDR and other forms of talk therapy, billing for EMDR often requires the use of specific CPT (Current Procedural Terminology) codes. CPT codes are used to standardize billing for insurance purposes and can be overwhelming to understand. For ongoing psychotherapy sessions involving EMDR, the CPT codes 90832, 90834, and 90837 are typically used, depending on the length of the session. In addition, extended CPT codes such as 99354 and 99355 can be added for sessions that exceed the standard time limits. However, as of January 1, 2023, these extended codes have been discontinued, creating challenges for therapists billing for extended sessions. It is important to note that insurance coverage for EMDR may vary, and therapists should contact the insurance company to confirm coverage and understand the billing process.

CPT codes for EMDR therapy

CPT (Current Procedural Terminology) codes are used to standardize billing across the medical field for insurance purposes. CPT codes 90832, 90834, and 90837 are used for ongoing psychotherapy sessions, which can include multiple EMDR sessions. CPT code 90834 is the most commonly used code for EMDR sessions. CPT code 90832 is used for 16 to 37-minute sessions, 90834 for 38-52 minute sessions, and 90837 for 53 minutes or longer.

If an EMDR session extends beyond the typical time range, an extended CPT code can be added to cover the extra time. CPT code 99354 can be added for sessions that are 0-30 minutes longer, and CPT code 99355 is used for sessions that go for 60 minutes longer. However, as of January 1, 2023, the AMA discontinued the use of CPT codes 99354 and 99355.

When billing for EMDR therapy, it is important to include the diagnostic code and the treatment plan for Acute Stress Disorder or PTSD. It is also recommended to familiarize yourself with the codes that the client's insurance company will accept to avoid claim rejections.

For EMDR therapists who are in-network with insurance, it is suggested to check with the insurance companies to see if certain coding options are possible, such as billing for 90-minute sessions using two units of 90834 or using 90837 with the add-on code G2212 for 15-minute increments.

For EMDR therapists who are self-pay or out-of-network, the discontinuation of the prolonged services CPT codes does not change the overall payment for intensive EMDR sessions. However, it does impact the superbill provided to clients for possible out-of-network coverage. Options for billing include using CPT code 90837 for the entire EMDR intensive, billing two units of 90834 or 90837 with the add-on code G2212 for 15-minute increments, or billing 90837 with the add-on code G2212.

CPT code 90834

The time range for CPT code 90834 is 38 to 52 minutes. Sessions under 38 minutes are billed as CPT code 90832, and sessions lasting over 53 minutes are billed as CPT code 90837.

When billing for CPT code 90834, there are several add-on codes that can be used:

• +90785 – Interactive complexity, e.g. play therapy using dolls or other toys.
• +99050 – Services provided outside of regular office hours.
• +99051 – Services provided during regular evening, weekend, or holiday office hours.
• +95 – Teletherapy services.

CPT code 90837

The American Medical Association (AMA) defines CPT code 90837 as:

> "Psychotherapy, 60 minutes with patient and/or family member. Services represent insight-oriented, behavior-modifying, supportive, and/or interactive psychotherapy."

According to Medicare, the following services should be included when billing CPT code 90837:

• Teaching grooming skills
• Monitoring daily living activities (ADL)
• Recreational therapy (dance, art, play)

It is important to note that CPT code 90837 is not used for clients with intellectual disabilities or severe dementia, in which case other CPT codes should be utilized.

In terms of billing for Eye Movement Desensitization and Reprocessing (EMDR) therapy, it is important to note that there is no specific CPT code for this treatment method. However, CPT code 90837 can be used for billing purposes, as EMDR typically requires longer sessions. When billing for EMDR, it is crucial to include the diagnostic code and the treatment plan for Acute Stress Disorder or Post-Traumatic Stress Disorder (PTSD).

CPT codes 90839 and 90840

When billing for CPT codes 90839 and 90840, it is important to document the following in your records:

• A preliminary assessment of risk, mental status, and medical stability
• The need for further evaluation or referral to other mental health services (if applicable)
• Communication with contacts who may have pertinent information for the assessment
• Substance use (if applicable)
• Outcome of the session

It is also worth noting that CPT code 90839 can only be reported once per day, and CPT code 90840 may have limits on how many times per day it can be reported, depending on the payer. Additionally, there may be restrictions on how many times per month or year these codes can be billed, depending on the location of service. Therefore, it is important to check your local regulations and guidelines when using these codes.

CPT code 90899

EMDR therapy is a type of therapy used to help clients process their trauma in a constructive and productive way. It is often used in conjunction with talk therapy and can be covered by insurance plans with mental health benefits.

When billing for EMDR therapy, it is important to note that the service is often used in conjunction with talk therapy. CPT code 90899 can be used in addition to standard psychotherapy CPT codes, such as 90834 for a 45-minute session or 90837 for a 60-minute session.

For Medicare clients, both CPT code 90899 and either 90834 or 90837 may be required for billing EMDR therapy. It is important to contact the insurance plan to understand their specific policies and requirements for billing extended sessions.

Frequently asked questions