Billing CPT Code 90833 with 99214
Yes, you can add CPT code 90833 (psychotherapy, 30 minutes) to CPT code 99214 (established patient office visit). 1
Understanding the Code Combination
The CPT code 90833 is specifically designed as an add-on code for psychotherapy that can be billed with an evaluation and management (E/M) service. According to the American Academy of Child and Adolescent Psychiatry guidelines, code 90833 is explicitly listed among the codes that can be used in conjunction with office visit codes, including 99214 1.
Proper Documentation Requirements
When billing these codes together, you must ensure:
Separate documentation for both services:
- The 99214 requires documentation of medical decision making of moderate complexity or spending at least 25 minutes with the patient 1
- The 90833 requires documentation of 30 minutes of psychotherapy provided during the same encounter
Time considerations:
- The time spent on psychotherapy (90833) must be separate and distinct from the time spent on the E/M service (99214)
- The 99214 typically involves about 25 minutes of face-to-face time 1
- The 90833 involves approximately 30 minutes of psychotherapy
Provider Qualifications
It's important to note that certain practitioners have limitations:
- Clinical psychologists and clinical social workers cannot bill for 90833 under Medicare, as they are not permitted to bill for psychotherapy services that include medical services or medical evaluation and management services 1
- Physicians, physician assistants, nurse practitioners, nurse-midwives, and clinical nurse specialists can bill for both services 1
Billing Process
When submitting the claim:
- List the E/M code (99214) as the primary service
- Add the psychotherapy code (90833) as the secondary service
- If providing services via telehealth, add the appropriate telehealth modifier (e.g., "95") 1
Common Pitfalls to Avoid
- Insufficient documentation: Ensure you clearly document the medical necessity for both services
- Time overlap: Make sure to document that the time spent on psychotherapy is separate from the E/M service time
- Incorrect provider billing: Verify that the provider type is eligible to bill both codes
- Undercoding: Research shows that many providers undercode their services, particularly in residency settings 2, which can lead to decreased clinic revenue
Conclusion
The combination of 99214 and 90833 is appropriate when both an E/M service of moderate complexity and 30 minutes of psychotherapy are provided during the same encounter. This combination allows for proper reimbursement of the cognitive work performed during complex patient encounters 3.