CPT 90838 Add-On Requirements with 99213
To bill CPT 90838 (psychotherapy for crisis, 60 minutes) as an add-on to 99213, you need a minimum of 30 minutes of psychotherapy time beyond the E/M service, making the total minimum visit duration approximately 50-59 minutes.
Understanding the Code Structure
CPT 90838 is specifically designed as an add-on code for crisis psychotherapy that can be billed alongside E/M codes like 99213 1. This differs fundamentally from the combination codes (90833,90836,90838) that bundle psychotherapy with E/M services 2.
Key Time Requirements
- 99213 baseline: 20-29 minutes total time for the E/M component 3, 4
- 90838 requirement: 30-60 minutes of psychotherapy time 1
- Total minimum visit duration: Approximately 50-59 minutes (combining the lower threshold of 99213 at 20 minutes plus the minimum 30 minutes for 90838)
Billing Logic and Documentation
The critical distinction is that 90838 represents crisis psychotherapy time that is separate from and additional to the medical E/M work captured in 99213 1, 2. Your documentation must clearly delineate:
- Time spent on medical evaluation and management (supporting 99213) 4
- Separate time spent providing crisis psychotherapy (supporting 90838) 1
- Clear indication that crisis psychotherapy was medically necessary 2
- Total time spent on the date of encounter 3
Common Pitfalls to Avoid
Do not confuse 90838 as an add-on with the combination code 90838 2. When 90838 is used as a combination code (psychotherapy with E/M), you cannot also bill a separate E/M code like 99213, as this constitutes double billing 2. However, when used appropriately as an add-on for crisis intervention, the codes can be billed together with proper documentation 1.
Ensure your documentation supports the "crisis" nature of the psychotherapy 1. The psychotherapy must address an acute crisis situation requiring immediate intervention, not routine psychotherapy that could be coded with standard psychotherapy codes.
Telemedicine Considerations
If providing these services via telehealth, both codes can be billed with modifier 95 for audiovisual services, but the same time and documentation requirements apply 1, 2. The bundling rules remain identical regardless of service delivery method 2.