Psychotherapy
Revised: 01-06-2014
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Overview
Eligible Providers
Eligible Recipients
Covered Psychotherapy Services
Documentation
Authorization
Billing
Legal References
Overview
Psychotherapy is:
 A planned and structured, face-to-face treatment of a recipient’s mental illness
 Provided using the psychological, psychiatric, or interpersonal method most appropriate to the needs
of the recipient; according to current community standards of mental health practice
 Directed to accomplish measurable goals and objectives specified in the recipient’s ITP
Eligible Providers
Psychotherapy may be provided by:
 Clinical Nurse Specialist in Mental Health (CNS)
 Licensed Independent Clinical Social Worker (LICSW)
 Licensed Marriage and Family Therapist (LMFT)
 Licensed Professional Clinical Counselor (LPCC)
 Licensed Psychologist (LP)
 Psychiatric Nurse Practitioner (NP)
 Psychiatrist
 Tribal Mental Health Professional
 Mental Health Practitioners working as Clinical Trainees
Eligible Recipients
Eligible recipients of psychotherapy must have a diagnosis of mental illness as determined by a
diagnostic assessment.
Exception: A new recipient may receive one session of psychotherapy, prior to completing the diagnostic
assessment.
Covered Psychotherapy Services
Psychotherapy (with patient and/or family member)
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Used for services with the patient and/or family member present
Include some time without the patient, however the patient must be present for a significant amount of
the psychotherapy time
Used for both outpatient and inpatient settings
May include hypnotherapy (conducted by a mental health professional or clinical trainee trained in
hypnotherapy). Do not bill hypnotherapy separately
May include individual psychophysiological therapy incorporating biofeedback, with psychotherapy
May be used with interactive complexity add-on
Evaluation and Management (E/M) with Psychotherapy (patient and/or family)
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Used when psychotherapy is performed in addition to E/M services
If providing both services, they must be separate and distinguishable.
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Time spent on E/M activities may not be counted towards the psychotherapy time
May be used with interactive complexity add-on
Family Psychotherapy:
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For the recipient and one or more family members or caregivers whose participation is necessary to
accomplish the recipient’s treatment goals. Family means a person who is identified by the recipient
(or recipient’s parent or guardian) as being important to the recipient’s mental health and may include
(but not limited to) parents, children, spouse, committed partners, former spouses, person related by
blood or adoption, or persons who are presently residing together as a family unit. Do not consider
shift staff or other facility staff members at the recipient’s residence as family
Family members or primary caregivers do not need to be eligible for MHCP
If you believe the recipient’s absence from the family psychotherapy session is necessary to carry out
the recipient’s treatment plan, document the length of time and reason for the recipient’s absence;
also document reason(s) for a family member’s exclusion from family psychotherapy
Multiple family group psychotherapy
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Multiple family group psychotherapy is designed for at least two, but no more than five families,
regardless of family members’ MHCP eligibility status or the number of family members who
participate in the family psychotherapy session.
Directed toward meeting the identified treatment needs of each recipient as indicated in the
recipient’s treatment plan
If a recipient is excluded from a session, document the reason for and length of time of the exclusion
Document reasons why a family member is excluded
Group psychotherapy
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Appropriate for individuals who because of the nature of their emotional, behavioral, or social
dysfunctions can derive benefit from treatment in a group setting
Provided by one mental health professional for 3-8 recipients
Provided by two mental health professionals for 9-12 recipients
 Group size cannot ever exceed 12 recipients
 Group size applies regardless of the number of MHCP recipients in the group
May be used with interactive complexity add-on
Interactive Complexity
Use the Interactive Complexity add-on code (90785) to designate a service with interactive complexity.
Report interactive complexity for services when any of the following exist during the visit:
 Communication difficulties among participants that complicate care delivery, related to issues such
as:
 High anxiety
 High reactivity
 Repeated questions
 Disagreement
 Caregiver emotions or behaviors that interfere with implementing the treatment plan
 Discovery or discussion of evidence relating to an event that must be reported to a third party. This
may include events such as abuse or neglect that require a mandatory report to the state agency
 The Mental Health provider overcomes communication barriers:
 By using any of the following methods:
 Play equipment
 Physical devices
 An interpreter
 A translator
 For recipients who:
 Are not fluent in the same language as the Mental Health provider
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Have not developed or have lost the skills needed to use or understand typical language
Documentation
Progress Notes
A progress note must be legible and is the documentation of treatment information which can be kept to a
minimum.
Progress notes include:
 Type of service
 Date of service
 Session start and stop times
 Scope of service (nature of interventions or contacts including treatment modalities, phone contacts,
etc.)
 Recipient’s progress (or lack of) to overall treatment plan goals and objectives
 Recipient’s response or reaction to treatment intervention(s)
 Formal or informal assessment of the recipient’s mental health status
 Name and title of person who gave the service
 Date documentation was made in the client record
Other elements that may be included:
 current risk factors the recipient may be experiencing
 emergency interventions
 consultations with or referrals to other professionals
 summary of effectiveness of treatment, prognosis, discharge planning, etc.
 test results and medications
 symptoms
For clinical trainees conducting psychotherapy, the clinical supervisor must review and approve
recipient’s progress notes in accordance with the clinical trainee’s supervision plan.
While providers need to keep progress notes in order to document treatment, it is at the discretion of the
provider whether to keep additional psychotherapy notes. A psychotherapy note is the documentation or
analysis of the contents of conversation during an individual, group or family psychotherapy session.
Psychotherapy notes are kept separate from the rest of the individual’s medical record and are protected
from normal record release under HIPAA even when requesting an authorization or continued services.
Clinical Supervision
Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the
client record after supervision occurs.
Authorization
Refer to Authorization for general authorization policy and procedures. For psychotherapy services,
authorization is required to exceed:
 26 hours psychotherapy (with patient and/or family member)(including biofeedback) per calendar
year, cumulative
 26 sessions of family psychotherapy per calendar year, cumulative
 10 sessions of multiple family group psychotherapy per calendar year
 52 sessions of group psychotherapy per calendar year, cumulative
Submit the following as part of the authorization process for continuation of services:
 Copy of the most current diagnostic assessment
 Clinical summary (including justification for each diagnosis)
 Individual treatment plan that includes:
 Measurable and observable goals
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 Start and end dates
 No status statements
Progress notes that include:
 Type of service
 Date of service
 Session start and stop times
 Scope of service (nature of interventions or contacts, treatment modalities, phone contacts, etc.)
 Recipient’s progress (or lack thereof) to overall treatment plan goals and objectives
 Recipient’s response or reaction to treatment intervention(s)
 Formal or informal assessment of the recipient’s mental health status
 Name and title of person who gave the service
 Date documentation was made in the client record
Other elements that may apply, including:
 Current risk factors the recipient may be experiencing
 Emergency interventions
 Consultations with or referrals to other professionals
 Summary of effectiveness of treatment, prognosis, discharge planning, etc.
 Test results and medications
 Symptoms
When requesting authorization for services that are to be performed with interactive complexity, include
the Interactive Complexity add-on code on the authorization request.
Billing
Submit claims only for the recipient who is the primary subject of the psychotherapy sessions, regardless
of the number of other family/group members in the session.
When more than one family member is a recipient (such as two or three siblings, each receiving treatment
within a specific timeframe), bill only for the time spent conducting psychotherapy for each recipient.
When group psychotherapy is rendered by two professionals, only one claim may be submitted for each
recipient. Professionals must determine which recipient each will bill for or one professional may claim for
all recipients and reimburse the other professional.
When billing:
 Bill psychotherapy services online using MN–ITS 837P
 Enter the treating provider NPI number on each claim line
 Hypnotherapy is part of psychotherapy, do not separately bill
 Teaching hospitals may enter the GC modifier for services performed under the direction of a
supervising physician
Use the following table for billing services with date of service on or after January 1, 2013:
Mental Health Psychotherapy Benefits for Children under age 21 and Adults
Proc Code
Brief Description
Unit
Service Limitation
(*Per CPT
Time Rule)
90832
90834
90837
Psychotherapy (with
patient and/or family
member)
Psychotherapy (with
patient and/or family
member)
Psychotherapy (with
patient and/or family
member)
30 (1637*) min
45 (3852*) min
60 (53+*)
min
Use the appropriate prolonged services code
(99354) with 90837 to report Psychotherapy,
face-to-face with the recipient, of 90 minutes
or longer.
Interactive complexity add-on code (90785)
may be used with:
 Psychotherapy (90832, 90834 or 90837)
Mental Health Psychotherapy Benefits for Children under age 21 and Adults
Appropriate
E/M and Psychotherapy
30 (16 E/M with psychotherapy add-on codes
E/M and
(with patient and/or family 37*) min
(90833, 90836, 90838)
90833
member)
Appropriate
E/M and Psychotherapy
45 (38E/M with Psychotherapy add-on limited to:
E/M and
(with patient and/or family 52*) min
 Clinical Nurse Specialist-Mental Health
90836
member)
(CNS-MH)
Appropriate
E/M and Psychotherapy
60 (53+*)
 Psychiatric Nurse Practitioner (NP)
E/M and
(with patient and/or family min
 Psychiatrist
90838
member)
90875
Individual
30 (16Calendar year threshold, see Authorization- 26
psychophysiological
37*) min
hours of psychotherapy (with patient and/or
therapy incorporating
family member), cumulative (including
biofeedback, with
biofeedback and E/M with psychotherapy addpsychotherapy
on).
90876
Individual
45(38psychophysiological
52*) min
therapy incorporating
biofeedback, with
psychotherapy
90846
Family Psychotherapy;
1 Session Calendar year thresholds, see Authorization:
without patient present
 26 sessions of family psychotherapy
90847
Family Psychotherapy
1 Session  10 sessions of multiple family group
with patient present
psychotherapy
90849
Multiple Family Group
1 Session
Psychotherapy
90853
Group Psychotherapy
1 Session Interactive complexity add-on code (90785)
may be used with 90853.
Calendar year threshold, see Authorization- 52
sessions of group psychotherapy.
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Refer to the CTSS Billing table for additional information about CTSS services.
Refer to 2012 Psychotherapy for information about billing services with date of service prior to January 1,
2013.
For mental health services provided by:
 Community Mental Health Center
 Doctoral-prepared mental health professional
 Master’s prepared mental health professional
Payment rate is up to:
 100% of MHCP allowed rate
 100% of MHCP allowed rate
 80% of MHCP allowed rate
Legal References
MN Rules 9505.0372 (psychotherapy services)
Code of Federal Regulations, title 45, section 164, parts 501 (45 CFR 164.501) (psychotherapy notes)