and different plans available from each insurance company. This will decrease billing errors and non-payment issues, as clinicians will avoid billing for a non-covered CPT code.
example, CPT codes 90832, 90834, and 90837 refer to different individual therapy session times. Individual therapy can include “informants,” such as family members or caregivers. For play therapists, a combination of CPT codes can be used to include time to talk with caregivers as part of the session time, provided the client is seen for the majority of the session. This differs from family therapy CPT codes, which are used exclusively to bill for family therapy sessions, either with (90847) or without (90846) the client present.
Navigating the insurance
process has a steep learning curve initially. Providing play therapy to children and families who want and need to use their insurance can be clients and therapists…
In 2013, interactive complexity codes were introduced to specify a need the “use of play equipment… to overcome barriers to diagnostic or therapeutic interaction with a patient… who has not developed or lost expressive or receptive language skills to use or understand typical language” (American Psychiatric Association, 2012). Because play therapy facilitates developmentally appropriate communication with children, many play therapists use the add-on 90785 interactive complexity code. It cannot be used alone; it can be added to select therapy services, such as intake, individual, and group therapy, but not to family therapy.
Payment amounts for the 90785 add-on code can vary widely among insurance companies (e.g., from $2 to $12), and some do not pay at all. There is little risk in billing the 90785 code, because even if it is not covered, it usually will not trigger a denial of the original CPT billing code. Consistent with other CPT billing codes, clinical necessity for the 90785 add-on must be included in treatment notes, tying into why play therapy was chosen in the treatment plan. Ultimately, therapists are responsible for knowing CPT code details and differences and understanding usage norms; otherwise, they risk committing insurance fraud accidentally by making mistakes they could have avoided by reading provider manuals.
7. Understand the Norms Understanding insurance industry norms will help play therapists properly reference CPT codes. The 90834 billing code is the standard in the therapy industry; this reflects a session time between 38 and 52 minutes, referred to as the “45-minute session.” Because 90834 is the
22 | PLAYTHERAPY | June 2018 |
www.a4pt.org
norm for most insurance companies, billing for sessions longer than this (i.e., using 90837 for sessions of 53+ minutes) could result in a denied claim or could require a pre-authorization for services. Therapists would have to argue clinical necessity to petition for longer session times on a case-by-case basis, because longer times are not standard practice. accurate information.
Payment for different CPT codes can vary tremendously by state and by insurance company. In Tennessee, some companies pay the same for both 90837 and 90834 codes, a couple pay slightly more for 90837, authorization is obtained. It is also wise not to be too distinctive from therapists providing similar services. For example, if most play therapists bill for play therapy using CPT code 90834 (45 minutes), and another consistently bills CPT code 90837 (53+ minutes), s/he could be flagged by insurance companies, triggering an otherwise-unnecessary audit. Insurance companies periodically review clinicians’ code usage, and if one bills CPT code 90837 consistently, they will ask the therapist to explain the higher occurrence than standard. Play therapists who believe the 90837 code is warranted as their standard should document clinical necessity for that time frame and prepare to defend that practice should they be reviewed or audited.
pay and deductible amounts. Clinicians can call the insurance company their insurance card. Therapists can better estimate the clients’ precise payment responsibility at the time of service, and whether that fee applies to their deductible or to a designated co-pay. However, sometimes what insurance companies report on the phone does not match what they actually pay, which means a different amount is owed by the client.
9. Acquire an Electronic Medical Record
(EMR) System Many companies sell EMR or electronic health record (EHR) systems, so there are many options to consider. These systems store client records and make billing insurance companies easier and quicker. I sought feedback from colleagues and tried the top three recommended before choosing. Trying systems during free initial periods allows therapists time to explore different EMRs’ functions before making an informed decision. Alternatively, therapists can hire agencies to assist with billing, but they usually cost more than purchasing an EMR/EHR. I recently contracted a small, private billing company to assist with secondary claims and reconciling accounts a few hours each month so I could concentrate on providing therapy services.
10. Check with Colleagues Sharing what works between colleagues is invaluable because insurance companies will not or cannot disclose billing information. For example, I
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