Addon Codes

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90840 Addon Code

+90840 is an Addon to Psychotherapy for crisis (90839).  In a crisis scenario, 90839 is billed for the first 60 minutes (though it can be used for 30-74-minute sessions), and 90840 is billed for each additional 30 minutes. Using both of these codes together requires that the session lasts 75 minutes or longer.  

90785 Addon Code

Description:  Interactive complexity due to maladaptive communication, use of an interpreter, caregiver emotions or behavior interfering with the visit, or mandated report to 3rd party.

  • "E.g., high reactivity, repeated questions, disagreement, code reflects intensity, not added time, in service delivery."

This code can be separately billed with a psychotherapy code WHEN AT LEAST ONE OF THE FOLLOWING IS PRESENT:

  • When delivery of care is complicated due to managing maladaptive communication among involved parties (e.g. high anxiety, high reactivity, repeated questions, or disagreement)
  • In a case where the implementation of the treatment plan is hindered due to caregiver emotions or behaviors.
  • When a discussion of a sentinel event and/or mandated report to a third party is initiated with the patient and any other participants (e.g., abuse or neglect)
  • When the use of play equipment or other physical devices is needed to communicate with the client to overcome barriers to therapeutic interaction or diagnostic assessment. This might be needed for
    • clients who have not developed or have lost the expressive language communication skills to explain his/her symptoms and response to treatment
    • clients who have lost receptive language skills and are unable to understand the therapist if he/she were to use typical language communication
    • clients who are not fluent in the same language as the therapist

When is this code typically used?

The definition is vague.  However, according to the CPT manual and Magellan, interactive complexity is meant primarily to be used with:

  • young and verbally undeveloped or impaired clients
  • clients who have other individuals legally responsible for their care [e.g., children]
  • clients who request to have others be involved in their care, such as an interpreter or family member
  • clients who require the involvement of other third parties, such as child welfare agencies or parole officers.

This code is most often used by play therapists or those who work with young children.  The client’s inability to express emotions and the need for intermediary devices would likely make 90785 appropriate.  In this case, it could be billed for each session where play devices are used.

When SHOULDN'T you bill for 90785?

  • While this code can be used with the CPT codes for Diagnostic Assessment (90791), Psychotherapy (90832, 90834, 90837), and Group Therapy (90853), you cannot use it for Couples or Family Therapy (90846, 90847), Psychotherapy for Crisis (90839, 90840), or for Psychological or Neuropsychological Testing.
  • Don’t use it just because you did a longer session. 90785 is meant to reflect increased intensity of service, NOT increased session time.  (But as always, document in the session note the ACTUAL therapy start and stop time of the session).
  • Don’t use it every time because you have a client who isn’t good at expressing emotions.
  • According to the Center for Medicare Services (CMS), “90785 generally should not be billed solely for the purpose of translation or interpretation services.”

96127 Addon Code

Description: CPT code 96127 is a billing code used for conducting brief emotional and behavioral assessments performed with standardized instruments. CPT 96127 may be used for administering screenings, such as the Patient Health Questionnaire (PHQ-9).

  • +96127 can be used up to four times per visit
  • Depending on the payer, you may need modifier 59 to indicate the screening was distinct or independent from other non-evaluation and management services. Include documentation to support.

99050 or 99051 Addon Code

  • 99050 is used for “services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service.”  
  • 99051 code is used for “services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.”
  • So, if you regularly work Monday through Friday, 9 AM to 5 PM, and do a session at 6 PM on a Thursday, you would bill 99050 since it's outside your regularly scheduled office hours. But if you regularly work Monday through Friday, 11 AM to 7 PM, and do that same 6 PM Thursday session, you would bill 99051 since it's within your regularly scheduled evening office hours. It all depends on when you regularly work and what your payer considers evenings and holidays.
    • “Evening” is generally defined as after 5 PM on weekdays. “Holidays” generally apply to federal holidays. But if you’re unsure what warrants using 99050 or 99051, check with local payers to see if other hours or holidays may be reimbursed.
    • These codes only apply to “In-person” services/appointments.  Insurance will deny these addons for teletherapy appointments.

How to add an addon code in TN

Inside the note header, you can add the appropriate addons.

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