Ensure accurate use of psychotherapy add-on codes with E/M services

Help reduce claim denials, ensure appropriate reimbursement, and support compliance when you use accurate documentation and billing of psychotherapy add-on codes with Evaluation & Management (E/M) services. 

Flagging the problem

Recently, Magellan’s Special Investigations Unit (SIU) identified the following trend in documentation:

• Providers report total encounter time only and do not specify psychotherapy start and stop times or clearly account for E/M time.

Example: Billing 99214 with 90833 while documenting a 20-minute visit with 16 minutes of psychotherapy leaves only 4 minutes for the moderate-complexity E/M service. This raises concerns about service adequacy and appropriate reimbursement.

Include psychotherapy add-on codes

When you provide psychotherapy on the same day as an E/M service, report one psychotherapy add-on code in addition to the primary E/M code, based on psychotherapy time.

Psychotherapy documentation expectations

Psychotherapy documentation must be separate from E/M documentation and should include the following details:

• Time spent on psychotherapy
• Individualized (not cloned) therapeutic interventions used
• Patient response to the interventions
• Treatment goal(s) addressed during the session
• Progress toward established treatment goals

Common pitfalls to avoid:

• Using the same time for both E/M and psychotherapy
• Combining medication management and psychotherapy documentation into one narrative
• Omitting clear time allocation for each service
• Using vague statements such as “psychotherapy provided” or “supportive therapy performed”
• Cloning or carrying forward documentation across multiple service dates without meaningful updates about changes in care, medication management or patient outcomes

Verify benefits and contracted services

Coverage for psychotherapy add-on codes varies by member benefit plan and provider contract. You are responsible for verifying member benefits and confirming which services you/your facility or organization contracts with Magellan to provide. For contract-specific questions, contact your network representative; for benefit information, contact Magellan at the specific phone number for the member's program.

More Information

• Review Magellan's policy on examples of fraud, waste, and abuse and HIPAA standard code sets in Section 4 of Magellan's National Provider Network Handbook (PDF).
• If you have additional questions regarding our audit/investigation processes, contact the SIU via email at SIU@MagellanHealth.com or via our hotline 1-800-755-0850 (you can remain anonymous).