This is how I answered that question in my
Special Report: The 2013 CPT Codes -- What Every Therapist Needs to Know (available at
www.theinsurancemaze.com order page) : Be aware that sessions of this length may only be reimbursed with preauthorization and for special circumstances. So, bottom line -- If the session meets the criteria for a crisis session, you might use these new cirisis codes (check if authorization is needed -- believe it or not, it sometimes is). If not a crisis, you may either 1) use the 60 minute therapy code or prolonged services codes for all sessions longer than 52 minutes, knowing that you may need preauthorization, or 2) bill one 45 or 60 minute session to insurance and contract privately with the client to pay any additional time out of pocket (have them agree to in writing). If it’s a Medicare client, you have to have the client sign an Advance Beneficiary Notice. In addition to the psychotherapy code for 60 minutes and above (90837), there are codes 99354 (60 minutes Prolonged Services) and 99355 (Prolonged Services, each additional 30 minutes) which can be used by all licensed professionals, but it seems these might be designed for use when a scheduled session unexpectantly goes way overtime -- also, reimbursement as always is subject to the plan’s rules and reimbursement policies (see the AMA Errata published December 12, 2012 for more on these codes). Bottom line: call the plan to see if they reimburse for those codes or if preauth is needed before billing them.
Barbara Griswold, MFT
Author, Navigating the Insurance Maze -- The Therapist's Complete Guide
www.theinsurancemaze.com barbgris@aol.com