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Anthem Offers CPT 90837 Documentation Guidelines

Posted By Karen J. Hardin, Tuesday, November 7, 2017
Updated: Tuesday, November 7, 2017

Several OPA members who are also panel providers for Anthem Blue Cross Blue Shield have reached out to me regarding letters they have recently received. The letter is similar to communications received from other insurance companies in the past, addressing the providers use of CPT Code 90837. Psychologists who receive the letter are informed that their use of CPT Code 90837 (60-minute psychotherapy session) is “higher than the expected billing distribution as determined by the average billing behavior of other physicians within your specialty and peer group.” The letter goes on to state, “Our goal is to help providers ensure that the documentation and reporting guidelines are followed and that their documentation supports the level of care billed for each service.”

Letter recipients have reached out to me expressing concern and confusion regarding the purpose of the letter.  Most feel confused about the meaning of the above statements. In an effort to help, I reached out to Anthem and asked for more information. In their response, Anthem clarified: “our letter is strictly educational in nature and its purpose is to ensure that your documentation supports the codes that are being billed.” Their response continues by outlining the documentation they would expect to see to support the CPT 90837 service billed:

  • Date of service
  • Length of session (start/end time), therapy time with patient and/or family
  • Therapeutic maneuvers utilized
  • Diagnosis -for each visit- related to treatment and therapy for the visit 
  • Progress or lack of progress to the goals
  • Updates to treatment plan if necessary
  • Provide signature (Electronic or written)

Also to note, these services are NOT included in the “time” for the session:

  • Time spent arranging services/appointments
  • Time spent in communication with other healthcare providers
  • Time spent documenting or providing reports

The intent of the letter, then, is to remind recipients to follow documentation guidelines for CPT Code 90837. No information was given on whether record audits should be expected at some point in the future. However, it seems clear that following these guidelines should help Anthem providers pass audits with no issue. I would also like to note that these record keeping guidelines are very similar to current standard accepted practices for the insurance industry and to recommendations I have given in the past.  

I hope you find this helpful.  Please feel free to stay in touch should you have other issues or concerns.

Jim Broyles, PhD
OPA Director of Professional Affairs

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