Important changes to extended sessions for therapy. The Prolonged Services CPT add-on codes 99354 and 99355, which allowed for additional reimbursement for longer sessions, have been deleted. We have put together some guidance on how to navigate this situation and any possible alternatives or updates.
Additional Details: According to the American Medical Association (AMA), the two Prolonged Services codes (99354 and 99355) were removed in 2023. These codes were previously used to bill for longer therapy sessions and obtain additional reimbursement from certain insurance plans. There is a new extended session replacement code – 99417. However, the replacement code (99417) cannot be used with psychotherapy codes 90837 or 90847 for extended sessions, as confirmed by experts and the CPT codebook.
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Suggested Approach: Given the current circumstances, it is important to acknowledge that insurance reimbursement for longer therapy sessions will no longer be available using the previous Prolonged Services codes. However, I recommend the following steps to navigate this situation:
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Consider Splitting Sessions: While the current options for additional reimbursement may be limited, it’s worth exploring other aspects of therapy services that insurance plans may cover. Consider splitting sessions into 2 if appropriate for a patient or meeting more often. Make sure you are documenting this as normal.
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Stay Informed: Keep yourself updated on any potential changes or updates from the AMA regarding reimbursement options for extended therapy sessions. We will be updating our providers with anything that becomes available. Please refer to our Help Desk with questions re billing changes & updates.
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Communicate with Clients: Ensure that your clients are informed about the changes in insurance reimbursement for longer sessions. Transparently communicate the reasons behind the modifications and any potential implications for them. You may consider discussing alternative session formats or durations that can be accommodated within the reimbursement guidelines.
What Help Therapy is doingAdvocating for Change: We are reaching out to our professional associations and urging them to pressure the AMA for new codes or alternatives that allow for appropriate reimbursement for extended therapy sessions. By collectively advocating for change, there may be a higher likelihood of influencing future updates in the coding system.
Keeping our Providers Informed: We will be continuing to regularly update these Help Desks and will communicate with you for any changes regarding your billing
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Trying new ways to code: IF you have already had extended sessions with clients, we will do our best to bill these in a way that gets you paid. For example, trying to bill the 99417 code and fighting the denial. Billing more than one session of 90837, etc. As always, we will make every effort to get you paid!
Please note that these suggestions are based on the current information available, and it is essential to stay updated with any future developments from the AMA or insurance providers. If you have any further questions or require additional assistance, feel free to let us know.
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