The only difference between 90834 (the other commonly used CPT code) and 90837 is the time. 1 0 obj
that insure or administer group HMO, dental HMO, and other products or services in your state). P)&|Ohi"a`~HoIW%a"H{W(oL8L?4KY2R C%s3=7s3F144f13m>y3@Lf7o3fz 3Fz|Y'-_7ERH@;eH 8*}++R(RVQ*!Qi@DJ^{# I=#J=j#G=z7la
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o|gM{U]fLgUU`' These codes are not intended to limit the length of time you schedule for psychotherapy. Appeals and Disputes HIPAA Transaction Standards Questions? 333 0 obj
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Denny and his team are responsive, incredibly easy to work with, and know their stuff. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://therathink.com/provider-address-change-forms/, https://therathink.com/rate-negotiation-tool/, https://www.bls.gov/opub/ted/2021/consumer-prices-increase-6-2-percent-for-the-year-ended-october-2021.htm, Inquire about our mental health insurance billing service, offload your mental health insurance billing, Holiday availability on Thanksgiving, Christmas, We charge a percentage of the allowed amount per paid claim (only paid claims). Highmark retains the right to review and update the reimbursement policy guidelines at its sole discretion. Codes 90832-90834 represent insight oriented, behavior modifying, supportive, 3 0 obj
Gather up this information for each of the insurance contracts youre working with! Vision Services-Nonsurgical Benefits to Change Effective September 1, 2021. Cigna will reimburse virtual care services when all of the following are met: 1) Modifier 95 or GQ or GT is appended to the appropriate Current Procedural Terminology (CPT) and/or HCPCS procedure code(s); 2) Services must be interactive and use both audio and video internet- based technologies Coding prolonged services in a home or residence. TheraThink.com 2023. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. Obvious but please be honest. It's our goal to ensure you simply don't have to spend unncessary time on your billing. Free Account Setup - we input your data at signup. You can call, text, or email us about any claim, anytime, and hear back that day. How Much Money Can A Counselor in Private Practice Make? To gain insight into U.S. behavioral health trends over the last year, we identified the most common mental health CPT codes 2022. Tufts Health Plan Commercial products; Fax: 617.972.9409 CareLinkSM - Refer to CareLink Procedures, Services and Items Requiring Prior Authorization TUFTS HEALTH PUBLIC PLANS Products Tufts Health Direct - A Massachusetts Qualified Health Plan (QHP) (a commercial product); Fax:888.977.0776 Tufts Health Together - MassHealth MCO Plan and Accountable Care Partnership Plans . Alma is taking a provider-first approach to addressing the quality and affordability of mental health care at scale. Note: If you have not requested an increase in your rates in the last two years, consider a high ask of 10%-15%. aK!vn -M%0UiJhhqFl'w:7TgC But Cigna has a different requirement. You can now check eligibility (PDF) for the flu shot. As a therapist or mental health provider in private practice working with insurance, your contracted rates with insurance companies are in essence your fee caps for your hourly income. Setting a No-show Cancelation Policy for Your Counseling Practice, 2013 CPT Code Revisions: What the Changes Mean for Counselors, CPT Code Add On FAQ: 2013 Changes for Mental Health Providers. This means, for a 90837 (60 minutes) the session minimum would be 90 minutes; for a 50-minute 90847, the session must be a minimum of 80 minutes. For the aforementioned reasons, I am requesting reimbursement increases for the following CPT codes. Denny and his team are responsive, incredibly easy to work with, and know their stuff. 90837 is defined as a session of 60 minutes, ranging from 53 minutes to longer. %
Did you get a letter from Blue Cross or another insurance plan, saying something about your use ofthe 90837 CPT code (Psychotherapy 60 min)? The payers seem to be allowing the use of the 99354 and in fact reimburse at a higher rate for the 99354 than the original procedure code. 6trZenlH!)4Sh!B2d4N={3i[qi1Ok0&2T"\W^YxeT 8)d 8,753 Medical Reimbursement Claims $60,000 jobs available on Indeed.com. I know this code should not be used for ongoing couples or family treatment. BlueCross BlueShield, HealthPartners, Aetna, PreferredOne and Cigna have all reimbursed for the service." Every provider we work with is assigned an admin as a point of contact. James Schergen is a co-founder of TheraThink. We are your billing staff here to help. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. My daily insurance billing time now is less than five minutes for a full day of appointments. This specialized code has been approved by the Center for Medicare and Medicaid Services Administration (CMS) since 2015 (search for "92167" on page 14 of this CMS document ). Please call the Suicide & Crisis Lifeline at 988 or use these resources to get immediate help. This ensures we provide valuable resources to our readers. Add-on CPT Code 99354 is defined as a prolonged services code and is defined as an extra 30-74 minutes of therapy. 1 United Behavioral Healthand United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California Our data is encrypted and backed up to HIPAA compliant standards. Denny and his team are responsive, incredibly easy to work with, and know their stuff. %PDF-1.5
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If I have paid my provider in full, how do I request that reimbursement be sent to me? Analytics cookies help website owners to understand how visitors interact with websites by collecting and reporting information anonymously. Medicare and some Medicaid programs will continue to cover telebehavioral health through December 31, 2024. We recommend calling if you know that you will have an extended session or if you want to check before you file a claim. Tip:If a patient has private insurance, verify coverage via the insurance provider policy or request the patient to confirm coverage before each appointment. Our data is encrypted and backed up to HIPAA compliant standards. The intention is to display ads that are relevant and engaging for the individual user and thereby more valuable for publishers and third party advertisers. Flu Shots Get payment, coverage, billing, & coding information for the 2022-2023 season. 90837 is considered a routine outpatient CPT Code and is one of the most common CPT codes used in mental health insurance claims coding and billing. I cannot capture in words the value to me of TheraThink. 2 0 obj
You will need to find the provider relations mailing address for your respective insurance company and the best way to find that is to call provider relations directly. Granados states that Anthem Blue Cross reviewed one year of all their paid claims. If 90837 + HJ session is billed to Cigna, they may process it as a normal mental health claim! Department Contact List for customer service, program telephone and fax numbers, and staff email. Rated 4.5 overall from 10,849 Google reviews. A pandemic. "Cigna" is a registered service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating . CHCP - Resources - Clinical Reimbursement Policies and Payment Policies Clinical Reimbursement Policies and Payment Policies Here you will find links to several key resources for health care professionals to help your practice perform efficiently and make it easier to do business with Cigna. QMPt~T{qp``bUVa!FyNHWVC7Mq+h&Ukn01[F,0/-lAD3(*qJ Ny.! Out of this fear, many therapists are choosing to downcode sessions, using the 90834 45-minute psychotherapy code instead, which typically represents lower reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. The USA Consumer Price Index has now shown a 6.2% increase in prices in 2021. Log in to our provider portal. To support access to quality, cost-effective care for your patients with a medical plan administered by Cigna, we routinely review clinical, reimbursement, and administrative policies, as well as our medical coverage policies and precertification requirements. TheraThink.com 2023. You'll always be able to get in touch. 90404: Cigna / MHN EAP sessions. Billing Tips and Reimbursement. Fee Schedule. Make it easy and rewarding to go in-network. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. All insurance policies and group benefit plans contain exclusions and limitations. Assistive Care Services Fee Schedule. This is a good use of money! Free Account Setup - we input your data at signup. x]n77w8:$@H6{08{!Ed3dU I Y:],Vlv/??rjw^tsr'Qvrw{tzq.wOo/w!#_jglnr{xvrRv/5~wzz}uw/vnx+zZZf6|_q^iJ;wROMt?\>O/=KmqU8^-J|R!mw6B;\Wo.?._>yM). For all other types of cookies we need your permission. Other insurers have warned providers for billing 90837 too much. Not sure if this includes your specific situation with an insurer? Code listed above is not a guarantee of coverage for service. Providers whose claims showed a higher-than-typical use of the 90837 code received the letter. For tips on coding private insurance claims, see: Contact the staff at the regional telehealth resource centerclosest to you for help setting up billing and reimbursement for a new telehealth service. Centers for Medicare Services CPT Code 90837 definition: individual outpatient psychotherapy services rendered for 60 minutes. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Finally, due to the dramatic increase in demand for mental health services and the added stresses involved in treatment due to these unusual times, I request an increase in pay as an essential and integral worker serving ______(Aetna, Cigna, etc) clients. We'll assume you're ok with this, but you can opt-out if you wish. How much does Blue Cross Blue Shield Pay Counselors and Psychologists? 99354 used to only be allowed by Medical Doctors, but has since expanded and is applicable to 90837 and 90487. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. BarbGris@aol.com. %PDF-1.6
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CPT Code 90837 is a procedure code that describes a 60 minute individual psychotherapy session performed by a licensed mental health provider. Cigna; As a Licensed Clinical Counselor, online therapy can also be covered under these insurance plans. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Documentation Wizard, Misery or MasterySM, and the Documentation Wizard Logo are service marks of Beth Rontal.Designed and Hosted by Coastal Waters Creative - Local Business Websites and Digital Marketing, This website uses cookies to improve your experience. And we hope this short guide and template can help make a meaningful impact on you and your familys financial wellbeing in 2022 and for years to come. There is no way to report prolonged care with psychotherapy. Because all sessions billed as 99404 are EAP, they should not have any patient responsibility. Unclassified cookies are cookies that we are in the process of classifying, together with the providers of individual cookies. They are NOT telling you it is a problem that you use it more frequently than your peers. Non-covered services These telebehavioral health services are not Medicare reimbursable. To see which telebehavioral and telemental health services Medicaid covers, check your states current laws and reimbursement policies. This is inflation: the increase in prices associated with an increase in money supply. We understand that it's important to actually be able to speak to someone about your billing. The definition of 99417 is above. Anthony is a Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and author of How to Thrive in Counseling Private Practice. var today = new Date();
You can call, text, or email us about any claim, anytime, and hear back that day. Information on Medicaid reimbursement for telehealth by state is available at the Center for Connected Health Policy with live policy trend maps. 1. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only. Thriveworks is currently working towards complete Accessibility of this website. As defined by the CPT, 90834 should be used when you spend an estimated 38-52 minutes on therapy with the client, and 90837 is for all therapy sessions that are at least 53 minutes long. Note: We only work with licensed mental health providers. United Healthcare has reversed course and as of 2019, Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, Inquire about our mental health insurance billing service, offload your mental health insurance billing. Cigna Insurance Company It is unique in that their reimbursement rates do not vary based on behavioral health service provided. All Rights Reserved. Counselors Practicing Without a License: Is it Legal? 90832 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes with the patient and/or family member (time range 16-37 minutes). Health care billing code changes initiated during the COVID-19 public health emergency cover telehealth and include specific information for audio-only or video-only visits. Cigna created this procedure code to describe EAP sessions taking place through their billing system. of our employees with tuition reimbursement, seminars, and other activities that help us stay on the leading edge of behavioral care. The rates of reimbursement are the same nationally, and hence they are considered quite low for some areas of the country. Individual providers then were compared to their specialtys baseline. As a global health service company, Cigna aligned with HealthSpring in 2012 to assist the growing market of Americans, aged 65 and older, transition from career into retirement. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. Reimbursement for out-of-network plans is a possibility. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. A lock () or https:// means youve safely connected to the .gov website. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). Get credentialed with major insurance payers in under 45 days. It's our goal to ensure you simply don't have to spend unncessary time on your billing. I know 90837 may be used only for individual sessions, or when family comes into a session to serve as informants for ongoing individual treatment. Get updates on telehealth
In order to ensure I do not change the proportion of clients away from (Aetna, Cigna, etc), I ask for a fair but competitive increase in pricing to keep up with my other insurance contracts. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. The Illinois Counseling Association Insurance Task Force partnered with the National Association of Social Workers, Illinois Chapter (NASW-IL) to address Cigna's Health Insurance fee schedule for . As with all of these codes, both CPT and HCPCS, the prolonged code may only be added to the highest-level code in the category and then only when time is used to select the service. <>
Progress Notes webinar What Should Be In Your Charts. Preference cookies enable a website to remember information that changes the way the website behaves or looks, like your preferred language or the region that you are in. Try out our rate negotiation template tool here: https://therathink.com/rate-negotiation-tool/. 99404 is defined as Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual. . Medication management: +90863 when provided in addition to a psychotherapy session on the same day; use in conjunction with (90832,90834 and 90837). CCSD schedule. This also means there is no time descriptor for Cigna EAP claims. Applied Behavior Analysis (ABA) Billing. This website is not intended for residents of New Mexico. In other words 99355 can be used multiple times for one appointment. Note: We only work with licensed mental health providers. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 22 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Should Counselors Sign Non-compete Agreements? The federal government, state Medicaid programs, and private insurers have expanded coverage for telebehavioral and telemental health during the COVID-19 public health emergency. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Just like other CPT codes, it should go in the 24(c) location of a CMS 1500. You can call, text, or email us about any claim, anytime, and hear back that day. APPs will have six months from January 1, 2021 to contact our Provider Information Management team to complete the requirements to become enumerated and begin This letter is a request for an increase in reimbursement rates for the routine outpatient mental health services that I provide and have provided to (Aetna, Cigna, UHC) clients for _____ years. We're here to help. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Free Account Setup - we input your data at signup. If you have any questions or would like more information about participating in a Cigna health care network, please contact us. ICD-10 codes (medical necessity): It is the responsibility of the provider to code to the highest level specified in the ICD-10 CM. Read More. Although Medicare reimburses for audio and video telehealth services, reimbursement for audio-only telehealth services is currently only covered through December 31, 2024. Thankfully, United Healthcare has reversed course and as of 2019 has started accepting 90837 without prior authorization. 376 0 obj
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The social work and counseling CPT codes below are additional codes that may be used by social workers in various areas of service. Reimbursement Policy . In 2013 reimbursement for 90832 (30 minutes), the replacement for 90804 (20-30 minutes) went from $41.92 to $51.62, about a 23% raise. Mental Health License Practitioner Levels: Practitioner Level 1: Physician/Psychiatrist Practitioner Level 2: Psychologist, CNS-PMH Practitioner Level 3: LCSW, LPC, LMFT, RN Practitioner Level 4: LMSW; LAPC; LAMFT The above list of codes eligible for reimbursement via various telemedicine modalities may vary based on state law or regulation to the contrary. Lung Cancer Screening Benefits to Change for Texas Medicaid Effective . Thank you. Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838). License Level Reimbursement Policy - Updated 10-24-2022 Maximum Frequency Per Day - Anniversary Review Approved 5-23-22 Medicare Incident to Bill - Updated 4-1-2022 National Correct Coding Initiative Reimbursement Policy - Anniversary Review Approved 5-23-22 Non-Emergent Transport and Lodging - Anniversary Review Approved 5-23-22 Best Cpt Codes For Mental Health & Therapy - Top 2023 Codes. Read our editorial policy for more information. Cigna Healthcare monitors claims by conducting claims audits and by reference to medical records. Having more social contacts is one of the goals but is taking a long time to achieve.. Heres a very short list that can get you started: https://therathink.com/provider-address-change-forms/. Take a look at our quick 90837 billing cheat sheet below: The following license is required for rendering 60 minute individual therapy sessions: Typically no, authorization is not required. Enhanced payback rates for teletherapy and in-person visits. Department of Vermont Health Access. Preventive care services In this guide, well walk you through the process of asking for a raise with insurance companies. We understand that it's important to actually be able to speak to someone about your billing. Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. Balance Billing. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. What matters is whether you are using the code correctly. You free me to focus on the work I love!. In addition to providing exceptional clinical care and customer service, we accomplish our mission by offering important information about mental health and self-improvement. We are your billing staff here to help. Cigna asks that you do not use the HJ modifier and instead bill EAP with a different procedure code, 99404. And you are NOT being singled out the letter is being sent to thousands of therapists each year, in different waves. For more details about billing and reimbursement, including telehealth coding, watch Behavioral Health Billing & Coding 101: How to Get Paid(video) from the American Medical Association (AMA). Reimbursement policies are intended to reflect Highmark's coding & reimbursement guidelines. endstream
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CPT code 90837: Psychotherapy, 1 As the authority on the CPT code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. This site uses different types of cookies. The payment authorization box at the bottom of the claim form dictates to whom reimbursement will be sent. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. This reimbursement policy applies to all professionals who deliver health care services. Individual practitioners providing behavioral services at Cigna-participating medical practices: If you are providing behavioral services at a Cigna-participating medical practice and are not accepting direct referrals from the community, call 1.800.88.Cigna (1.800.882.4462) to apply to the practice's medical contract. CPT Code Requests: 90834: +12%, New Rate: $102 90837: +10%, New Rate: $91 90791: +8%, New Rate: $122 90847: +10%, New Rate: $112 90846: +10%, New Rate: $105 I have enjoyed serving (Aetna, Cigna, etc) clients and hope to do so in the future. Website Design & Marketing by AbundantPractices. Since it is an add-on code it must be billed with 90837 or 90847 (90791 and 90834 are not allowed). Marketing cookies are used to track visitors across websites. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. This isnt the most descriptive CPT code and beyond the routine procedure codes (90834/90837) 99404 is one of the most frequently billed CPT codes. Thank you. You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. Copyright 2008-
We are dedicated to providing you with valuable resources that educate and empower you to live better. >i|G;lXVXqenu(9R Be sure to also include the authorization in box 23. Every provider we work with is assigned an admin as a point of contact. There is no CPT code for sessions greater than 60 minutes. Promulgated Fee Schedule 2022. Cigna will typically cover 60-70% of the allowed amount for out-of-network coinsurance reimbursements. The 96127 CPT Code has been getting serious attention from professionals who are looking to maximize their services / revenue with screening or assessment services. I have enjoyed serving (Aetna, Cigna, etc) clients and hope to do so in the future. document.write(year);
Many states currently match Medicares telebehavioral and telemental health coverage. How Much Does Cigna Pay Counselors and Psychologists? After waiting three to four weeks for receipt and processing, call provider relations to ensure your request has been received. Apply to Customer Service Representative, US Medical Claims Arbitrator (remote), Client Associate and more! Updated Fee Schedule July 2022. I cannot capture in words the value to me of TheraThink. Below are claims tips for common scenarios that you may encounter depending on the type of service you provide. Intake reimbursement increased also from $100.81 for 90801 in 2012 to $106.94 for 90791 in 2013, an increase of about 6%. Outside of work, James can be found in Seattle drinking tea and playing frisbee. Planned services performed in the evening, weekend, or during a holiday. Details. Counselor Fees for Records Requests, Court Appearances, Letters, Treatment Summaries, etc. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. Reimbursement Rate Updates for Procedure Code Q5123 Effective July 1, 2021. For example, clinical nurse specialists are reimbursed at 85% for most services, while clinical social workers receive 75%. Still, the vast majority of insurance companies consider 90387 to be routine and will cover it as they would other mental health procedure codes. I cannot capture in words the value to me of TheraThink. We accept most insurances, and offer weekend and evening sessions. var year = today.getFullYear();
Behavioral Health Overlay Services Fee Schedule. Coverage for services may vary for individual members, based on the terms of the benefit contract. Let us handle handle your insurance billing so you can focus on your practice. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical . If the patient is in their home, use "10". ) g
2!#`6X V^V|[ =H*pB22Dl,x*LBqUR` '.rcUaup0aX*KXBX2^"%"4:9zt %1*|hHH0:^fTh My daily insurance billing time now is less than five minutes for a full day of appointments. If you have any additional questions or concerns, you may also call our Provider Services Center, at 800.926. . Counseling intake process: What counselors need to consider. Finally, we frequently update old content to reflect the most up-to-date information. (Source)The inversion of this statistic is that if you havent had an increase in your rates in 2021, youve lost 6% of your hourly rate. Psychotherapy codes are reported as one unit/day. hb```B We still recommend that you call the insurance companies in cases where youre not sure if 90837 is covered. Services represent insight oriented, behavior modifying, supportive, and/or interactive psychotherapy.