Provider updates

CareOregon’s claim payment practices for psychotherapy high day billing have changed. Claims dating back to January 1, 2024, may be impacted. Psychotherapy services that exceed eight (8) hours in a single day will be denied. If a single rendering provider bills for more than eight hours of services, using any combination of the specified codes below, all psychotherapy services for that day will be denied. Medical records will be required for claims payment on any day, or 24-hour period, in which a provider claims more than eight hours of psychotherapy.

We understand these changes may require adjustments to your billing practices. They are necessary to align with payor group guidelines and uphold the highest standards of accuracy, integrity, and regulatory compliance. CareOregon’s goal is to ensure consistent, fair, and accurate claim processing that benefits all stakeholders, and we appreciate your cooperation as we implement these changes.  

Minimum time required for psychotherapy codes

The minimum time required between the provider and the client for each psychotherapy code is as follows:

• CPT Code 90832: Psychotherapy, 30 min with patient (30 minutes minimum)
• CPT Code 90833: Psychotherapy, 30 min with patient with evaluation & management services (35 minutes minimum)
• CPT Code 90834: Psychotherapy, 45 min with patient (38 minutes minimum)
• CPT Code 90836: Psychotherapy, 45 min with patient with evaluation & management services (43 minutes minimum)
• CPT Code 90837: Psychotherapy, 60 min with patient (53 minutes minimum)
• CPT Code 90838: Psychotherapy, 60 min with patient with evaluation & management services (58 minutes minimum)

Denial of charges

All services billed for the entire day will be denied if the total psychotherapy time exceeds the eight-hour limit.

Claim reconsiderations

Denied claims will be eligible for reconsideration with submission of clinical records for ALL services performed on the date of service being reconsidered. Provider appeals/reconsiderations can be submitted via the Provider Connect Portal through the Submit Claim Attachments feature.

A provider may also submit one of the following for payment to CareOregon’s Payment Integrity (fax number 503-416-1381):

• A client appointment log for the day, including reception check-in and check-out times for each client.
• Medical records for client visits conducted on that day.

Supervisory claims

Claims submitted with an indication of a supervisory claim will be excluded from the eight hours of service limit

• Provider specialty type must meet the minimum requirements of being a supervisory provider. (refer to OAR 309-019-0130)
• Only claims that meet the strict documentation requirements of "Incident to" should be billed under these guidelines as supervisory.
• Instructional supervisory claims are only allowed in registered instructional facilities.
• To bill a supervisory claim, providers should report a “DQ” in box 17 of the CMS-1500 form or Loop 2310A, NM108 of the 837 file.

Additional information

For more information, please view our High day billing of psychotherapy coding quick guide.

If you have financial hardship and would like to discuss a re-payment plan or have further questions, please contact Payment Integrity at paymentintegrity@careoregon.org.