Understanding Key CPT Codes: A Comprehensive Guide

CPT codes, or Current Procedural Terminology codes, are essential for healthcare providers to accurately bill for services rendered to patients. These codes ensure consistency and transparency in medical billing and insurance claims. In this article, we’ll explore important CPT codes, including whether CPT 99354 Still Active, the purpose of 90837 CPT Code, the function of 96372 CPT Code, and the differences between CPT 99213 and CPT 99214.

CPT 99354 Still Active?

One of the most frequently asked questions about extended service billing is, Is CPT 99354 Still Active? The answer is yes—CPT 99354 is still active and widely used.

CPT 99354 is designated for prolonged evaluation and management (E/M) services that require 30-74 minutes of additional face-to-face time with a patient beyond the standard service duration. It is typically used when a provider spends extra time addressing complex medical or mental health issues.

This code is often paired with other primary E/M codes, such as CPT 99213 or CPT 99214, to account for the extended time required. Providers should document the additional time spent and the reason for the prolonged service to ensure proper reimbursement.

90837 CPT Code: Individual Psychotherapy Services

The 90837 CPT Code is one of the most common codes used for billing individual psychotherapy sessions. It covers 60 minutes of face-to-face therapy with a patient, making it ideal for mental health professionals, including psychologists, licensed counselors, and social workers.

Key Features of 90837 CPT Code:

• Duration: Typically 53 minutes or longer (up to 60 minutes).
• Purpose: Used for diagnosing and treating emotional, mental, or behavioral issues.
• Documentation Requirements: Therapists must record the session length, therapy goals, treatment methods, and patient progress.

The 90837 CPT Code is reimbursable through most insurance plans, but therapists need to confirm that extended sessions are covered to avoid claim denials.

96372 CPT Code: Therapeutic Injections

The 96372 CPT Code is used for billing therapeutic, prophylactic, or diagnostic injections administered by a healthcare provider. This code applies when the injection is performed without the need for intravenous (IV) access.

Key Uses of 96372 CPT Code:

• Injection Types: Includes intramuscular (IM), subcutaneous (SubQ), and intradermal injections.
• Examples: Vaccines, antibiotics, pain relievers, hormone therapy, and allergy medications.
• Exclusions: The medication administered must be billed separately from the injection service itself.

Providers must document the medication, dosage, administration site, and patient response to ensure compliance and proper reimbursement when using the 96372 CPT Code.

CPT 99213: Office or Outpatient Visits

CPT 99213 is one of the most widely used codes for established patient office visits. It represents a low to moderate complexity evaluation and management (E/M) service and is often utilized for routine checkups or follow-up visits.

Key Features of CPT 99213:

• Time Requirement: Typically 15-29 minutes spent face-to-face with the patient.
• Purpose: Evaluation of stable or minor acute illnesses, prescription renewals, and preventive care.
• Documentation: Providers must document the patient’s history, physical examination, and medical decision-making process.

This code is ideal for patients who require a basic assessment or ongoing care for a manageable condition.

CPT 99214: Mid-Level Office Visits

Similar to CPT 99213, CPT 99214 is also used for established patient visits but is billed for moderate to higher-complexity cases.

Key Features of CPT 99214:

• Time Requirement: 30-39 minutes of face-to-face time with the patient.
• Purpose: Management of more complex or chronic conditions requiring adjustments to treatment plans.
• Documentation: Requires detailed notes covering history, exam findings, and the decision-making process.

Providers often use CPT 99214 when treating patients with multiple complaints, managing chronic conditions, or prescribing new medications requiring close monitoring.

Key Differences Between CPT 99213 and CPT 99214

• Time Spent:
  • CPT 99213: 15-29 minutes.
  • CPT 99214: 30-39 minutes.
• Complexity:
  • CPT 99213: Low to moderate complexity.
  • CPT 99214: Moderate to high complexity.
• Documentation:
  • CPT 99213: Brief or focused notes.
  • CPT 99214: Detailed examination and decision-making process.

Choosing between these codes depends on the severity of the patient’s condition and the amount of time required for evaluation and treatment.

Understanding and using CPT codes correctly is crucial for healthcare providers to ensure accurate billing and reimbursement. Whether confirming if CPT 99354 Still Active for prolonged services, billing therapy sessions with the 90837 CPT Code, recording injections using the 96372 CPT Code, or differentiating between CPT 99213 and CPT 99214, proper documentation is key.

By mastering these codes, providers can deliver high-quality care while maintaining compliance with billing regulations. If you’re a healthcare professional, keeping up-to-date with CPT codes ensures smoother operations and better financial outcomes for your practice.