Understanding Key CPT Codes: A Comprehensive Guide

Current Procedural Terminology (CPT) codes are an essential part of the healthcare billing process. They ensure standardized documentation for medical, psychological, and procedural services. In this guide, we’ll explore important CPT codes, including CPT 99354 Still Active, 90837 CPT Code, 96372 CPT Code, CPT 99213, and CPT 99214. We’ll break down their uses, billing guidelines, and scenarios where these codes are applicable.

CPT 99354 Still Active

The CPT 99354 Still Active code is used for prolonged evaluation and management (E/M) services that require direct patient contact. Specifically, it applies when services extend beyond the typical time allocated for a procedure or consultation by 30-74 minutes.

Key Features of CPT 99354:

• Purpose: To account for extended time spent with a patient during an office visit or outpatient consultation.
• Billing Rules: It must be reported in addition to the primary E/M service code.
• Scenarios: Often used for complex cases requiring longer face-to-face interactions, such as managing chronic illnesses or in-depth mental health evaluations.

Despite frequent updates to CPT codes, CPT 99354 Still Active remains valid as of now, making it a reliable option for billing extended services.

90837 CPT Code

The 90837 CPT Code is widely used for psychotherapy sessions lasting 60 minutes. It is one of the most common codes utilized by mental health professionals, including psychologists, social workers, and licensed counselors.

Key Features of 90837 CPT Code:

• Purpose: To bill for individual psychotherapy sessions that involve diagnostic evaluation, therapy planning, and treatment.
• Time Requirements: Minimum of 53 minutes and typically up to 60 minutes.
• Billing Tips: Providers must document session details, including treatment goals and techniques, to justify the time spent.
• Usage Examples: This code is frequently used in cognitive-behavioral therapy (CBT), trauma-focused therapy, and counseling for anxiety or depression.

Mental health professionals rely heavily on the 90837 CPT Code to ensure accurate billing for in-depth therapy sessions.

96372 CPT Code

The 96372 CPT Code is used for therapeutic, prophylactic, or diagnostic injections administered by a healthcare professional. It covers the administration of medications or vaccines that do not require infusion.

Key Features of 96372 CPT Code:

• Purpose: Billing for single or multiple injections given during a patient visit.
• Exclusions: Does not include medication costs, which must be billed separately.
• Common Uses: Frequently used for injections like antibiotics, steroids, hormone therapies, and vaccines.
• Billing Guidelines: Providers must document the medication administered, injection site, and patient’s response.

Healthcare providers often pair the 96372 CPT Code with an office visit code if the injection is part of a broader treatment plan.

CPT 99213

The CPT 99213 code is one of the most commonly billed codes for established patient office visits that are of low to moderate complexity. It applies to visits involving evaluations, follow-ups, or minor medical decision-making.

Key Features of CPT 99213:

• Time Frame: Typically 15-29 minutes of face-to-face time with the patient.
• Purpose: Evaluation of symptoms, adjustments to treatment plans, or minor diagnostic assessments.
• Documentation Requirements: Must include the patient’s history, examination findings, and medical decision-making details.
• Examples of Use: Follow-up visits for chronic conditions like hypertension, diabetes management, or minor illnesses such as ear infections.

The CPT 99213 code is ideal for routine visits that do not require extensive evaluation or prolonged care.

CPT 99214

The CPT 99214 code is used for moderate-complexity office visits for established patients. It is typically billed when the visit requires more time and detailed medical decision-making than CPT 99213.

Key Features of CPT 99214:

• Time Frame: Typically 30-39 minutes of face-to-face interaction.
• Purpose: More complex evaluations involving the management of chronic conditions or multiple diagnoses.
• Billing Documentation: Must include comprehensive notes on medical history, examination results, and decisions made during the visit.
• Examples of Use: Managing multiple chronic illnesses, reviewing lab results, prescribing new medications, or making referrals to specialists.

The CPT 99214 code is often used in cases requiring moderate decision-making, making it one of the most frequently billed codes in outpatient care.

CPT codes are essential tools for accurately documenting and billing medical and psychological services. Here’s a quick recap of the codes covered:

• CPT 99354 Still Active: Used for prolonged services beyond the typical appointment time.
• 90837 CPT Code: Covers 60-minute psychotherapy sessions for mental health treatments.
• 96372 CPT Code: Billed for therapeutic and diagnostic injections administered by healthcare providers.
• CPT 99213: Suitable for low-complexity evaluations and follow-ups for established patients.
• CPT 99214: Designed for moderate-complexity office visits requiring more detailed evaluations.

Understanding these codes helps providers streamline their billing process, reduce claim rejections, and focus on delivering high-quality care. Whether you’re a physician, therapist, or billing specialist, having a firm grasp of these codes ensures compliance and accurate reimbursements.