Understanding Key CPT Codes: A Comprehensive Guide for Healthcare Professionals

Current Procedural Terminology (CPT) codes play a critical role in the healthcare system, helping providers standardize billing for medical services and procedures. This blog explores commonly used codes, including CPT 99354 Still Active, 90837 CPT Code, 96372 CPT Code, CPT 99213, and CPT 99214. We’ll break down their definitions, use cases, and billing guidelines to ensure accurate coding and compliance.

CPT 99354 Still Active – Prolonged Services with Direct Patient Contact

One frequently asked question is whether CPT 99354 Still Active is a valid code. The answer is yes—this code remains active and is widely used for prolonged evaluation and management (E/M) services.

CPT 99354 applies to situations where a provider spends additional time (30-74 minutes) beyond the standard visit duration with a patient, addressing complex cases that require more attention. It is used alongside primary E/M codes, such as CPT 99213 or CPT 99214, to reflect extended time spent with a patient.

Key Points:

• Purpose: To report extended face-to-face time with a patient.
• Requirements: Must be used in conjunction with a base E/M code.
• Documentation: Detailed notes specifying the reason for prolonged services are essential.

Healthcare providers rely on CPT 99354 Still Active for cases that require thorough evaluation, such as patients with chronic conditions or complex treatment plans.

90837 CPT Code – Psychotherapy Services

The 90837 CPT Code is one of the most commonly used codes for mental health services, specifically for individual psychotherapy sessions lasting 60 minutes. It’s a vital code for therapists, psychologists, and psychiatrists who provide talk therapy to address mental health conditions like anxiety, depression, and trauma.

Key Features:

• Time Frame: Typically applies to sessions lasting 53 minutes or longer.
• Purpose: Used for individual psychotherapy services.
• Insurance Billing: Providers should verify insurance policies to ensure coverage and eligibility.

90837 CPT Code is popular among mental health professionals as it accurately reflects the extended time required for therapy sessions, making it easier to bill appropriately for services rendered.

96372 CPT Code – Therapeutic, Prophylactic, or Diagnostic Injections

The 96372 CPT Code is used to report the administration of injections, including therapeutic, prophylactic, or diagnostic substances. It applies when a healthcare professional administers an injection, but it excludes chemotherapy or other specialized infusions.

Key Details:

• Purpose: Covers injections such as vaccines, antibiotics, and pain management medications.
• Supervision: Requires the presence of a qualified healthcare provider during administration.
• Exclusions: Cannot be used for self-administered injections or when performed by the patient.

Billing for 96372 CPT Code requires documentation of the injection type, dosage, and patient response, ensuring compliance with coding standards.

CPT 99213 – Office or Outpatient Visit (Low Complexity)

CPT 99213 is a commonly used code for office or outpatient visits involving low-complexity medical decision-making. It typically applies to patients presenting with mild symptoms or stable conditions requiring minimal management.

Key Details:

• Time Requirements: 20-29 minutes spent with the patient.
• Evaluation: Includes history-taking, physical examination, and medical decision-making.
• Common Uses: Routine follow-ups, prescription renewals, and minor health concerns.

For providers managing straightforward cases, CPT 99213 simplifies billing by reflecting shorter visit durations and low-complexity care.

CPT 99214 – Office or Outpatient Visit (Moderate Complexity)

For more complex cases, CPT 99214 is used to report office or outpatient visits that involve moderate-complexity medical decision-making. It applies to situations requiring a more in-depth evaluation or treatment adjustments.

Key Features:

• Time Requirements: 30-39 minutes spent with the patient.
• Evaluation Scope: Detailed history, physical exam, and problem-solving discussions.
• Common Uses: Managing chronic illnesses, reviewing lab results, and creating treatment plans.

Compared to CPT 99213, CPT 99214 covers longer visits and more detailed medical assessments, making it ideal for patients with ongoing health concerns.

Tips for Accurate CPT Coding

1. Document Thoroughly: Always maintain detailed records to support the selected CPT codes. Include time spent, medical decisions made, and procedures performed.
2. Understand Modifiers: Use appropriate modifiers when billing for multiple services to avoid denials.
3. Verify Insurance Policies: Check with payers to ensure the codes you plan to use are covered and reimbursable.
4. Stay Updated: Regularly review CPT code updates to ensure compliance with the latest standards.

Accurate coding is essential for effective billing and reimbursement in healthcare. Whether you’re documenting prolonged services using CPT 99354 Still Active, billing psychotherapy sessions with the 90837 CPT Code, administering injections with the 96372 CPT Code, or managing outpatient visits using CPT 99213 and CPT 99214, understanding these codes helps streamline workflows and ensures compliance.

By mastering these commonly used CPT codes, healthcare providers can improve efficiency, reduce claim denials, and focus more on patient care. Stay informed, document properly, and leverage these codes to optimize your practice’s billing process.