Coding and Reimbursement

The Current Procedure Terminology (CPT) code set is used to denote the medical and surgical procedures and diagnostic services rendered by providers. The CPT coding system provides a uniform language for describing these services for all billing and documentation and, under HIPAA, is required to be used for procedures provided by all providers and payers in the United States. The Centers for Medicare and Medicaid (CMS) assigns values to those CPT codes covered by Medicare and most insurance companies base their reimbursements on the values established by CMS for these procedure codes.

For the provider, the key to appropriate insurance reimbursement lies in accurate procedure coding. Coding errors can lead to delayed payments or rejections of submitted claims. Consistent errors can trigger audits, or even charges of fraud and abuse, and removal from managed care networks. Always verify CPT information with the AMA's current CPT manual, which is the ultimate authority on procedure coding.

For diagnosis codes refer to the DSM.


Procedure Coding Resources for APA Members

The Basics

Evaluation and Management (E/M)


CPT Coding Webinars/Training Options

CME courses devoted to general CPT coding and CPT coding using evaluation and management codes as well as a CPT workshop are offered each year at the APA Annual Meetings.


Procedure Coding for Smoking-Cessation Counseling

There are several procedure codes available to describe services provided to encourage behavior change in individuals who use tobacco.

See more resources on smoking cessation and mental illness.


Interactive Complexity Guide

A new concept in 2013, interactive complexity refers to 4 specific communication factors during a visit that complicate delivery of the primary psychiatric procedure. Report with CPT add-on code 90785.

Train-the-Trainers


Practice Management HelpLine

If you are an APA member and need assistance with practice management issues, please contact our Helpline.

Contact Us 

Procedure Coding Network for APA Members

If you have a specific question about how to code for a particular patient encounter, please send it to APA's Office of Healthcare Systems and Financing coding network at hsf@psych.org and include:

  • Your name, APA member number, city, state, phone number, fax number, and e-mail address
  • State the question or describe the problem thoroughly but succinctly—a short paragraph is usually all that is necessary
  • Include any relevant correspondence from Medicare carriers, insurance companies, or third-party payers
  • Cite any actions that have been taken relating to the problem, i.e., calls made, letters written