3.0 Billing and Verification

hopscotch providers will use current procedural terminology (cpt) codes to track and bill services for client sessions the cpt code is a required section of each provider note a cpt code is the number assigned to a session by a provider which is used by insurance companies to determine the appropriate payment reimbursement according to their contracted rate with hopscotch cpt code total duration of psychotherapy session 90791 psychiatric diagnostic evaluation without medical services (intake)90791 psychiatric diagnostic evaluation without medical services (intake) psychiatric diagnostic evaluation without medical services (intake) 90832 psychotherapy, 30 minutes with client (16–37 minutes) psychotherapy, 30 minutes with client (16–37 minutes) 90834 psychotherapy, 45 minutes with client (38–52 minutes) 90837 psychotherapy, 60 minutes with client (53 or more minutes with client) 90846 family psychotherapy (without the patient present), 50 minutes (26 or more minutes) 90847 family psychotherapy (conjoint psychotherapy with patient present), 50 minutes (26 or more minutes) the cpt code selected by a provider for their session should accurately reflect these pieces of information the actual time spent with the client in session example a 60 minute session was scheduled for 3 00 p m the client arrives for the session at 3 15 p m and receives therapy until 4 00 p m the appropriate cpt code to use for this session is 90834 (psychotherapy, 45 minutes with client) as the client only received services for 45 minutes during the scheduled time 2\ the purpose of session (diagnostic evaluation/intake vs psychotherapy session) 3\ who was present during the session (individual, family session, client not present, etc ) in addition, providers should note the following with regard to insurance billing any other client encounters outside of the above cpt codes are not billable hopscotch (and providers) will not balance bill clients balance billing occurs when a client is charged for the difference between a provider’s established rates and insurance reimbursement providers may not offer to waive co pays or deductibles for clients hopscotch is committed to the highest level of integrity in client services and billing practices providers are expected to provide the same level of integrity and be knowledgeable as to what constitutes insurance fraud and misrepresentation of services as it pertains to hopscotch client billing knowingly providing cpt (and dsm codes) that do not accurately reflect the actual services provided is illegal and unethical, and considered insurance fraud fraudulent activity by a provider is grounds for immediate termination as well as professional board complaints, civil, and criminal legal action client billing and insurance verification hopscotch collects insurance information and maintains a credit card on file for all clients added to our platform hopscotch handles all eligibility checks and collection of copays for clients if a client has any questions regarding billing for sessions, please have them contact support\@joinhopscotch com providers cannot independently bill clients themselves for services rendered through the hopscotch platform and through hopscotch’s contracted insurance payors this is a violation of hopscotch’s and our insurance payors’ organizational policies and will be considered grounds for immediate termination