2023 Changes to billing insurance for EMDR Intensives (updated July 2023)

I initially set out to add a few updates to my original blog post from January about the 2023 changes to billing insurance for EMDR intensives. As I started trying to tweak the original post in a way that was easy to understand I quickly realized that it became way too confusing so I scrapped it all and am making an entirely new post here. I took down the original blog because some of that information is now inaccurate (as of July 2023) and I want to make sure that to the best of my ability I am providing up to date information. 

The never ending question of “how can I bill insurance for EMDR intensives” continues to evolve. This year with several changes to CPT codes it has become particularly confusing to figure out what might work. As always, these are recommendations and possible options but the only way to be 100% certain is to contact the insurance companies you are contracted with and verify the benefits of the client’s insurance you are working with to determine what is actually covered per their plan and your contract. (Yes, I know that’s a gigantic pain and time suck, but it is the best way to go 😬). 

In this new post I am going to try to keep the explanations as simple as possible and recap the information most pertinent to making your billing decisions.

Here is what we know so far: 

As of January 1, 2023 the AMA discontinued the use of CPT codes +99354 and +99355 which were previously used in conjunction with 90837 to bill for prolonged sessions (EMDR intensives). 

 

Also an update for 2023 CMS language now defines 90837 as “53 minutes or more” which removes the previous time limit of 53-89 minutes. 

 

As the year has progressed NASW now reports a potential solution for therapists needing to code for providing 90+ minute services. The recommendation is to report two units of 90834 for a total of 90 minutes. 

 

Crisis codes 90839 and 90840 are still available for use when a prolonged session meets the criteria for a crisis situation.  If the focus of your intensive session fits the criteria for a “crisis session” yes this is a great option. I do not recommend routinely billing crisis codes for all EMDR intensives that your client is not in crisis. 

 

There has also been a recent change to allow master’s level providers to use the add on code G2212 for 15 minute increments. Kym Tolson explains more about this and billing two units of 90834 in this very helpful video. 

Now for the confusing and sometimes controversial part: what to do with this information and how to apply it to EMDR intensives to maximize payment for services and navigate the nuance of what is and is not a covered service by insurance. 

For EMDR therapists who are in-network with insurance: 

I recommend checking with the insurance companies you are contracted with to see if any of these options are possible:

1. Can you offer 90 minute sessions and bill 2 units of 90834?
2. Can you use 90834 + G2212? If so, how many units of 90834 and G2212 are allowed?
3. Can you use 90837 + G2212? If so, how many units of 90837 and G2212 are allowed?

If these are allowed/covered for you, also ask what is the reimbursement rate for each. 

From this information, you can then decide what combination of codes to use and how much time you can have covered by insurance for a prolonged session. Use this information to decide what you want to offer to clients and how you want to structure your EMDR intensive programs. 

If none of the above are options under your insurance contract I would recommend doing two or three sessions (using only 90837s) closer together. Maybe thats 3 sessions during one week or 2 sessions per week for 2 weeks. This gives you the ability to continue to utilize the client’s insurance benefits and also see the client for more time total in the week. Typically there are no maximum limits on the frequency of sessions covered, but it is always best to verify your client’s benefits for your contract with the insurance company to be sure. 

‼️ I have previously recommended an option for splitting the intensive into essentially two appointments. A 90837 for the first portion covered by insurance and then self pay for the remainder of the time beyond the covered service. With the change in language of the 90837 from a firm 89 minute maximum to beyond 53 minutes I think this option would be much riskier. If the 90837 encompasses an endless amount of time then there’s no justification for the intensive being a service provided outside of what is covered. 

My practice has been out of network with insurance since 2022 so I have not personally tried any of these options. When I was billing insurance for intensives the old codes were in place. I want to know what you’re having success with! Please let me know if you have had success with any of these new billing options! 

For EMDR therapists who are self-pay / out-of-network with insurance:

The discontinuation of the prolonged services CPT codes does not change the overall payment of your intensive EMDR sessions. Your clients are still paying you in full for the time scheduled. This does change the superbill if you are providing one for your clients to submit to their insurance company for possible out-of-network coverage of their claim. I see there being 3 options: 

1. Bill 90837 for the entire EMDR intensive under the assumption that 90837 is now for anything over 53 minutes 
2. Bill 2 units of 90834 (for the 90 minutes) with the add on code G2212 for the additional units of 15 minute increments up to to the total time of the intensive 
3. Bill 2 units of 90837 with with the add on code G2212 for the additional units of 15 minute increments up to to the total time of the intensive 

While these changes are a bit confusing to keep up with, I find it encouraging that we may have at least some options for providing EMDR in the intensive format and having insurance cover it. This is certainly an improvement from January when it seemed like there were zero options available. Since this information is new for 2023 and continuously evolving, I will add more updates to this post (or re-write it again) as I learn more.

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