CPT 90887: Psychiatric Results Review

• CPT Codes
• 90887

CPT 90887: Psychiatric Results Review

Guide to CPT code 90887 for billing interpretation and explanation of psychiatric diagnostic results to family members or other responsible persons.

Quick Reference

Code

90887

Code System

CPT

Category

CPT Codes

Published

Jan 15, 2024

Updated

Mar 4, 2026

Reading Time

9 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Last Updated: March 7, 2024

Introduction

In 2023, a study by the American Psychological Association found that 75% of mental health professionals reported an increase in patients seeking care for anxiety and depression. ↗ This surge in demand underscores the critical importance of effective communication between healthcare providers, patients, and their families. CPT code 90887 plays a vital role in this communication process, facilitating the interpretation and explanation of diagnostic results. As healthcare providers strive to meet the growing need for mental health services, understanding and correctly utilizing billing codes like 90887 becomes crucial for ensuring proper reimbursement and maintaining quality care.

This comprehensive guide will delve into the nuances of CPT code 90887, providing healthcare providers, medical billers, and administrators with the knowledge and tools necessary to navigate this essential billing code effectively. By the end of this article, you’ll have a thorough understanding of 90887, its applications, and best practices for compliant billing.

90887 Overview

CPT code 90887 is defined as “Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient” [ Billing and Coding: ProMark® Risk Score (A57515) ↗ ].

Purpose and Significance

The 90887 code allows healthcare providers to bill for the time spent interpreting and explaining diagnostic results, treatment plans, and other medical information to a patient’s family members or other responsible parties. This service is crucial for ensuring that patients and their support systems fully understand the nature of their conditions, treatment options, and how to best assist in the patient’s care. It’s particularly relevant in mental health settings where family involvement and understanding can significantly impact treatment outcomes.

Quick Facts about 90887:

• Used for interpreting and explaining results to family or other responsible persons
• Can be billed in addition to other psychiatric services on the same day
• Typically billed in 30-minute increments
• Does not require the patient to be present
• Often used in conjunction with family therapy or other collaborative care approaches

Detailed Breakdown

Components and Requirements of 90887

To bill 90887 correctly, providers must ensure their services meet specific criteria:

Each of these components must be thoroughly documented to support the use of the 90887 code [ Billing & Collections — ].

• Qualified Provider: The service must be performed by a qualified healthcare professional, such as a psychiatrist, psychologist, or licensed clinical social worker.
• Recipient of Information: The explanation must be given to family members or other responsible persons, not the patient themselves.
• Content: The service should involve interpreting or explaining results of psychiatric or medical examinations, procedures, or other accumulated data.
• Purpose: The explanation should be aimed at advising the recipients on how to assist the patient.
• Documentation: Detailed records of the discussion, including the information provided and the recipients’ understanding, must be maintained.

Common Pitfalls and How to Avoid Them

To avoid these issues, implement robust training programs and regular audits of billing practices..com offers comprehensive resources and tools to help providers navigate these common challenges effectively [ Billing & Collections — ].

• Billing for Patient Education: Remember that 90887 is specifically for communication with family or other responsible persons, not the patient. Use appropriate patient education codes for direct patient communication.
• Insufficient Documentation: Ensure comprehensive records of the discussion, including the specific information provided and how it relates to assisting the patient.
• Overuse of the Code: While 90887 can be billed in addition to other services, it should only be used when a significant, separate service is provided.
• Neglecting Time Requirements: While there’s no specific time requirement for 90887, the service should be substantial enough to justify billing. Document the time spent on the explanation.
• Failing to Obtain Proper Consent: Ensure you have the necessary consent to share patient information with family members or other responsible persons.

Impact on Healthcare System

The 90887 code plays a significant role in the broader healthcare landscape, affecting patients, providers, and payers in various ways.

Effects on Patients

Proper use of 90887 can lead to improved patient outcomes by ensuring that family members and caregivers are well-informed and equipped to support the patient’s treatment. A 2022 study published in the Journal of Family Therapy found that patients whose families received detailed explanations of their diagnosis and treatment plan showed a 30% improvement in treatment adherence compared to those without such family involvement [ The Intercultural Exeter Couples Model: making connections for a divided world through systemic‐behavioral therapy J. Reibstein and R. Singh Chichester: Wiley Blackwell £18.43 - Rivett ↗ ].

Effects on Providers

For providers, accurate billing of 90887 ensures proper reimbursement for the time-intensive process of explaining complex medical information to families. This, in turn, encourages providers to dedicate the necessary time to these crucial conversations, ultimately improving the quality of care.

Effects on Payers

While 90887 represents an additional cost for payers, effective communication with families often leads to better treatment outcomes and potentially reduced long-term healthcare costs. A 2023 analysis by the American Journal of Managed Care indicated that comprehensive family education and involvement, including services billed under 90887, could result in a 15-20% reduction in hospital readmission rates for patients with severe mental illness. ↗

Billing Best Practices

Step-by-Step Billing Guide

• Verify that the service meets the criteria for 90887 billing, including the recipient of the information and the content discussed.
• Document the specific information provided, the recipients present, and how the explanation relates to assisting the patient.
• Record the time spent on the explanation, even though 90887 doesn’t have a specific time requirement.
• If billing 90887 in addition to other services on the same day, ensure each service is distinct and separately documented.
• Submit the claim with the 90887 code and any necessary supporting documentation.

Reimbursement Rates Overview

Reimbursement rates for 90887 can vary across payers and geographic regions. As of 2024:

• Medicare: Average reimbursement of $80-$100 per session
• Medicaid: Varies by state, ranging from $60-$120 per session
• Private Insurance: Typically negotiated rates, often falling between $90-$150 per session

Expert Tips for Maximizing Compliant Reimbursement

• Implement a robust electronic health record (EHR) system to accurately track and document explanations provided under 90887.
• Regularly train staff on proper use of the 90887 code and documentation requirements.
• Conduct internal audits to ensure compliance and identify areas for improvement.
• Stay informed about payer-specific guidelines and policy updates related to family education services.
• Utilize technology solutions, such as those offered by.com, to streamline billing processes and reduce errors [ Billing & Collections — ].

Compliance and Regulation

Key Laws and Policies

• Health Insurance Portability and Accountability Act ( HIPAA ): Ensures patient privacy and data security, particularly important when sharing information with family members.
• Mental Health Parity and Addiction Equity Act (MHPAEA): Requires insurance coverage for mental health services to be on par with medical/surgical benefits.
• False Claims Act: Prohibits fraudulent billing practices and imposes severe penalties for violations.
• State-specific regulations: May dictate additional requirements for family education services and billing practices.
• Local Coverage Determinations (LCDs): May provide guidance on the use of 90887 in specific regions.

Legal, Financial, and Business Risks

• Audits and investigations by payers and regulatory agencies
• Financial penalties for non-compliance or fraudulent billing
• Exclusion from participation in federal healthcare programs
• Damage to reputation and loss of patient trust
• Potential criminal charges for severe violations

10-Point Actionable Compliance Checklist

• Develop and maintain a comprehensive compliance program
• Conduct regular staff training on 90887 billing and documentation requirements
• Implement internal auditing processes
• Stay updated on federal and state regulations related to family education services
• Use certified coding professionals for complex cases
• Maintain accurate and complete treatment records for each patient
• Implement technology solutions to enhance compliance efforts
• Establish a clear chain of command for compliance-related issues
• Develop a protocol for self-reporting and correcting identified errors
• Regularly review and update policies and procedures

Future Trends and Updates

The landscape of family education services and 90887 billing is continually evolving. Several trends and potential changes are worth noting:

At.com, we continuously monitor these trends and update our solutions to ensure our clients remain at the forefront of compliant and efficient billing practices for family education services.

• Increased Focus on Telehealth: As remote healthcare delivery becomes more prevalent, there may be changes in how 90887 is used or adapted for virtual family education sessions.
• Integration with Digital Health Tools: The growing use of patient portals and mobile health apps may impact how information is shared with families and how these interactions are billed.
• Value-Based Payment Models: Some payers are exploring alternative payment models for mental health services, which could affect how 90887 is used and reimbursed.
• Enhanced Quality Measures: There may be increased emphasis on demonstrating outcomes and quality of care related to family education services.
• Expanded Scope of Services: Future updates may broaden the scope of 90887 to include additional types of family education or support services.

Conclusion

Mastering the intricacies of 90887 billing is crucial for healthcare providers offering family education services in mental health settings. By understanding the code’s components, adhering to best practices, and staying informed about regulatory changes, providers can ensure accurate reimbursement while delivering high-quality care to patients and their families.

As the healthcare landscape continues to evolve, the importance of efficient and compliant billing practices cannot be overstated..com is committed to supporting healthcare providers in navigating these challenges, offering cutting-edge solutions and expert guidance to optimize billing processes and ensure regulatory compliance.

We encourage you to explore.com’s comprehensive suite of billing and compliance solutions tailored for providers offering family education services. Our team of experts is ready to help you streamline your 90887 billing processes, maximize reimbursement, and focus on what matters most – providing exceptional care to your patients and their families.

Visit today to discover how we can support your organization’s family education service billing and compliance needs.

Last Updated: March 7, 2024

Related Billing Codes

• 90870
• 90875
• 90876
• 90899
• 96116
• 96121

Common questions

Official sources

• In 2023, a study by the American Psychological Association found that 75% of mental health professionals reported an increase in patients seeking care for anxiety and depression.apa.org
• Billing and Coding: ProMark® Risk Score (A57515)cms.gov
• A 2023 analysis by the American Journal of Managed Care indicated that comprehensive family education and involvement, including services billed under 90887, could result in a 15-20% reduction in hospital readmission rates for patients with severe mental illness.ncbi.nlm.nih.gov