Provider updates

CareOregon’s claim payment practices for psychotherapy high day billing will change effective September 1, 2025. Psychotherapy services that exceed eight (8) hours in a single day will be denied. If a single rendering provider bills for more than eight hours of services, using any combination of the specified codes below, all psychotherapy services for that day will be denied. Medical records will be required for claims payment on any day, or 24-hour period, in which a provider claims more than eight hours of psychotherapy.

As a Medicaid payer, CareOregon has regulatory obligations to ensure the accuracy of its encounter data, including claims information regarding rendering providers. By implementing these changes, we aim to ensure consistency, regulatory compliance, and fairness in claim processing, ultimately benefiting all stakeholders involved. 

Minimum time required for psychotherapy codes

The minimum time required between the provider and the client for each psychotherapy code is as follows:

• CPT Code 90832: Psychotherapy, 30 min with patient (16 minutes minimum)
• CPT Code 90833: Psychotherapy, 30 min with patient with evaluation & management services (21 minutes minimum)
• CPT Code 90834: Psychotherapy, 45 min with patient (38 minutes minimum)
• CPT Code 90836: Psychotherapy, 45 min with patient with evaluation & management services (43 minutes minimum)
• CPT Code 90837: Psychotherapy, 60 min with patient (53 minutes minimum)
• CPT Code 90838: Psychotherapy, 60 min with patient with evaluation & management services (58 minutes minimum)

Denial of charges

All services billed for the entire day will be denied if the total psychotherapy time exceeds the eight-hour limit.

Claim reconsiderations

Denied claims will be eligible for reconsideration with submission of clinical records for ALL services performed on the date of service being reconsidered. Provider appeals/reconsiderations can be submitted via the Provider Connect Portal through the Submit Claim Attachments feature.

If a claim denial was received when more than 8-hours of services were provided, a provider must submit one of the following for payment to CareOregon’s Payment Integrity (fax number 503-416-1381):

• A client appointment log for the day, including reception check-in and check-out times for each client.
• Medical records for client visits conducted on that day.
• For EDI claims for which additional paperwork or documentation will be submitted, complete the “CareOregon Paperwork (PWK) Fax Cover Sheet” form and indicate submission in the PWK segment (Loop 2300).
• Form is available online on CareOregon’s Provider Support page (www.careoregon.org/providers/support), under the section “Submitting claims and receiving payment” -> “How to submit claims, claim reconsiderations, and claim appeals” -> click the link “complete this form”: https://www.careoregon.org/docs/default-source/providers/provider-support/ehipaa/pwk_cover_sheet.pdf

Additional information

Psychotherapy high day billing guidance document is available on the Provider Support webpage:

1. Scroll down to the section “Submitting Claims and Receiving Payments”,
2. Click the drop-down “Provider Coding Quick Guides”,
3. Click link “High day billing of psychotherapy”.