Can I use a specific CPT code with Thrizer?

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Overview

Thrizer can support claim submission when a session can be structured with a supported CPT code structure, a diagnosis code, provider information, service details, and a billed amount. Using a CPT code in Thrizer does not guarantee coverage, claim approval, deductible application, or reimbursement. The insurance carrier makes those decisions after the claim is processed. Most standard psychotherapy CPT codes work with Thrizer. Some testing, crisis, health behavior, medication management, rehabilitation, speech, nutrition, acupuncture, and other service codes may also be compatible. They may require review depending on the service, provider type, and code combination.

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How CPT codes work in Thrizer

A CPT code tells the insurance carrier what type of service was provided. For a charge to be submitted as a claim through Thrizer, the charge generally needs:

• a CPT code structure
• one or more diagnosis codes
• provider information, including a valid NPI
• service date and appointment details
• billed amount
• client insurance information

For OON Pay and Thrizer Pay, claim submission is tied to a successful charge. If the charge does not process successfully, the claim is not submitted.

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Common CPT codes for mental health clinicians

These are some of the most common codes clinicians ask about when using Thrizer.

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Add-on and extension codes

Some CPT codes are designed to be used with a primary CPT code. These are often called add-on or extension codes. Thrizer supports a different time-based add-on code only when approved Thrizer knowledge explicitly names the exact primary/add-on combination. Thrizer does not currently support multiple units of the same CPT code, such as 97110 × 3. The currently documented supported combination is: Include each code once. If another time-based combination is not explicitly documented as supported by Thrizer, contact Thrizer support before charging the session through an insurance payment type. An externally recognized add-on relationship, appearance in Thrizer’s active code list, or a past successful claim does not establish support for the combination.

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If a session involves more than one CPT code

Thrizer supports one primary CPT code per claim. A claim may include a primary CPT code plus a different time-based add-on code only when Thrizer explicitly documents the exact combination as supported. If the session includes multiple unrelated services, each service should be billed separately. For example, if two codes represent different services rather than additional time for the same service, they may need to be entered as separate charges.

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Codes that may require review

Some services may require additional review before Thrizer can confirm compatibility. Examples may include:

• EMDR intensives
• testing batteries or other services involving repeated units of one CPT code
• crisis services with add-on time
• services provided by supervised or associate clinicians
• services outside traditional psychotherapy
• occupational therapy, speech therapy, physical therapy, nutrition, or other pilot services
• medical specialist or medication-management services
• any CPT code combination where it is unclear whether the second code is an add-on or a separate service

When review is needed, include:

• the CPT code or codes
• the service description
• the session duration
• the clinician license type
• whether the code is intended as the main service or an add-on code

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What CPT support does not mean

CPT support in Thrizer means the service may be compatible with Thrizer’s claim submission process. It does not mean:

• the CPT code is clinically correct for the service
• the code is covered by the client’s plan
• the claim will be approved
• the client will receive reimbursement
• the amount will apply to deductible
• the insurer will accept a specific CPT code combination
• the service meets medical necessity requirements

Those decisions are made by the insurance carrier and may vary by plan.

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What to avoid

Avoid combining unrelated CPT codes into one charge. Avoid using a CPT code only because it appears more likely to reimburse. Avoid treating a successful benefit check as a guarantee that a CPT code will be accepted. Avoid submitting a claim before the service, diagnosis, provider, and charge details are complete.

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If you can’t find a CPT code

Many CPT codes across psychotherapy, testing, health behavior, evaluation and management, rehabilitation, speech, nutrition, and acupuncture service families may be compatible with Thrizer. If you want to confirm a specific code, contact support with the code, the service description, and the clinician license type. Compatibility with Thrizer does not guarantee insurer coverage, claim approval, or reimbursement. Some sessions include a primary CPT plus a different time-based add-on code for the same underlying service. Thrizer supports the combination only when approved Thrizer knowledge explicitly names it. The currently documented combination is 96132 with 96133, with each code included once. Repeated units of one CPT code are not currently supported. Unrelated services should be billed as separate charges. If another combination is not documented, contact support before charging.

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Non-CPT services

Some services, such as coaching or other non-medical services, may not be compatible with claim submission processes. If a service cannot be structured with a supported CPT code, diagnosis code, and standard claim information, it should be processed as Self-Pay. No insurance claim is submitted for Self-Pay.

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