Skip to main content

​
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.

​
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.
CPT code support means the code may be compatible with Thrizer’s claim submission process. It does not mean the code is covered, clinically appropriate, reimbursable, or accepted by every insurance plan.

​
Common CPT codes for mental health clinicians

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

​
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 may support a primary CPT code plus add-on or extension units when the additional code represents extra time or additional units for the same underlying service. Examples include: If you are unsure whether a code is an add-on code or a separate service, contact Thrizer support before charging the session through an insurance payment type.

​
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 add-on or extension units when those additional units are part of the same underlying service. 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.

​
Codes that may require review

Some services may require additional review before Thrizer can confirm compatibility. Examples may include:
  • EMDR intensives
  • testing batteries with multiple units
  • 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

​
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.

​
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.

​
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. For sessions that involve a primary CPT plus an add-on or extension representing additional time of the same underlying service, the units can typically be included on the same charge. Examples include 90839 with 90840, or 96132 with 96133. Unrelated services should be billed as separate charges. If you are unsure whether two codes represent the same service or separate services, contact support before charging.

​
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.

Can I use a specific diagnosis code with Thrizer?

Learn how diagnosis-code support works in Thrizer and what diagnosis-code support does not guarantee.

Which insurance companies does Thrizer work with?

Learn how insurer support works and why plan-level benefits still need to be checked.

Checking client benefits

Learn how to check estimated out-of-network benefits before charging a client.