Can I use a specific CPT code with Thrizer?

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Overview

Check whether Thrizer supports the CPT code and combination for your Service before charging. The clinician, claim details, and code combination must also meet the requirements below. A supported code doesn’t establish clinical correctness, coverage, or reimbursement. Most standard psychotherapy codes work with Thrizer. Other service families or combinations may need compatibility review. If a code is missing or the supported combination is unclear, contact Support before charging through OON Billing.

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How CPT codes work in Thrizer

A CPT code identifies the type of service on the claim. In Clinician Portal → Clients → Add Charge, review the selected rendering clinician, Service and CPT details before submitting. See Charging clients for Service selection and How Thrizer submits insurance claims for the complete required information and successful-payment trigger.

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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, including multiple units of that add-on code, only when the exact primary/add-on combination and unit count are listed in Thrizer’s current supported configuration. Thrizer does not support repeating a primary CPT code as multiple units, such as 97110 × 3. An unlisted add-on combination or unit count is not supported. If you are unsure whether a code is an add-on code, believe the current configuration differs, or do not know whether two codes represent separate services, contact Thrizer support before charging the session through an insurance Billing Type.

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If a session involves more than one CPT code

Each claim supports one primary CPT code. For additional time on the same service, apply the exact supported combination and unit-count rules under Add-on and extension codes. Unrelated services must be billed as separate charges; do not combine them into one charge or claim.

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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

Thrizer code support does not answer clinical or documentation questions. The insurance carrier determines claim acceptance, coverage, deductible application and reimbursement, which may vary by plan.

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What to avoid

Choose the code that matches the care provided, not the one that seems more likely to reimburse. Keep unrelated services on separate charges and complete the Service, diagnosis, provider, and charge details before submission. A successful benefit check doesn’t guarantee that the insurer will accept a code.

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If you can’t find a CPT code

Contact Support through your Thrizer account with the code, Service description and clinician license type. Use the review preparation list when the Service or combination needs clarification. A code missing from a list is a reason to request review; it is not, by itself, proof that the individual code is unsupported. An unlisted add-on combination or unit count remains subject to the stricter add-on rules.

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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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