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99354 CPT Code: How to Bill for Extended Therapy Sessions (Without Losing Reimbursement in 2025)

Stanley Efrem

Mar 26, 2025

The American Medical Association's removal of CPT code 99354 in 2023 has altered the map of billing and reimbursement for extended therapy sessions. Mental health professionals previously received additional compensation between $132.09 and $140.26 for these longer sessions.

Extended therapy sessions are vital for treating severe mental health conditions and trauma. Standard session times often fall short for these cases. The absence of codes 99354 and 99355 creates major challenges for providers to secure proper reimbursement for this needed work.

This piece offers a detailed look at the current billing landscape for extended therapy sessions. You'll discover alternative billing methods and documentation requirements that help secure proper reimbursement. The guide covers strategies like using multiple 90834 units while following insurance requirements and delivering quality patient care.

Understanding CPT Code 99354 in 2025

Mental health professionals relied on CPT code 99354 as their financial backbone to bill for extended therapy sessions. This code helped therapists receive extra payment when their patients just needed longer treatment times.

What is CPT code 99354 and its current status

CPT code 99354 served as an add-on code for extended, face-to-face outpatient services beyond regular session times. Therapists used it to bill the first hour of additional time after the base session. Before January 2023, they paired it with 90837 (60-minute individual therapy) for sessions over 90 minutes, or with 90847 (family therapy) for sessions longer than 80 minutes [1].

The American Medical Association removed CPT codes 99354 and 99355 on January 1, 2023 [2][3]. The replacement code 99417 doesn't work with psychotherapy codes 90837 or 90847 for extended sessions [1]. This means insurance companies no longer reimburse longer therapy sessions using these prolonged services codes [2].

How 99354 is different from standard therapy billing codes

99354 worked only as an add-on code unlike standard therapy codes that represent complete services. Therapists could bill this code under specific conditions:

Direct, face-to-face outpatient services
Same day of service as the main service
Performed by the same provider
Sessions lasting at least 30 minutes beyond the usual time [4]

The code also needed detailed documentation to prove medical necessity, including exact start and end times [4]. This is a big deal as it means that providers needed more documentation than standard therapy codes.

Key changes to extended session billing since 2023

The code's removal created major billing challenges for mental health professionals. Insurance companies now handle extended sessions differently:

Some accept two units of 90834 (45-minute individual therapy) for 90-minute or longer sessions [1]
Others suggest billing two units of 90837 for sessions over 91 minutes [1]
A few accept HCPCS code G2212, though this code works best for medical providers using Evaluation and Management codes [1]

Documentation has become even more significant. The core team must really explain in progress notes why patients need extended service, especially for trauma-related treatments [1][3]. Getting pre-authorization from insurance providers helps reduce risks and ensures smoother payment processes [4].

Documentation Requirements for Extended Sessions

Documentation has become more important since CPT code 99354 was eliminated. Insurance companies now examine clinical notes with greater detail to decide if extended therapy sessions qualify for reimbursement.

Everything in your clinical notes

Your financial defense relies on detailed documentation when billing longer sessions. Clinical notes must include exact session start and end times. Auditors often flag patterns where sessions start at :00 or :30 [5]. On top of that, you need to document specific therapeutic interventions and the patient's response to these techniques [6].

Your notes should show how the session connects to the patient's treatment goals. A full picture must include current symptoms and functional impairments that prove ongoing medical necessity [5].

Medical necessity justification templates

Medical necessity is the life-blood of extended session reimbursement. Your documentation should cover:

The reason your patient needed professional extended treatment [8]
The specialized techniques you used during extra time [8]
The benefits patients got from your expertise [8]
The complexity that needed your ongoing clinical input [8]

For trauma treatments, notes should really explain the clinical reasons behind extended therapy sessions [4]. Your justification needs to describe the patient's condition before, during, and after therapy. This shows the most important benefits that are "sustainable and of practical value" [8].

Common documentation errors to avoid

Some documentation mistakes lead straight to claim denials. We noticed that therapists don't document minimum time requirements for extended billing [6]. Notes that ramble on with unnecessary details can hurt your case.

Setting irrelevant goals unrelated to diagnosis is a common mistake. Insurance companies don't like it when progress updates are missing from established goals [5].

Claims face extra review when notes lack proof of the therapist's professional value [8]. Your treatment plans need regular updates every three months to meet compliance rules [5].

Step-by-Step Billing Process for Extended Therapy

Billing extended therapy sessions needs a well-laid-out approach that starts before patients walk in. The post-99354 changes mean your billing procedures need to adapt.

Pre-session insurance verification workflow

Your reimbursement success depends on thorough insurance checks. Here's the verification process you need before scheduling extended sessions:

Get a copy of the patient's insurance card (front and back)
Call the mental health benefits number on the back
Ask if extended sessions have coverage without CPT code 99354
Get confirmation about their accepted coding methods
Write down the representative's name and reference ID number

This verification step matters because insurers handle extended session reimbursement differently. To cite an instance, see Blue Cross Blue Shield of Texas's payment for two units of 90837, while AmBetter denies these as duplicate services [10].

Coding sequences for different session lengths

Now that 99354 is gone, you need to use different coding sequences based on how long sessions last:

90-minute individual therapy options:

Some payers take two units of 90834 (45-minute therapy) [1]
Others accept two units of 90837 (60-minute therapy) [1]

Extended family/couples therapy options:

Some insurers might accept two units of 90847 [4]
CIGNA allowed this approach but United Healthcare rejected it [1]

Crisis sessions over 60 minutes:

90839 covers the first 60 minutes
90840 adds each extra 30 minutes [11]

Submitting claims with proper modifiers

Modifiers are vital to getting proper reimbursement. Your extended session claims need these steps:

Check if the service provider needs modifiers. Physical therapist assistants or occupational therapy assistants need CQ or CO modifiers if they handle more than 10% of the service [12].

Multiple unit billing might need the 59 modifier to show distinct services. This happens most often with different therapy types on the same day, like individual plus family therapy [3].

Telehealth extended sessions might need special modifiers from some payers. Make sure to check these requirements during verification [13].

Technology Solutions for Extended Session Management

The right technology makes all the difference in managing extended therapy sessions in the post-99354 era. Modern software helps you document better, get paid correctly, and spend less time on paperwork.

EHR settings for tracking extended sessions

Your Electronic Health Record (EHR) system lets you add appropriate codes to the base code for extended sessions. The right EHR setup tracks these longer appointments and supports proper billing. Most behavioral health-specific EHRs give you these options:

Set up templates for extended session documentation
Configure time-tracking features that record exact start and end times
Create alerts for insurance verification requirements specific to longer sessions

Your EHR should capture the unique aspects of mental health patient care, especially when you have extended sessions. Finding a behavioral health-specific EHR isn't hard, but you need to research carefully to ensure it supports your extended session workflow.

Automated documentation tools

AI-powered documentation tools help mental health providers cut down on paperwork while staying compliant. These HIPAA-compliant platforms record therapy sessions and create notes in your preferred format. They handle the heavy lifting of documentation so you can focus on patient care.

Platforms like Yung Sidekick are a great way to get automated note generation for extended sessions. Note that you stay 100% responsible for the content of finalized notes, so always check AI-generated documentation for accuracy.

Billing software configurations

The right billing software makes claim creation, submission, and invoicing easier for extended sessions. Your billing platform should be able to:

Process multiple units of the same code for extended session billing Catch potential errors that might cause denials for extended sessions Work with clearinghouses that accept alternate extended session coding

Pick billing software that has template-based claim forms and standardized documentation workflows. Automating routine tasks helps you reduce paperwork and track overdue payments while meeting the changing requirements for extended session reimbursement.

Conclusion

Extended therapy session billing has changed substantially since providers stopped using CPT code 99354. This change brings new challenges, but alternative billing methods and proper documentation offer practical solutions.

Your success with extended session billing relies on three crucial factors. Insurance verification before booking longer sessions helps avoid claim denials. Your clinical notes must show medical necessity without falling into common documentation traps. The right technology makes documentation and billing smoother.

Mental health professionals who update their billing methods will keep their reimbursement rates steady. Different insurance providers accept various coding approaches, so you need to stay updated with payer policies. The billing world might look complicated, but these strategies will help you get fair compensation for extended therapy services.

Extended session billing will keep changing. Building strong documentation habits and staying connected with insurance providers will boost your practice's long-term success.

FAQs

How has billing for extended therapy sessions changed since 2023?

The removal of CPT code 99354 in 2023 has significantly altered billing practices for extended therapy sessions. Mental health professionals now need to use alternative billing methods, such as multiple units of existing codes or seeking pre-authorization from insurance providers, to ensure proper reimbursement for longer sessions.

What documentation is essential for billing extended therapy sessions?

Thorough documentation is crucial for extended session billing. Key elements include exact session start and end times, specific therapeutic interventions used, the patient's response to treatment, and a clear connection between the session content and treatment goals. Additionally, current symptoms and functional impairments should be documented to demonstrate ongoing medical necessity.

How can therapists verify insurance coverage for extended sessions?

Before scheduling extended sessions, therapists should implement a verification process that includes obtaining the patient's insurance information, contacting the insurer's mental health benefits department, explicitly asking about coverage for extended sessions, and documenting the representative's name and reference ID number for future reference.

What are some common billing errors to avoid for extended therapy sessions?

Common errors include failing to document that the session meets minimum time requirements, setting too many unrelated goals, neglecting to discuss progress toward established goals, and failing to update treatment plans regularly. Additionally, notes that are too lengthy or lack clear documentation of the clinician's unique professional contribution may face scrutiny from insurers.

How can technology help manage extended therapy sessions?

Technology solutions can streamline extended session management. Electronic Health Record (EHR) systems can be configured to track longer appointments and support proper billing. AI-powered documentation tools can help generate session notes, while specialized billing software can process multiple units of the same code and flag potential errors that could trigger claim denials.