A Psychiatry Practice Was Billing 90833 Add-Ons Incorrectly for 14 Months. The Revenue Loss Was $112,000.
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THE SITUATION
5-psychiatrist group offering combined medication management and brief psychotherapy visits. They billed E/M codes (99213/99214) with the psychotherapy add-on 90833 for visits where both services were provided, a common and appropriate billing combination in psychiatry.
14 months of doing this. Fourteen months of BCBS Florida and Aetna denying or downgrading the 90833 add-on on approximately 30% of claims quietly, with remark codes the billing team wasn’t decoding correctly.
A new billing coordinator started in early 2024 and noticed the pattern in her 2nd week. She escalated. The practice owner called us.
WHAT WAS ACTUALLY WRONG
We pulled the denied and downgraded claims and decoded the remark codes. Two issues were driving 94% of the losses.
AdvancedMD’s default 90833 billing template didn’t include start/stop times. BCBS Florida and Aetna both require documented start and stop times for 90833 to be billable; it must reflect at least 16 minutes of psychotherapy time. The clinical notes had this information, but AdvancedMD wasn’t pulling it into the claim. Claims were submitting without the time field populated. Payers were downgrading to the E/M code only.
90833 was being billed on visits under 21 total minutes. The AMA guidelines for 90833 require a minimum 16-minute psychotherapy service within the visit, plus the E/M service time. For short medication checks (15–20 minute total visits), 90833 is not billable. The providers didn’t know the threshold AdvancedMD wasn’t flagging it, and short visits were routinely billing the add-on incorrectly.
The second issue created compliance exposure, not just revenue loss. We flagged it immediately.
WHAT WE DID
Week 1: Corrected the AdvancedMD 90833 template to pull start/stop time from the clinical note. Configured a hard stop: if time fields are blank, the claim cannot be submitted.
Week 2: Built a visit duration filter in AdvancedMD; any visit under 21 minutes flags for review before 90833 is included. Providers received a 45-minute billing compliance session covering the 90833 threshold rules.
Weeks 3–6: Pulled 14 months of incorrectly denied/downgraded 90833 claims where start/stop times were documented in the note but missing from the claim. Resubmitted with corrected claim data. Did not resubmit the under-21-minute claims; those were compliant write-offs.
Compliance documentation: Produced a retroactive documentation review for 90 days of claims. No overpayment liability identified; the under-threshold visits had not been paid on 90833; they had been denied. No repayment exposure.
THE RESULTS
| Metric | Before | After |
|---|---|---|
| 90833 Denial/Downgrade Rate | 30% | 3% |
| Revenue Recovered (resubmissions) | — | $89,000 |
| Compliance Exposure | Present | Resolved |
| Monthly Add-On Revenue | $11,200 (lost) | $14,800 (correct) |
| AdvancedMD Configuration Errors | 2 active | 0 |
$89,000 recovered from corrected resubmissions on the start/stop time issue. The under-threshold claims ($23,000) were correctly written off; billing them would have created compliance risk. Net legitimate recovery: $89,000.
WHAT THIS MEANS FOR YOUR PRACTICE
90833 billing is highly audited and easy to misconfigure. If your EHR template isn’t aligned with current BCBS and Aetna rules, you may be losing revenue, creating compliance risk, or both.