The Shadow Side of Therapy: Audits, Insurance Coverage, Documentation, and Medical Necessity

Course Materials

Part 1 Notes: Examples and Q&A
Part 2: A Quick Intro to Treatment Plans
Part 3: Audits and Records Requests
Part 4: Brief Telehealth Billing Update


American Medical Association, CPT® 2019 Standard Edition.  Chicago, IL; American Medical Association, 2018.

OPTUM 360 (2018).  Current Procedural Coding Expert.

APA Office of Health Care Financing.  (2016, November 16).  Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual.  Retrieved March 20, 2018, from

OPTUM by United Behavioral Health. (2014, February), Coverage Determination Guidelines, Extended Outpatient Sessions, Retrieved March 20, 2018, from

Dustman, R. (2016, February 16).  Prolonged Services Update and Other 2016 E/M Changes.  Retrieved March 20, 2018, from

Specific criteria must be met to use prolonged services code.  American Academy of Pediatrics News (January 10, 2018); Retrieved Feb 10, 2019 from

American Academy of Child and Adolescent Psychiatry. (2018)  CPT Training Manual. Retrieved Feb 11, 2019 at

Direct Prolonged Serices: Inpatient and Outpatient Coding.  American Academy of Pediatrics (2016). Retrieved Feb 11, 2019 at

The 2013 Psychotherapy Codes: An Overview for Psychologists. (n.d.). Retrieved March 20, 2018, from


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