SALT LAKE CITY, UT — Therapists in the Salt Lake City area are voicing new concerns after Select Health changed how it handles billing for extended psychotherapy sessions. The issue affects patients who need visits lasting 90 to 120 minutes, especially in complex trauma and PTSD treatment where clinicians say more time can be necessary for safe, stable closure.
Licensed clinical social worker Jessica Little said the change creates extra work for her practice and can make it harder to keep care moving for clients who need longer appointments. She said the adjustment has forced some providers to rethink scheduling, billing and how they structure treatment for people who cannot be adequately served in a standard hour.
Why some therapists say longer sessions matter in trauma care
Little said she works with complex trauma and attachment-related disorders, including patients with PTSD. Her practice often uses EMDR, or eye movement desensitization and reprocessing, a therapy approach that can require more than a single hour when the goal is to finish safely and help the patient leave grounded.
She said shorter appointments may not always be enough to complete treatment in a way that avoids leaving a client overwhelmed. In her view, extended sessions are sometimes part of standard, medically necessary outpatient care, not an optional add-on. That is why she and other therapists have been alarmed by a billing policy that appears to narrow how those visits can be reimbursed.
The Green Lotus Center for Personal Growth & Wellbeing, where Little practices, has had to adjust because of the change. She said that in some cases, providers must now move clients into two separate one-hour sessions instead of a single extended visit.
How an AMA coding change created a billing workaround
The tension traces back to a coding change in 2023, when the American Medical Association removed certain modifier codes that had helped providers bill for extended psychotherapy sessions. According to Little, a workaround emerged that allowed therapists to bill two units of codes so patients could still receive medically necessary services.
She said the problem was that insurance companies did not all recognize the workaround right away. As a result, many plans treated psychotherapy visits as though only one hour of service could be billed for these patients, even when a longer visit was clinically needed.
Little said some insurers eventually accepted the workaround, but she described Select Health as pulling back on it in 2026. She said the company notified providers 15 days after a policy began that extended psychotherapy sessions could no longer be billed in that way.
Select Health says its policy supports consistent documentation
FOX 13 asked Select Health about the billing change tied to policy CR-110 and Little’s concerns about how the rule is being applied. In response, the company said it is committed to access to high-quality behavioral health care for members.
Select Health said the policy concerns established documentation requirements for time-based procedure codes. The company said the rule is meant to support accurate and consistent billing practices and does not limit a provider’s ability to decide the best care or treatment plan for a patient.
The insurer also said it values provider relationships and continues to work with clinicians to answer questions and support member care. That response leaves open a dispute over how the billing guidance should be interpreted in practice, especially for therapists who say longer sessions are clinically necessary.
What the billing change means for therapists in solo practice
For Little, the policy is not just a paperwork issue. She said she runs her own business as a sole proprietor and does not outsource billing, which means the change adds work she is not paid to do. That extra burden matters in a field where therapists already say they are stretched thin.
She said the new approach has also affected scheduling. In some cases, she said, clients have been moved into separate appointments because the longer session is no longer reimbursed in the same way. That can create new co-pays for patients and complicate treatment plans that were built around a single extended visit.
Patients who need 90-minute therapy visits may face new hurdles
Little said the biggest concern is for patients who need more time than a standard session allows. Those clients, she said, may no longer have a clear outpatient reimbursement path for 90- to 120-minute psychotherapy appointments under the current Select Health policy.
She also said she has tried to verify the insurer’s explanation by checking with multiple groups, including the AMA, CMH, Utah state contacts and Medicaid-related offices. In her view, the support she has found does not match Select Health’s interpretation that billing must be limited to one unit.
For now, therapists are left balancing clinical needs, billing rules and patient affordability. Select Health says it is still working with providers, but the disagreement shows how a coding decision can ripple quickly into appointment length, office workflows and access to care for people seeking mental health treatment.