2019 CPT Codes Updated: Please review the 2019 updates to psychological and neuropsychological testing CPT codes.
If you have a question about billing beyond our guide to mental health CPT codes, you can reach out about our mental health insurance billing service.
CPT (Current Procedural Terminology) is a standardized medical codeset maintained by the AMA. CPT codes are five digit numeric codes describing everything from surgery to radiology to psychotherapy.
For therapists that are on managed care panels or provide superbills to their clients, knowing your CPT codes is paramount to getting paid in full and avoiding insurance audits.
The amount insurance companies will reimburse depends on a number of different factors (professional credentials, geographic location, etc.), but using the correct CPT Code and add-on code(s) to express the exact service is an important part to the whole process and in ultimately determining your payment!
Errors, accidental or otherwise, will directly impact insurance company’s payment of services. If you need help with making sure your billing and coding is error-free, our mental health billing service can help. Think about reaching out if the rest of this article hurts your feelings.
Downcoding (including less services on the claim than actually provided) will usually mean you get paid less, while upcoding (including more services on the claim than actually provided) can get you in trouble with your managed care panels.
It’s also important to note that it might be tempting to maximize your CPT codes to earn higher reimbursements.
This is highly recommended against and can get you flagged, audited and removed from insurance panels. Even if this is your biller’s error, the therapist is the one who ultimately bears the responsibility and will be the one penalized.
Here’s a video guide we did of this article!
Mental Health CPT Coding for Therapy
CPT coding for psychotherapy doesn’t have to be difficult! There are an overwhelming amount of total CPT Codes (~8,000), however only 24 are specifically designated for psychotherapy and other mental health services.
To make matters even simpler, nearly all therapists will regularly use an even smaller subset of these 24. CPT is a large and dynamic code set that changes year to year, but the psychotherapy codes seldomly change.
The most recent change for psychotherapy codes took place in 2019, then 2013, and previously 1998. To ensure your coding is current and up to date, consider using a billing service instead of having to remember all the codes.
Mental Health CPT Add-on Codes
A CPT Add-on Code is a code describing a service performed in in conjunction with a primary service. Many of these add-on codes are associated with a specific CPT Code or a small set of CPT Codes and cannot be used otherwise.
For instance, the CPT Code for interactive complexity (+90785) can be used for a diagnostic (90791, 90792) or a normal psychotherapy session (90832, 90834, 90837) but not a crisis psychotherapy session (90839).
Add-on Codes are identified by a + sign in front of the number, i.e. +90840 is an add-on code for extra time in the case of crisis psychotherapy. On CMS 1500 forms CPT Add-on codes are simply added on a new line.
Add-on codes are extremely important to use in order to most accurately describe the services being rendered and to ensure your services are maximized per session. We help the mental health providers that work with us in our billing service do all of this for every appointment.
Mental Health CPT Cheatsheet
The most common CPT Codes used by therapists:
Outpatient Mental Health Therapist Diagnostics, Evaluation, Intake CPT Code:
- 90791 – Psychiatric Diagnostic Evaluation (usually just one/client is covered)
Outpatient Mental Health CPT Codes:
- 90832 – Psychotherapy, 30 minutes (16-37 minutes).
- 90834 – Psychotherapy, 45 minutes (38-52 minutes).
- 90837 – Psychotherapy, 60 minutes (53 minutes and over).
- 90846 – Family or couples psychotherapy, without patient present.
- 90847 – Family or couples psychotherapy, with patient present.
- 90853 – Group Psychotherapy (not family).
- 98968 – Telephone therapy (non-psychiatrist) – limit 3 units/hours per application.
Outpatient Mental Health Crisis CPT Codes:
- 90839 – Psychotherapy for crisis, 60 minutes (30-74 minutes).
- +90840 – Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 90839.
Other Behavioral Health CPT Codes:
- +90785 – Interactive Complexity add-on code. Covered below.
- 90404 – Cigna / MHN EAP CPT Code. These two companies use a unique CPT code for EAP sessions.
- 96101 – Psychological testing, interpretation and reporting by a psychologist (per Hour)
- 90880 – Hypnotherapy – limit 10 units/hours per application
- 90876 – Biofeedback
- 90849 – Multiple family group psychotherapy
Outpatient Psychiatry Diagnostics / Evaluation / Client Inake CPT Code:
- 90792 – Psychiatric Diagnostic Evaluation with medical services (usually just one/client is covered)
Outpatient Psychiatry CPT Codes:
- 99201 – E/M – New Patient Office Visit – 10 Minutes
- 99202 – E/M – New Patient Office Visit – 20 Minutes
- 99203 – E/M – New Patient Office Visit – 30 Minutes
- 99204 – E/M – New Patient Office Visit – 45 Minutes
- 99205 – E/M – New Patient Office Visit – 60 Minutes
- 99211 – E/M – Established Patients – 5 Minutes
- 99212 – E/M – Established Patients – 10 Minutes
- 99213 – E/M – Established Patients – 15 Minutes
- 99214 – E/M – Established Patients – 25 Minutes
- 99215 – E/M – Established Patients – 40 Minutes
- 99443 – Telephone therapy (psychiatrist), – limit 3 units/hours per application
2019 Mental Health Psychological and Neuropsychological Testing CPT Codes
These codes are only effective January 1st, 2019.
Assessment of Aphasia and Cognitive Performance Testing
- 96105 – Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech
production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour
- 96125 – Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s
time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
Developmental/Behavioral Screening and Testing
- 96110 – Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation,
per standardized instrument
- 96112 – Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory, and/
or executive functions by standardized developmental instruments when performed), by physician or other qualified health care
professional, with interpretation and report; first hour
- + 96113 – Each additional 30 minutes (List separately in addition to code for primary procedure)
- 96127 – Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring
and documentation, per standardized instrument
These codes have changed in 2019.
Neurobehavioral Status Exam
- 96116 – Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language,
memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both faceto-face
time with the patient and time interpreting test results and preparing the report; first hour
- +96121 – Each additional hour (List separately in addition to code for primary procedure)
Test Evaluation Services
- 96130 – Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data,
interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive
feedback to the patient, family member(s) or caregiver(s), when performed; first hour
- +96131 – Each additional hour (List separately in addition to code for primary procedure)
- 96132 – Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient
data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive
feedback to the patient, family member(s) or caregiver(s), when performed; first hour
- +96133 – Each additional hour (List separately in addition to code for primary procedure)
Test Administration and Scoring
- 96136 – Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more
tests, any method, first 30 minutes
- +96137 – Each additional 30 minutes (List separately in addition to code for primary procedure)
- 96138 – Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
- +96139 – Each additional 30 minutes (List separately in addition to code for primary procedure)
Automated Testing and Result
- 96146 – Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only
Mental Health Evaluation & Management (E/M) Codes
There are also E/M (evaluation & management) in conjunction with psychotherapy, used by authorized prescribers, psychiatrists, and MDs.
Coding E/M is trickier, harder to document and more vulnerable to audit but usually results in greater reimbursement.
There’s also a series of E/M codes that are used without the psychotherapy component.
For more in-depth coverage on E/M coding for psychotherapy there are some good free webinars released by AACAP on E/M CPT Codes.
- +90833 – E/M code for 30 minutes of psychiatry (used with 90832).
- +90836 – E/M code for 45 minutes of psychiatry (used with 90834).
- +90838 – E/M code for 60 minutes of psychotherapy (used with 90837).
- Psychotherapy must be at least 16 minutes.
- Time is very important and should be rounded to the nearest CPT Code.
- Outpatient vs. Inpatient is not important.
- E/M codes can only be used by prescribers (MD, DO, APN, PA).
Criteria for Interactive Complexity (+90785)
+90785 is one of the new add-on codes in the most recent CPT update in 2013.
This code is used as an umbrella add-on code and can be used for four different criteria. The most common scenarios usually involve children, although this is not necessarily always the case.
Common Examples of Interactive Complexity:
- The use of play equipment with young children.
- Involvement of parents with discordant views that complicate the treatment plan.
- Report of abuse/neglect.
Interactive complexity can be used in conjunction with the primary CPT Codes for diagnostics, psychotherapy, or group therapy and cannot be used for couple/family therapy or crisis codes.
+90785, can be used with: 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90853.
Unsure when to use the interactive complexity code? Need help asking if it will be approved? Our billing service exclusively for mental health providers is here to help.
Am I Being Underpaid? Was I Paid the Right Amount?
Here’s typical rates depending on the therapist’s credentials:
Typical Reimbursements by Type of Therapist
|Type of Therapist||Reimbursement/Session|
|Marriage Family Therapists||~$60-65|
These rates can vary significantly therapist to therapist but are good benchmarks for comparison.
How about CPT Codes? How do they affect the rate of reimbursement? This is a difficult and complex calculation, depending on the level of education, location, and license. The AMA has created a code search feature on their website that shows payment based off CPT Code and location.
This information is somewhat incomplete and is based off medicare payments and does not specify a number of other important factors. However, this tool is still very useful to compare the relative value CPT Codes against one another.
Private insurance will be correlated with some deviation from these numbers.
Reimbursement by CPT Code (Three Different Geographies)
Reimbursement (Rest of CA)Reimbursement (Los Angeles)Reimbursement (WA)
Data from AMA Codemanager. These numbers are useful for relative comparison of individual CPT Codes and geography.
Distilled Guide to Mental Health CPT Codes
If you are just starting out or just beginning to deal with managed care, keep it simple.
CPT Codes appear far more complex from the outside looking in. Make a quick cheatsheet.
Don’t worry about memorizing all the CPT Codes (there’s alot!) or even all of the mental health ones. You will likely just use just a few individual codes.
Memorize the relevant codes and use google or other references to find the correct CPT codes for more unique scenarios.
Call to verify eligibility and benefits and make sure those codes will be approved with that client’s coverage.
And if all of that sounds like too much trouble, offload the work to us. You won’t have to know one CPT code from another to get your billing paid in full.
Consider Outsourcing Your Billing
Don’t want to learn any of this stuff? We are your team of billing experts here to translate all of this gibberish into English! Reach out about our billing service if you are a licensed mental health provider (we only work with licensed mental health providers).