The Definitive Guide to Mental Health CPT Codes (+Industry Rates) [UPDATED 2017]

UPDATE:  Because of the large number of questions from our audience and providers, we would like to answer a common question from the outset.

After ICD10, how have CPT codes changed?

They have not!  Please read on!

Second update: If you have a question about billing you’d like our expertise on, you can ask your mental health billing questions and search our archive.

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. 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.

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. 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 2013, previously 1998. In other words, you only really need to learn them once!

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.

CPT Cheatsheet

The most common CPT Codes used by therapists:

Diagnostics:

  • 90791 – Psychiatric Diagnostic Evaluation (usually just one/client is covered)
  • 90792 – Psychiatric Diagnostic Evaluation with medical services (usually just one/client is covered)

Therapy:

  • 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).

Crisis:

  • 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:

  • +90785 – Interactive Complexity add-on code. Covered below.

There are also E/M (evaluation & management) in conjunction with psychotherapy, used by authorized prescribers. 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).

Key Points

  • 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.
  • Interpreters/translators.
  • 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.

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
Social Workers ~$55-60
Marriage Family Therapists ~$60-65
Counselors ~$60-65
Psychologists ~$70-80

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)
90791 $137.10 $141.17 $132.98
90792 $147.84 $152.16 $143.39
90832 $66.14 $68.03 $64.25
+90833 $67.69 $69.69 $65.70
90834 $87.66 $90.15 $85.18
+90836 $85.71 $88.21 $83.18
90837 $131.28 $134.95 $127.54
+90838 $113.07 $116.42 $109.75
90846 $106.46 $109.51 $103.38
90847 $109.75 $112.82 $106.60
90853 $26.99 $27.83 $26.21
90839 $137.22 $141.04 $133.28
+90840 $65.75 $67.61 $63.89
+90785 $14.67 $15.08 $14.24

Data from AMA Codemanager. These numbers are useful for relative comparison of individual CPT Codes and geography.

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.

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40 Comments

  1. Victoria September 11, 2016 at 3:08 am #

    This was very helpful thank you for taking the time to write this up in one clear concise place and manner.

    Reply

    • Denny October 21, 2016 at 4:51 am #

      Happy to help Victoria! Glad it was so useful.

      Reply

      Denny
  2. J. Mark Manley MFT September 14, 2016 at 4:44 pm #

    Thank you!

    Reply

    • Denny October 21, 2016 at 4:52 am #

      Of course, Mark.

      Reply

      Denny
  3. Anne September 20, 2016 at 2:44 pm #

    Another thank you, much appreciated!

    Reply

    • Denny October 21, 2016 at 4:54 am #

      Absolutely, Anne, happy we could be of service.

      Reply

      Denny
  4. Tina September 22, 2016 at 10:48 am #

    This site was a fantastic one stop website in summing up all of the necessary information in a thorough yet brief description.

    Reply

    • Denny October 21, 2016 at 4:53 am #

      Tina, your comment made our team’s day. Thank you so much for the kind words. We are trying to be as practical and helpful as possible.

      Reply

      Denny
  5. Nita Gamache,, LPC/MHSP September 28, 2016 at 3:52 pm #

    Thank you so much for sharing your insight. Very helpful to me!

    Reply

    • Denny October 21, 2016 at 4:52 am #

      Glad we could be of service, Nita.

      Reply

      Denny
  6. Meredith van ness October 21, 2016 at 4:19 am #

    Great tips. Thanks.

    Reply

    • Denny October 21, 2016 at 4:52 am #

      Thanks for your comment Meredith. Happy to help.

      Reply

      Denny
  7. Austin October 26, 2016 at 7:57 am #

    Denny, what code should be used if a Psychologist is doing an evaluation via the internet? Cpt.99444 is an E/M code used for online eval, but I was wondering if there was a different code assigned to Psych?

    Reply

    • Denny February 10, 2017 at 6:17 pm #

      Hey Austin,

      You should definitely call the insurance company to approve these services. Tele-therapy and internet therapy are almost never reimbursed from our experience. Definitely call to ask, it will depend on each insurance company and require some very special filing instructions.

      Definitely a tough one! Insurance companies are not keen on remote therapy and rarely grant it unless the patient has no way to get access to a network therapist otherwise (they are disabled, in a very remote area, have no transportation).

      Reply

      Denny
  8. Karen December 16, 2016 at 7:23 am #

    Do you know of therapists who offer longer-length sessions, billing a 75-minute session as 90834 + 90832, for example, or a 90-minute session as 90837 + 90832)?

    Reply

    • Denny December 16, 2016 at 1:11 pm #

      Hi Karen, you would use 90837 and then change the number of units from 1 to 1.5!

      Reply

      Denny
  9. christine December 21, 2016 at 6:50 am #

    This is so helpful, thank you! How would you bill an initial assessment appointment that was stopped short by the patient after 20 minutes?

    Reply

    • Denny February 8, 2017 at 5:13 pm #

      We would call up the insurance co and ask specifically about this case, as specific cases like this vary insurance co to insurance co, state to state. If that were totally fruitless, we would bill 90791 with 1 units because the whole hour was allotted for the patient, even if they ended it abruptly. Likewise, if a patient misses a session, they would be charged a cash full fee, or if they arrived late, they would be billed for the whole session.

      It’s important to have a written agreement with your patients / clients about how you are handling payment and walk them through it before beginning your work together. You can check that out at https://therathink.com/mental-health-provider-intake-form/

      Reply

      Denny
  10. Suzanne January 26, 2017 at 12:55 pm #

    Thank you so much for this cheat sheet – is it very informative! Is there a minimum time requirement for billing 90791?

    Reply

    • Denny February 8, 2017 at 5:09 pm #

      We recommend your intake session to be between 45 and 60 minutes.

      Reply

      Denny
    • Denny February 8, 2017 at 5:39 pm #

      We recommend at least 45 minutes for an intake session (90791) to be billed with 1 unit. Great question.

      Reply

      Denny
  11. Rose March 27, 2017 at 5:32 am #

    Is there a case for a 90 minute session that isn’t crisis? So a 90837 and 90832 together?

    Reply

    • Denny March 28, 2017 at 11:10 am #

      I would recommend calling ahead of time and asking, since it’s not a crisis e.g. reactionary. You would bill 90837 with 2 units instead of 1 unit, in terms of billing on your CMS1500 form.

      Thanks Rose!

      Reply

      Denny
  12. Willie March 28, 2017 at 7:53 pm #

    I’m having trouble finding the correct billing rate for CPT 90837 here in Los Angeles. The Medi-cal site has the rate at $38., but on this site its much higher.

    Reply

    • Denny March 29, 2017 at 12:02 pm #

      You will need to contact provider support at Medi-Cal to obtain that information.

      Reply

      Denny
  13. Rafael March 29, 2017 at 7:03 am #

    Can +99354 Prolonged service in the office or other outpatient setting be added to 90847 Family psychotherapy? or is it only for individual psychotherapy? I am wondering how best to code couples or family sessions that last longer than 50 minutes. Thanks!

    Reply

    • Denny March 29, 2017 at 12:02 pm #

      A 90847 session is coded as 45 to 74 minutes for 1 unit.

      For 1.5 units, the session length is 75 to 104 minutes.

      And for 2 units, it’s 105+.

      Then you can think about using a different addon code.

      Reply

      Denny
  14. Diana April 27, 2017 at 3:52 am #

    This was very helpful. Receiving denials when my physician uses E/M codes 99213-99215 with a mental health diagnosis. This article helped me to be able to explain how to code the E/M code for psychiatry with medication management.

    Reply

    • Denny May 1, 2017 at 1:21 pm #

      Happy to help Diana! 🙂

      Reply

      Denny
  15. Jason May 16, 2017 at 8:19 am #

    Great information! Is the code 90785 to be billed only one time during the course of therapy or can it be billed at each qualifying occurrence?

    Reply

    • Denny May 16, 2017 at 2:19 pm #

      Hey Jason,

      The short answer is no, because it doesn’t make sense that there would be that level of intensity with every visit.

      You should, though, always bill the most accurate claim possible. So use the code when it best describes the services rendered, and some may or may not be denied, based on that insurance company’s policy. Calling to follow up on these sorts of denials for medical necessity can be beneficial, but the addon code will not generate a very large increase in per appointment revenue, so it might not be worth your time. Some things to consider.

      Take it straight from the APA:

      “Interactive complexity, the new add-on code 90785, refers to specific communications factors that add to the difficulty of service delivery and increase the intensity of effort required of the health care professional in a particular treatment session. This code is intended to
      reflect added intensity, not added time, involved with delivering a service. Practitioners should not assume that they can bill 90785 for each session they have with a “difficult” patient. ”
      http://www.apapracticecentral.org/good-practice/new-psychotherapy-codes.pdf

      Reply

      Denny
  16. Erin P. May 18, 2017 at 9:48 am #

    Thank you So Much for this article. We’re having a hard time receiving reimbursements since beginning 2017 (wonder why :P). Each insurance co. is inconsistent with pay-outs; first they Reimburse for 90837, next time they don’t, & this is for the Same Patient. You’d think if an insur. co. paid out for 90837 for ‘patient A’ for one DOS, would be reimbursed again on a claim form with a DOS of 2 weeks later. What’s the deal? Why would Any insur. co. pay out for a regular therapy session (90837, 90834) one week, but not a few weeks later; for the Same Patient? Since this has been the case since the beginning of 2017, your article is really helpful & the quick link resources you put on here are a big help too! So now I love you. Will you marry me Denny? 🙂

    Reply

    • Denny May 18, 2017 at 10:33 am #

      Hey Erin, your comment made me laugh, thanks!

      That’s a really strange situation, so I would call to ask about what’s going on. If you’re billing it correctly and there aren’t any authorizations or limits for that client, then as long as coverage remains active, you should be reimbursed repeatedly.

      This is one of those situations where folks hire us to help, since we cannot give a great answer without investigating! For help there you can check out our mental heath billing service or call yourself!

      Good luck, what a weird one!!!

      Reply

      Denny
  17. Dr. Cheryl Arutt June 9, 2017 at 5:19 pm #

    Has anyone ever actually received reimbursement for +90785 – Interactive Complexity add-on code ? The insurance adjusters at the major health insurance companies (even supervisors) are treating it like a coding error because of the “+” sign and when it is explained to them the major insurers have all, without exception, acted like they had never seen it before. Has anyone used it and gotten it paid? If so, by which company?

    Reply

    • Denny June 14, 2017 at 2:41 pm #

      We have Dr Arutt. Please do not use the “+” sign when submitting the billing, that’s the reason why it’s not working!

      Reply

      Denny
  18. Jayne July 15, 2017 at 4:03 am #

    Thank you for this article. Question, I see these reimbursements are mostrly geared towards therapists, psychologists, SW, can psychiatric nurse practitioners use this?

    Reply

  19. Dawn August 7, 2017 at 4:10 pm #

    What is the CPT code for billing things like disability paperwork?

    Reply

  20. Daniel White August 24, 2017 at 11:40 am #

    Can you please help us to bill High Level Inpatient Psychiatric Evaluation taking approximately 90 minutes of time for CNP ?? we are trying to bill 99223 which is getting denied.

    Your response will be highly appreciated.

    Reply

  21. Theresa August 24, 2017 at 12:29 pm #

    Is the chart referring to licensed clinical social workers where it indicates “social worker”… if so it is really out of line, as our training, responsibility to patients and privileges are as in depth as any of the licensed behavioral health professionals. Ouch!

    Reply

  22. ariel August 31, 2017 at 4:43 am #

    I am confused by you saying you can bill for multiple units of 90837. You say for a 90 minute session you should code 90837 and bill 1.5 units. It was my understanding that 90837 was for 53 minutes, or longer, essentially into eternity. : P Have you been successful in getting reimbursed for more than one unit or 90837 billed on the same day?

    Reply

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