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.

CPT Codes are different from Diagnosis Codes or ICD10 F-Codes for billing and coding your insurance claims.  Here’s our mental health diagnosis code list if you need to look one up.

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.

Article Index:

• Most Common Mental Health CPT Codes
• Add-On CPT Codes for Mental Health Billing
• Mental Health CPT Code Cheat Sheet [PDF]
• Testing & Evaluation CPT Codes
• Psych and Evaluation and Management (E/M) Codes
• Sample Reimbursement Rates by License Type
• Sample Reimbursement Rates by CPT Code

The Most Common Mental Health CPT Codes

The most common CPT Codes used by therapists and behavioral health professionals:

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
• 90845 – Psychoanalysis

Mental Health Add-On CPT Codes

Here is a short list of the most common Add-On codes for routine outpatient mental health billing.

• Add-On CPT Code 90785 – Interactive complexity. Example: play therapy using dolls or other toys. This is an interactive complexity add-on code that is not a payable expense. This code only indicates that the treatment is complex in nature.
• Add-On CPT Code 90863 – Pharmacologic Management after therapy.
• Add-On CPT Code 99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
• Add-On CPT Code 99051 – Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.
• Add-On CPT Code 99354 – Additional time after the additional time of 74 minutes. Adding another 30 minutes. (Only use if the duration of your session is at least 90 minutes for 90837 or 80 minutes for 90847).
• Add-On CPT Code 99355 – Additional time after first 60 minutes. First additional 30 to 74 minutes.
• Add-On CPT Code 90840 – 30 additional minutes of psychotherapy for crisis. Used only in conjunction with CPT 90839.
• Add-On CPT Code 90833 – 30 minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, then has 30 minute session.
• Add-On CPT Code 90836 – 45 minute psychotherapy add-on. Example: Clinical Nurse Specialist evaluates medication response, then has 45 minute session.

If you’re wondering how to handle billing add-on codes, we can help make this process simple and automatic.  Learn how we can help by inquiring about our billing service.

Outpatient Psychiatry Diagnostics / Evaluation / Client Intake 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

Mental Health CPT Code Cheat Sheet

Download a copy of our PDF Behavioral Health CPT Code Cheat Sheet!

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 seldom 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.

Behavioral 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 behavioral health 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 Testing CPT Codes [2020]

These codes are only effective January 1st, 2019.

Assessment of Aphasia and Cognitive Performance Testing CPT Codes

CPT Code 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

CPT Code 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

CPT Code 96110

Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

CPT Code 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

Add-on CPT Code + 96113 – Each additional 30 minutes (List separately in addition to code for primary procedure)

CPT Code 96127

Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

Psychological/Neuropsychological Testing CPT Codes

These codes have changed in 2019.

Neurobehavioral Status Exam CPT Codes

CPT Code 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

Add-on CPT Code +96121 – Each additional hour (List separately in addition to code for primary procedure)

Test Evaluation Services CPT Codes

CPT Code 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

Add-on CPT Code +96131 – Each additional hour (List separately in addition to code for primary procedure)

CPT Code 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

Add-on CPT Code +96133 – Each additional hour (List separately in addition to code for primary procedure)

Test Administration and Scoring CPT Codes

CPT Code 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

Add-on CPT Code +96137 – Each additional 30 minutes (List separately in addition to code for primary procedure)

CPT Code 96138

Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes

Add-on CPT Code +96139 – Each additional 30 minutes (List separately in addition to code for primary procedure)

Automated Testing and Result CPT Codes

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.

• Add-on CPT Code +90833 – E/M code for 30 minutes of psychiatry (used with 90832).
• Add-on CPT Code +90836 – E/M code for 45 minutes of psychiatry (used with 90834).
• Add-on CPT Code +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).

Medicare 2023 Reimbursement Rates by CPT Code

(Source)

Interactive Complexity (+90785):  Criteria and How to Bill

+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.

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

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.

Therapist Reimbursement Rates for 2023

Read our definitive guide with 2023 reimbursement rates for mental health CPT codes.

Downcoding Claims

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!

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.

Additional Resources 

• • Medicare Reimbursement by CPT Code & Area
  • CPT Reimbursement Lookup & RVU (Relative Value Unit) Overview
  • Crosswalk of 2012 to 2013 CPT Codes
  • CPT 2013 Standard Edition [Probably Unnecessary]
  • Insurance Reimbursement Comparison Tool

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).