Mental Health CPT Codes: The Definitive Guide 
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.
- 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 
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).
- 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
|CPT Code||Description||Medicare Reimbursement Rate 2020||Medicare Reimbursement Rate 2021||Medicare Reimbursement Rate 2022||Medicare Reimbursement Rate 2023|
|90791||Psychological Diagnostic Evaluation||$140.19||$180.75||$195.46||$174.86|
|90792||Psychological Diagnostic Evaluation with Medication Management||$157.49||$201.68||$218.90||$196.55|
|90832||Individual Psychotherapy, 30 Minutes||$68.47||$77.81||$85.07||$75.57|
|90833||Individual Psychotherapy with Evaluation and Management Services, 30 minutes||$71.00||$71.18||$77.88||$69.47|
|90834||Individual Psychotherapy, 45 Minutes||$91.18||$103.28||$112.29||$99.97|
|90836||Individual Psychotherapy with Evaluation and Management Services, 45 minutes||$89.74||$90.02||$98.30||$88.11|
|90837||Individual Psychotherapy, 60 Minutes||$136.95||$152.48||$164.84||$147.07|
|90838||Individual Psychotherapy with Evaluation and Management Services, 60 minutes||$118.57||$119.33||$129.30||$116.57|
|90839||Individual Crisis Psychotherapy initial 60 min||$157.66||$141.31|
|90840||Individual Crisis Psychotherapy initial 60 min, each additional 30 min||$78.64||$70.15|
|99201||Evaluation and Management Services, Outpatient, New Patient||$46.49||Not Covered||Not covered||Not covered|
|99202||Evaluation and Management Services, Outpatient, New Patient||$77.48||$73.97||$80.91||$72.86|
|99203||Evaluation and Management Services, Outpatient, New Patient||$109.92||$113.75||$124.39||$112.84|
|99204||Evaluation and Management Services, Outpatient, New Patient||$166.86||$169.93||$185.26||$167.40|
|99205||Evaluation and Management Services, Outpatient, New Patient||$209.75||$224.36||$244.99||$220.95|
|99211||Evaluation and Management Services, Outpatient, Established Patient||$23.07||$23.03||$25.71||$23.38|
|99212||Evaluation and Management Services, Outpatient, Established Patient||$45.77||$56.88||$62.76||$56.93|
|99213||Evaluation and Management Services, Outpatient, Established Patient||$75.32||$92.47||$100.57||$90.82|
|99214||Evaluation and Management Services, Outpatient, Established Patient||$110.28||$131.20||$141.78||$128.43|
|99215||Evaluation and Management Services, Outpatient, Established Patient||$147.76||$183.19||$200.00||$179.94|
|99354||Prolonged Services||$132.26||$132.09||$140.26||Not covered|
|99355||Prolong Services with E/M||$100.91||$100.33||$101.32||Not covered|
|90846||Family psychotherapy without patient, 50 minutes||$103.58||$99.10||$107.37||$95.56|
|90847||Family psychotherapy with patient, 50 minutes||$107.19||$102.59||$111.15||$99.63|
|96105||Assessment of aphasia and cognitive performance||$101.54||$109.26||$98.27|
|96112||Developmental testing administration by a physician or qualified health care professional, 1st hr||$131.55||$141.02||$126.74|
|96113||Developmental testing administration by a physician or qualified health care professional, each additional hour||$58.62||$66.54||$59.98|
|96116||Neurobehavioral status exam performed by a physician or qualified health professional, first hour||$97.00||$104.73||$93.19|
|96121||Neurobehavioral status exam performed by a physician or qualified health professional, additional hour||$82.35||$87.34||$75.91|
|96125||Standardized cognitive performance test administered by health care professional||$107.12||$115.69||$103.36|
|96127||Brief emotional and behavioral assessment||$4.89||$5.29||$4.74|
|96130||Psychological testing and evaluation by a physician or qualified health care professional, first hour||$120.73||$132.70||$120.30|
|96131||Psychological testing and evaluation by a physician or qualified health care professional, each additional hour||$91.42||$98.68||$86.75|
|96132||Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour||$133.29||$144.80||$130.13|
|96133||Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour||$103.98||$112.29||$98.95|
|96136||Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour||$46.76||$49.15||$42.70|
|96137||Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour||$41.87||$44.24||$39.31|
|96138||Neuropsychological or psychological test administration and scoring by a technician, first hour||$37.34||$38.56||$34.23|
|96139||Neuropsychological or psychological test administration and scoring by a technician, each additional hour||$37.34||$$39.32||$35.24|
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.
- 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.
Therapist Reimbursement Rates for 2023
Read our definitive guide with 2023 reimbursement rates for mental health CPT codes.
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.
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).
This was very helpful thank you for taking the time to write this up in one clear concise place and manner.
Happy to help Victoria! Glad it was so useful.
Of course, Mark.
Another thank you, much appreciated!
Absolutely, Anne, happy we could be of service.
This site was a fantastic one stop website in summing up all of the necessary information in a thorough yet brief description.
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.
Thank you so much for sharing your insight. Very helpful to me!
Glad we could be of service, Nita.
Great tips. Thanks.
Thanks for your comment Meredith. Happy to help.
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?
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).
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)?
Hi Karen, you would use 90837 and then change the number of units from 1 to 1.5!
Hi Denny, and in this case how would you describe the service? Would you list “Individual Psychotherapy, 60 minutes” (even for a session that is 75 or 90 minutes) or just “Individual Psychotherapy”?
On the CMS form, you should use 90837 for a 60 minute session. The next increment of time would be a 90 minute session that you should bill by increasing the units. Use 1.5 units and 90837.
This is so helpful, thank you! How would you bill an initial assessment appointment that was stopped short by the patient after 20 minutes?
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/
I would use a 90791 since this code does not have a designated time, whether your intake is 20 minutes or 3 hours you would still use this code, I would think
Thank you so much for this cheat sheet – is it very informative! Is there a minimum time requirement for billing 90791?
We recommend your intake session to be between 45 and 60 minutes.
We recommend at least 45 minutes for an intake session (90791) to be billed with 1 unit. Great question.
The minimum for a 90791, as well as any CPT that is not time indicated already is 15 minutes.
Is there a case for a 90 minute session that isn’t crisis? So a 90837 and 90832 together?
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.
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.
You will need to contact provider support at Medi-Cal to obtain that information.
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!
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.
I am having some problems with +99354. I am billing it with 90837, but I am getting denials from Anthem and was wondering if maybe I need a modifier?
To add a longer duration of visit, change the number of units from 1 to 1.5, in this case. That CPT code addon is incompatible with 90837.
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.
Happy to help Diana! 🙂
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?
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. ”
Denny, My reading of the codes is that it would often appropriate to use this code in each session — not just because the session is difficult or the client is difficult, but if you are working with a client who is pre-verbal or doing play therapy every week or are having to use an interpreter or communicating is in some way hampered. Don’t you agree?
Great question Barbara and yes a case with an interpreter would be a specific situation where repeated use of this code would be appropriate. The point of “difficulty” here is about rendering service itself, so to your point, a required interpreter would be the cause of increased difficulty. Often times people are concerned about the patient’s Dx being “difficult” but this is a misreading of coding on this case. So we make the distinction between rendering services, logistically, and the clients Dx being a challenging one. Great question to tease out this nuance.
Also pleasure hearing from you as always!
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? 🙂
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!!!
CPT code 90863 must now be billed with a primary service code. What other codes can I use to bill this service and it not be an add on?
I would strongly recommend against billing this CPT code as it is so ambiguous. Pick a more precise CPT code for less of a billing headache.
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?
We have Dr Arutt. Please do not use the “+” sign when submitting the billing, that’s the reason why it’s not working!
Thank you for this article. Question, I see these reimbursements are mostrly geared towards therapists, psychologists, SW, can psychiatric nurse practitioners use this?
What is the CPT code for billing things like disability paperwork?
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.
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!
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?
Hi Ariel :). Depending on the Insurance company (United Health being one that hasn’t been accepting 90837 same day for us), we haven’t been having too much trouble getting a same day reimbursement for 90837.
We’re in Wisconsin btw, & I’m sure the state you’re billing from makes a difference too. Hope that helps!
90791 – When I work with children I find it is most helpful for the first session to be parents only. Can I bill 90791 for this or must the child be present?
Hey Denny what a wonderful gift this page has been. Clinicians are always pressed for time. And most want the”best practices” for “best outcomes” but when our time is consumed in the minutiae of coding for proper billing less time can be devoted to giving those who come to us for help our best. So thank you for this unselfish gesture.
Washington Reimbursement rates are listed in the article. Are these rates based upon Medicare or private insurance rates?
These are Medicare rates as they are the only rates that are reliable on an ongoing basis.
Thank you for helping me do my job bro! I’ve been on your email list for over a year now & would have a Lot of reimbursement probs. without you! 🙂
These quoted rates are extremely low reimbursement rates. No one should call these industry standard rates – I am a private practitioner and these rates are less than 50% of standard rates – taking into consideration even of insurance contracts I hold. Insurances need to be confronted. These calculators don’t allow real rates collected (and taxes paid on those full rates should be identifiable pretty easily) to be entered by real providers. You don’t go to your tax accountant, dentist, local pizzeria or college professors and ask for a sliding fee…why should mental health providers be negotiating rates all the time? Stand up to these insurance moguls and demand fair reimbursements.
I know that most insurance companies do not cover phone sessions. I also don’t take most insurances. For my out-of-network patients, I will supply a statement at the end of each month. On occasion, I will do a phone session. On the statement, I will note the session date and use the CPT code 90837 and then note that this was a phone session. Is this acceptable?
I am a sole practitioner in mental health I am licensed mental health counselor. When I submit the claims, I put a procedural code and a place of service code. I have an Anthem client and on our first encounter I billed a 90791 (diagnostic evaluation ) and POS 11.
They are not paying a claim because they say it needs an “OFFICE CODE”. The plan has a $20 copay and 0 deductible for mental health. They are applying the entire amount to the medical deductible because the calam needs an “Office Code” what is this and why have I never encountered this before? and where on the claim form CMS 1500 would it go?
Hey Terri, that is the office place of service code. I would recommend calling and asking. If the claim went to their deductible, it was approved and worked — the client simply has a deductible to pay out from. Sounds like you did things right but simply didn’t exact the deductible payment — I would call to ask and also get a quote for eligibility and benefits. Our guide on that is here: https://therathink.com/how-to-verify-eligibility-and-benefits-for-mental-health/
Hello I’m a liscence therapist in NYS . Can you tell me what codes I use for an initial therapy /mental health session for private practice? Also, for a 45 minute and 60 minute session. I’m very new to this so I appreciate any insight. Thank you.
Happy to help Trish! For your intake use 90791. For a 45 minute session, use 90834 and for a 60 minute session, use 90837!
Can you please help me out with the situation where Medicaid of GA denied CPT 90834 for age restriction as this code is covered only for members under 21 years of age. where as we billed the code for patient age of 60 years?
This seems to an inaccurate reading of the denial. I would call back and verify EOB information including the exact denial reason. 90834 is a CPT code that has nothing to do with age. Nor would any Medicaid plan be age restricted. I think you should call back and ask them to tell you in plain language why the claims are denied. Then resolve that problem and resubmit corrected claims and/or appeal. We do this sort of work for our providers in our mental health billing service every day, so this type of work is why folks choose us.
Hi! I have a question about home based therapy. If one of my therapists was to start doing home based therapy would they bill a different code than the normal 90832-90837? We are just trying to make sure we are billing properly. Any help or advise would be greatly appreciated!
My first recommendation is to call to pre approve home based sessions. You will want to change the place of service code and use the same CPT codes. We have an article on mental health place of service codes here: https://therathink.com/place-service-codes-mental-health-billing/
Do you know if there is a modifier or add on procedure code to bill with an initial and group therapy that were performed on the same day? Thank you!
You can use modifier 59 or with Medicare, XE for the same provider with a different service offering or XP for a different provider.
I am a psychiatrist and psychoanalyst and see patients mostly four times a week. Should I be using the GZ542ZZZ code and is there any commercial reimbursement for that? I have used the 90836 but I am definitely seeing patients more often than normal. I want to have my billing reflect the reality of my services but also need to keep the lights on!
Hi Douglas, I don’t know what that ‘code’ refers to exactly but here’s what I suggest for seeing clients more regularly than once a week: 1) call ahead of time to inform their insurance plan of their diagnosis and warranted treatment plan, 2) use the authorization for billing, 3) make sure you continue to seek authorization based on medical necessity directly with their plan. This is something we help out with in our mental health billing service.
Is there an update to this for 2018?
Any changes? Thank you!
Yes, changed have been made to psychological and neurospychological / neuropsych testing as well as testing in general. We’ve posted those changes!
Is there a minimum length of time for group sessions required to bill 90853? Does the group session have to be at least 45 minutes to bill?
Great question. We recommend sessions to be at least 60 minutes but each session length ‘recommendation’ is up to each insurance company.
You have done a wonderful job with this write up! It was also enlightening to see the comparison of different geographical regions within the US and the pricing.
Happy to help Elizabeth. Truly our pleasure to assist with these mental health cpt code questions.
Wow!! Thank you for this very informational site! Great job, much appreciated, most helpful!
Of course Gwen, so glad we were able to help!
My son is at a private, for profit, residential treatment center in NC. He receives 4 group therapy sessions per week. My sons primary therapist (Ph.D, LCSW) facilitates 1 session per week and there are other therapists facilitating the other 3 groups. His primary therapist is the only one taking time to write clinical notes documenting each weeks session in my sons individual file so it cal legally be coded & billed to insurance on the superbill. The other therapists are not writing group notes in his individual file so the sessions can not be documented on our superbill. Therefore, only 1 group session per week is able to be legally coded & billed to insurance on our superbill. The RTC does not deal with coding & billing and have recommended three different 3rd party billing companies that parents could use to collect the superbill.
My questions are:
* Do all of the group sessions my son participates in each week need to be documented in his individual file showing how he participated so the sessions can be to be legally coded, in case insurance requests clinical documentation?
* Is it proper protocol & best practice for all the therapists, LCSW, write their clinical notes not only in the group file but in each child’s individual file so it can be coded & documented on the
* Do the therapists have a legal obligation to do this?
* Are the therapists able to go back & write these notes in his individual file?
* The founder/executive director/current acting clinical director of the RTC facility said they usually only write ONE group note per MONTH for each type of group (trauma group, etc.)
Is this usual & best practice for therapists and RTC’s?
The executive director said he would look into this matter and we have attempted to get an answer for 2 months now.
Our son has been at the facility for 8 months and graduates in 1 month.
* Is there any recourse if they do not provide this so it can documented on the superbill?
* If a facility is providing a service, is it expected that the service be documented to show the service is being provided to the patient and payment can be rendered?
We also are currently in negotiations with our public school district to. help with payment of our sons stay. The district expects documentation showing how often our son receives group, individual and family therapy each week.
Hi Tonya, this is an extremely specific set of questions that needs to be handled by a lawyer you hire. We are not the appropriate entity to ask this question. For your own sake please do seek a legal counsel to help.
What happens if you do a 90791 and they turn out of not meet medical necessity according to the DSM 5 for a mental health diagnosis. Can you bill that without a diagnosis or how would you code it. Thanks
You must add the most accurate Dx codes you can for the intake. If medical necessity is required, call to obtain authorization for those sessions. We do this for free within our mental health billing service, of course.
what is the correct way to bill BCBS for 90 minute group psychotherapy session (CPT 90853) the fee schedule for BCBS does not specify time under the code.
We would call up and ask for each client to ensure they have coverage for the group session. We do this for our providers with our billing service.
When I send a new couple a TheraThink Client Intake the great thing that happens is that Denny and the folks in Seattle do the heavy lifting. I have saved countless hours. My clients are required to complete the insurance “intake” prior to their being scheduled (that works for me). I have learned to let go of what I can and focus on what I love!
I now truly do have a Team of Support behind me for 2021.