The Definitive Guide to Psychiatry CPT Codes [2019]

Psychiatry CPT codes are numerous and nuanced.  This guide will teach you the most common psychiatry CPT codes, psychiatry addon codes, psychiatry evaluation and management codes, and how to bill psychiatry CPT codes.

There are quite a few medical billing CPT codes for Psychiatry services and psychiatrists to use, some reimbursed more often or at higher rates than others.  We at TheraThink provide a billing service that can help de-code which psychiatry CPT codes to use.  This guide will also help you find out which codes to pick.

We will offer you a quick guide on codes, explain E/M codes, and then provide an exhaustive list of all psychiatry cpt codes.

Common Psychiatric CPT Codes

Common Psychiatric CPT Codes

Source: https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/business_of_practice/cpt/2018_CPT_module_revised_March_2018.pdf

Psychiatry CPT Code Cheat Cheat

Here is a downloadable Psychiatry CPT Code Cheat Sheet.

Download Part 1

Download Part 2

Psychiatry CPT Code Cheat Sheet Part 1

Psychiatry CPT Code Cheat Sheet Part 1

Psychiatry CPT Code Cheat Sheet Part 2

Psychiatry CPT Code Cheat Sheet Part 2

Evaluation and Management Psychiatric CPT Codes

This chart helps better visualize the CPT codes by time.  This is not an exhaustive look into which E/M codes to use; please refer to our documentation and guidelines section later in this article.

The psychiatry CPT codes addressed are:

  • New Patient, Outpatient In-Office Services:
    • 99201, 99202, 99203, 99204, 99205;
  • Established Patient, Outpatient In-Office Services:
    • 99211, 99212, 99213, 99214, 99215;
  • New or Established Patient, Outpatient Consultation:
    • 99241, 99242, 99243, 99244, 99245;
  • Inpatient Consultations:
    • 99251, 99252, 99253, 99254, 99255.

E/M Codes and Time Chart

CPT Codes for Psychiatry

It’s extremely important to note that many of these codes will not be covered by a client’s insurance policy, may require authorization, or may have specific modifiers required depending on how services are rendered.

If you don’t want to manage any of this work, we’re happy to help do the insurance billing for your psychiatry practice.

CPT CodeDescription
90791Psychiatric Diagnostic Evaluation without medical services
90792Psychiatric Diagnostic Evaluation with medical services
90865Narcosynthesis
90867Therapeutic repetitive transcranial magnetic stimulation (TMS); initial
90868Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent
90869Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent motor threshold re-determination with delivery and management
90870Electroconvulsive therapy (ECT)
90875Individual psychophysiological therapy incorporating biofeedback training, 30 minutes
90876Individual psychophysiological therapy incorporating biofeedback, 45 minutes
90880Hypnotherapy
90882Environmental manipulation
90885Psychiatric evaluation of records
90887Interpretation or explanation to family
90889Preparation of psychiatric report
90899Unlisted psychiatric service or procedure
90901Biofeedback training by any modality
90911Biofeedback training, including EMG and/or manometry
99201E/M – New Patient Office Visit – 10 Minutes
99202E/M – New Patient Office Visit – 20 Minutes
99203E/M – New Patient Office Visit – 30 Minutes
99204E/M – New Patient Office Visit – 45 Minutes
99205E/M – New Patient Office Visit – 60 Minutes
99211E/M – Established Patients – 5 Minutes
99212E/M – Established Patients – 10 Minutes
99213E/M – Established Patients – 15 Minutes
99214E/M – Established Patients – 25 Minutes
99215E/M – Established Patients – 40 Minutes
99443Telephone therapy (psychiatrist), – limit 3 units/hours per application
90833Psychotherapy, 30 minutes, with E/M service (90833)
90836Psychotherapy, 45 minutes, with E/M service (90836)
90838Psychotherapy, 60 minutes, with E/M service (90838)
90832Psychotherapy, 30 minutes (90832)
90834Psychotherapy, 45 minutes (90834)
90837Psychotherapy, 60 minutes (90837)
9611896118 Neuropsychological testing by psychologist or physician
9610196101 Psychological testing by psychologist or physician
99441Telephone E/M service provided to an established patient, parent/guardian, 5-10 minutes
99442Telephone E/M service provided to an established patient, parent/guardian, 11-20 minutes
99443Telephone E/M service provided to an established patient, parent/guardian, 21-30 minutes
Addon CodesDescription
9935430 to 74 minutes, Prolonged Services With Direct Patient Contact Code Time beyond the time (90837) or typical time (E/M codes) of the primary service
9935575 to 104 minutes, Prolonged Services With Direct Patient Contact Code Time beyond the time (90837) or typical time (E/M codes) of the primary service
99355additional 99355 each additional increment up to 30 minutes
9935830 to 74 minutes, Prolonged Services Without Direct Patient Contact
99359additional increment up to 30 minutes, Prolonged Services Without Direct Patient Contact

Psychiatry CPT Code Modifiers

Here is a short list of the most common CPT Code modifiers that would be used while rending psychiatric services.

CPT Code Modifier 22

  • Unusual Procedure Services

This modifier is used when the work associated with the service provided is greater than that usually required for the listed code.

CPT Code Modifier 25

  • Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

This modifier is used to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual pre- and postoperative care associated with the procedure performed.

CPT Code Modifier 26

  • Professional Component

This modifier is used for procedures that are a combination of a physician component and a technical component.

When the physician component is reported separately, this modifier is added to the usual procedure.

CPT Code Modifier 52

  • Reduced Services

This modifier is used to report a service that is reduced in time.

Source

Setting & Documentation & CMS Guidelines for Psychiatric Services

These services are typically set in an office location.

Please review the Medicare guidelines for E/M guidelines and documentation for exhaustive detail:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

Unusual Psychiatry CPT Code Descriptions

These descriptions are directly copied from the American Psychiatric Association’s coding pamphlet.

Please refer to their documentation here: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/cpt-primer-for-psychiatrists.pdf

These services are often not reimbursed by insurance companies.  Call their insurance plan to obtain authorization or have a mental health billing service like ours help.

90865

Narcosynthesis for Psychiatric Diagnostic and Therapeutic Purposes (e.g. sodium amobarbital (Amytal) interview)

This procedure involves the administration, usually through slow intravenous infusion, of a barbiturate or a benzodiazepine in order to suppress inhibitions, allowing the patient to reveal and discuss material that cannot be verbalized without the disinhibiting effect of the medication. This code is reimbursed by most insurers.

90867

Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) initial treatment, including cortical mapping, motor threshold determination, delivery and management

90868

Subsequent TMS Delivery and Management, per session

90869

Subsequent TMS Motor Threshold Re-Determination with Delivery and Management

90870

Electroconvulsive Therapy (Includes Necessary Monitoring); Single seizure

This code is for electroconvulsive therapy (ECT), which involves the application of electric current to the patient’s brain for the purposes of producing a seizure or series of seizures to alleviate mental symptoms. ECT is used primarily for the treatment of depression that does not respond to medication.

The code includes the time the physician takes to monitor the patient during the convulsive phase and during the recovery phase. When the psychiatrist also administers the anesthesia for ECT, the anesthesia service should be reported separately, using an anesthesia code. ECT is covered by most insurance plans.

90875

Individual Psychophysiological Therapy Incorporating Biofeedback

Training by any Modality (face-to-face with the patient), With Psychotherapy (e.g., insight-oriented, behavior modifying, or supportive psychotherapy); approximately 20-30 minutes and,

90876

approximately 45-50 minutes

These two procedures incorporate biofeedback and psychotherapy (insight oriented, behavior modifying, or supportive) as combined modalities conducted face-to-face with the patient.

They are distinct from biofeedback codes 90901 and 90911, which do not incorporate psychotherapy and do not require face-to-face time. Medicare will not reimburse for either of these codes

90880

Hypnotherapy

Hypnosis is the procedure of inducing a passive state in which the patient demonstrates increased amenability and responsiveness to suggestions and commands, provided they do not conflict seriously with the patient’s conscious or unconscious wishes.

Hypnotherapy may be used for either diagnostic or treatment purposes. This procedure is covered by most insurance plans.

90882

Environmental Intervention for Medical Management Purposes on a Psychiatric Patient’s Behalf With Agencies, Employers, or Institutions

The activities covered by this code include physician visits to a work site to improve work conditions for a particular patient, visits to community-based organizations on behalf of a chronically mentally ill patient to discuss a change in living conditions, or accompaniment of a patient with a phobia in order to help desensitize the patient to a stimulus.

Other activities include coordination of services with agencies, employers, or institutions. This service is covered by some insurance plans, but because some of the activities are not face-to-face, the clinician should check with carriers about their willingness to reimburse for this code.

90885

Psychiatric Evaluation of Hospital Records, Other Psychiatric Reports, Psychometric and/or Projective Tests, and Other Accumulated Data for Medical Diagnostic Purposes

Although this would seem to be a very useful code, because reviewing data is not a face-to-face service with the patient, Medicare will not reimburse for this code and some commercial carriers have followed suit.

Medicare considers the review of data to be part of the pre-/postwork associated with any face-to-face service.

90887

Interpretation or Explanation of Results of Psychiatric, Other Medical Examinations and Procedures, or Other Accumulated Data to Family or Other Responsible Persons, or Advising Them How to Assist Patient

Medicare will not reimburse for this service because it is not done face-to-face with the patient, and clinicians should verify coverage by other insurers to ensure reimbursement. It is appropriate to use an E/M code in the hospital where floor time is expressed in coordination of care with the time documented.

90889

Preparation of Report of Patient’s Psychiatric Status, History, Treatment, or Progress (Other Than for Legal or Consultative Purposes) for Other Physicians, Agencies, or Insurance Carriers

Psychiatrists are often called upon to prepare reports about the patient for many participants in the healthcare system. This code would be best used to denote this service. However, because this is not a service provided face-to-face with a patient, Medicare will not reimburse for this code either, and clinicians should verify coverage by other insurers.

90899

Unlisted Psychiatric Service or Procedure

This code is used for services not specifically defined under another code. It might also be used for procedures that require some degree of explanation or justification.

If the code is used under these circumstances, a brief, jargon-free note explaining the use of the code to the insurance carrier might be helpful in obtaining reimbursement. If it is used for a service that is not provided face-to-face with a patient, the psychiatrist should check with the patient’s insurer regarding reimbursement.

95970, 95974, 95975

Neurostimulators, Analysis–Programming

These codes have been approved for vagus nerve stimulation (VNS) therapy for treatment-resistant depression. Clinicians performing VNS therapy should use the appropriate code from the 95970, 95974, and 95975 series of codes found in the neurology subsection of the CPT manual. Medicare will not reimburse for these codes.

M0064

Brief Office Visit for the Sole Purpose of Monitoring or Changing Drug

Prescriptions Used in the Treatment of Mental Psychoneurotic and Personality Disorders – M0064 is not, in fact, a CPT code. It is a HCPCS Level II code (CPT codes are HCPCS Level I), part of the HCPCS system used by Medicare and Medicaid. M0064 should only be used for the briefest medication check with stable patients

Source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/cpt-primer-for-psychiatrists.pdf