As a psychologist or counselor, keeping up with changes related to billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid and private health insurance carriers can be overwhelming. Yet in order to get compensated appropriately, it’s critical that you understand common mental health billing codes that apply to the fundamental services you provide. Here is a quick summary of the Current Procedural Terminology (CPT) codes related to mental and behavioral health services as of 2017.

  • 90791 — Psychiatric diagnostic interview without medical services
  • 90832 — Individual psychotherapy, 30 minutes (when performed with an evaluation and management service: 90833)
  • 90834 — Individual psychotherapy, 45 minutes (when performed with an evaluation and management service: 90836)
  • 90837 — Individual psychotherapy, 60 minutes (when performed with an evaluation and management service: 90838)
  • 90847 — Family Psychotherapy with patient present (without patient present: 90846; multiple-family group psychotherapy: 90849)
  • 90853 — Group psychotherapy

Given that the times associated with these codes are so specific, the actual time you spend with a patient may differ. In that case, it can be helpful to know the time ranges associated with some of the mental health billing codes listed above:

  • 90832 — 16 to 37 minutes
  • 90834 — 38 to 52 minutes
  • 90837 — 53 minutes or longer
  • Note: For any sessions lasting less than 16 minutes, the psychotherapy codes listed here should not be billed.

For insurance purposes, you’ll need to note start and stop times for every session of psychotherapy you provide. Without adequate documentation, for all intents and purposes, it will be as if you didn’t deliver the service. Also keep in mind that these are considered face-to-face services with the patient and/or family member, and require that the patient present for some or all of the service unless explicitly specified.

Given the increase of technology used to deliver services to patients in situations where face-to-face treatment is not possible, the new CPT modifier “95” will set a coding standardization for telemedicine services. This modifier is to be used for “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system,” or “synchronous telemedicine” for short. As a coding example, when 45 minutes of psychotherapy is delivered via telemedicine, append the CPT code 90834 with modifier 95, and be sure to indicate the originating place of service code (typically “11” for practitioner’s office). Note that this form of therapy may may not be accepted by all insurance companies, so contact us with specific questions.

Finally, add-on codes identify an additional part of the treatment above and beyond the principal service. Both the principal service code and add-on code should be listed on the billing form. Common add-on codes include:

  • 90785 — Interactive complexity add-on (for psychotherapy codes)
  • 90839 — Patient in crisis add-on – 60 minutes
  • 90840 — Patient in crisis add-on – Each additional 30 minutes

Practitioners should be aware that some insurance plans require authorization before some of these codes are billed. For clients with both physical and mental health problems who are using private insurance, psychologists are advised to confirm coverage with the carrier or plan administrator to streamline the billing process.

If you have unanswered questions about when to use these common mental health billing codes, contact our team of professionals for help.