Mental health billing can feel like learning a different language. One minute you’re conducting therapy, the next you’re figuring out which code describes what you just did. Get it wrong and you’re facing denied claims or delayed payments.
The good news? Behavioral health only uses about two dozen codes. The trick is knowing which ones apply to your practice and what mistakes to avoid.
Why Mental Health Billing Is Different
Most mental health codes are time-based, requiring precise session tracking. A 38-minute session gets billed differently than a 53-minute one and incorrect rounding triggers fraud flags.
Insurance companies scrutinize these claims heavily, demanding detailed documentation for medical necessity, accurate diagnosis codes and proper time tracking. Add evolving telehealth rules and payer-specific policies into the mix.
The Essential CPT Codes Every Provider Needs
Diagnostic Evaluation:
- 90791: Psychiatric evaluation without medical services
- 90792: Psychiatric evaluation with medical services (includes prescribing)
Individual Psychotherapy:
- 90832: 30 minutes (16-37 minutes actual time)
- 90834: 45 minutes (38-52 minutes actual time)
- 90837: 60 minutes (53+ minutes actual time)
Crisis and Family Therapy:
- 90839: Crisis intervention, first 60 minutes
- 90846: Family therapy without patient present
- 90847: Family therapy with patient present
- 90853: Group psychotherapy
Use 90791 for initial evaluations. Add 90792 if you’re prescribing during that visit. For ongoing therapy, match the code to your actual session time, not your intended time.
Quick Reference: Common Billing Codes
| Code | Service | Time Range | Use Case |
| 90791 | Diagnostic evaluation | N/A | Initial assessment |
| 90832 | Individual therapy | 16-37 min | Brief sessions |
| 90834 | Individual therapy | 38-52 min | Standard sessions |
| 90837 | Individual therapy | 53+ min | Extended sessions |
| 90847 | Family with patient | N/A | Family sessions |
| 90853 | Group therapy | N/A | Group sessions |
Modifiers That Actually Matter
Modifier 95: Telehealth via video, required by most payers for virtual sessions.
Modifier 93: Audio-only telehealth for phone sessions.
Modifier 25: Significant, separate E&M service on the same day as another procedure.
Modifier 59: Distinct services that shouldn’t be bundled together.
Use modifiers only when they accurately describe the session. Overuse raises audit flags.
Matching Diagnosis Codes to Procedures
CPT codes are the standardized codes used to describe the specific services a mental health provider delivers.
Every CPT code needs a matching ICD-10 diagnosis explaining why treatment was necessary. Common codes include F32.9 (depression), F41.1 (anxiety), F43.10 (PTSD), F90.2 (ADHD) and F10.20 (alcohol use disorder).
Specificity matters. F32.0 (mild single-episode depression) processes better than F32.9 (unspecified depression).
The Biggest Billing Mistakes
Incorrect time rounding is the most common error. A 50-minute session uses 90834 (38-52 minutes), not 90837 (53+ minutes). Document start and end times in your notes.
Using the same code repeatedly looks suspicious. Vary codes based on actual session length.
Missing telehealth modifiers gets claims denied. Virtual sessions need Modifier 95 (video) or 93 (phone).
Billing too frequently without prior authorization raises flags. Most plans cover one to two sessions weekly.
Weak documentation kills claims. Include session duration, specific interventions, patient participation and progress toward goals.
Skipping prior authorization means no payment. Check requirements before starting treatment.
Telehealth Billing in 2025
Bill the same CPT codes for telehealth as in-person sessions, adding proper modifiers. Video sessions use Modifier 95, phone-only uses Modifier 93.
Audio-only services remain covered, recognizing that not everyone has video capability. Document the patient’s location and the HIPAA-compliant platform used. Telehealth affects mental health billing more than ever in 2025.
What Changed in 2025
New code 90868 covers ultra-brief psychotherapy under 20 minutes. Codes 90791 and 90792 now require more detailed documentation of what happened during evaluations.
Collaborative care codes (99492-99494) expanded to include licensed counselors and marriage and family therapists. Using outdated codes gets claims rejected automatically, so stay current.
Documentation That Protects Your Practice
Every note needs date and time (with start/end for time-based codes), presenting problem and symptoms, specific interventions, patient’s response, progress toward goals and clinical assessment.
For evaluation codes, document a comprehensive assessment including mental status exam, diagnosis with supporting observations, risk assessment and treatment plan.
Don’t use identical templates. Auditors look for this pattern.
Time Tracking That Supports Claims
Track time from when clinical work starts until it ends. Documentation time after the session doesn’t count.
Use a timer or practice management software for automatic tracking. This removes guesswork and provides proof if questioned.
Insurance Verification Before Treatment
Verify benefits before the first session. Coverage varies between plans. Check if services need prior authorization and confirm copay amounts. Update insurance information regularly. Insurance verification is essential to prevent denied claims.
When to Consider Outsourcing
If billing takes hours weekly, outsourcing might save money. Specialized services know coding nuances, stay current on payer rules and catch errors early.
They handle denials, resubmissions and tracking, freeing you for clinical work.
Red Flags That Trigger Audits
Always billing the same high-level code makes auditors suspicious. Vary codes based on actual session length.
Seeing patients daily without a documented necessity invites scrutiny. Using family therapy codes when no family attended raises questions.
Best Practices for Clean Claims
Submit claims within 24-48 hours while details are fresh. Use a clearinghouse that scrubs for errors.
Keep a billing reference with your most-used codes and payer requirements. Review denial patterns monthly. Train front desk staff on verification and basic billing.
Setting Up Financial Policies
Create clear policies covering session fees, insurance acceptance, payment expectations, cancellation rules and unpaid balance procedures. Have patients sign before the first session.
Collect copays at time of service. For out-of-network patients, consider upfront payment with superbills for reimbursement.
Getting Help When You Need It
Between code changes, denials and payment tracking, handling everything yourself often costs more than getting help.Focus on providing excellent mental health care. If billing takes time from clinical work, MedLife’s team can streamline your revenue cycle and maximize reimbursements.