Mental health billing requires precise coding to ensure proper reimbursement and compliance with insurance requirements. Understanding the correct mental health CPT codes is crucial for maximizing revenue while avoiding claim denials and audit issues. This comprehensive guide covers the essential codes every mental health provider needs to know.
Essential Mental Health CPT Codes
Mental health services are organized into distinct categories, each serving specific therapeutic purposes and medical billing requirements. Here are the most commonly used codes:
| CPT Code | Service Description | Duration/Notes |
| 90791 | Psychiatric diagnostic evaluation | Initial assessment, once per year |
| 90832 | Individual psychotherapy | 30 minutes |
| 90834 | Individual psychotherapy | 45 minutes |
| 90837 | Individual psychotherapy | 60 minutes |
| 90846 | Family therapy (without patient) | 50 minutes |
| 90847 | Family therapy (with patient) | 50 minutes |
| 90853 | Group psychotherapy | Multiple patients |
| 90834+90837 | Extended therapy sessions | 75+ minutes (bill both codes) |
Diagnostic and Testing Codes
| CPT Code | Service Description | Provider Requirements |
| 96101 | Psychological testing by technician | Supervised by psychologist |
| 96102 | Psychological test interpretation | Licensed psychologist only |
| 96103 | Psychological test report writing | Licensed psychologist only |
| 96116 | Neurobehavioral status exam | Specialized training required |
| 96127 | Brief emotional/behavioral assessment | Can be administered by staff |
Medication Management Codes
| CPT Code | Service Description | Qualified Providers |
| 99213 | Office visit, low complexity | Psychiatrists, NPs, MDs |
| 99214 | Office visit, moderate complexity | Psychiatrists, NPs, MDs |
| 99215 | Office visit, high complexity | Psychiatrists, NPs, MDs |
| 90863 | Pharmacologic management | Prescribing providers only |
Provider-Specific Billing Capabilities
Different mental health professionals can bill specific codes based on their licensure and scope of practice:
Psychiatrists and Physicians have the broadest billing capabilities, including all psychotherapy codes, diagnostic evaluations, medication management, and E/M codes for office visits focused on medication adjustments.
Psychologists can bill diagnostic codes (90791), all psychotherapy codes (90832-90837, 90846-90847, 90853), and psychological testing codes (96101-96103). They cannot bill medication management codes.
Licensed Clinical Social Workers can bill psychotherapy codes and diagnostic evaluations within their scope of practice. However, they cannot provide psychological testing services or medication management.
Nurse Practitioners with psychiatric specialization can bill therapy codes and medication management services, similar to psychiatrists, provided they practice within state scope of practice laws.
Telehealth Billing Requirements
The expansion of telehealth services has created new billing opportunities. Medicare billing and most commercial insurers now reimburse telehealth services at parity with in-person visits.
Use Place of Service Code 02 for telehealth services delivered to patients in their homes, and ensure your claims processing system is configured for virtual service billing. Most insurers have simplified telehealth requirements and no longer require special modifiers.
Supervised Services and Limited Permit Billing
Practices employing limited permit counselors can bill standard mental health codes under supervision. The supervising clinician’s license and NPI number are used for billing, and thorough supervision documentation is required.
Documentation must include: regular supervision meeting records, treatment plan oversight, and clear establishment of the supervisory relationship. Only services within the supervisee’s authorized scope can be billed.
Common Billing Mistakes to Avoid
Time-Based Coding Errors occur when providers don’t match session duration to appropriate codes. A 35-minute session uses code 90832, not 90834, regardless of intended session length.
Inadequate Documentation leads to claim denials. Each service requires thorough documentation including treatment techniques used, patient response, and progress toward goals.
Frequency Violations happen when providers exceed allowable limits. Most therapy codes can be billed once per day, but diagnostic codes like 90791 typically have annual restrictions.
Working with Mental Health Clearinghouses
A mental health clearinghouse can significantly improve coding accuracy through real-time code validation and automated documentation checks. This prevents common errors before claims reach insurance companies, reducing denial rates and speeding payments.
Medicare-Specific Considerations
Medicare mental health billing has unique requirements including annual diagnostic evaluation limits and specific documentation standards. Understanding these distinctions is crucial for practices serving Medicare beneficiaries.
Mental health parity ensures Medicare covers mental health services at the same level as medical services, but proper coding and documentation remain essential for reimbursement.
Best Practices for Success
Stay current with annual CPT code updates, provide regular staff training on coding requirements, and maintain comprehensive documentation supporting all billed services. Whether handling billing internally or using external services, understanding these fundamentals ensures appropriate compensation for your valuable mental health services.
Need help optimizing your mental health billing codes and maximizing reimbursement? Our specialists can ensure accurate coding and streamlined claims processing for your practice.