Key takeaways
- Psychotherapy codes are chosen by documented time: 16–37 minutes is 90832, 38–52 is 90834, 53 or more is 90837.
- Prescribers who provide an E/M service and psychotherapy on the same day bill the E/M code plus a psychotherapy add-on (90833, 90836, or 90838).
- Report 90785 only when interactive complexity is documented — it is an add-on and is never billed alone.
- Check whether a carve-out organization manages the behavioral health benefit before the first visit.
- Telehealth place of service, modifiers, and audio-only rules differ by payer — check them per claim.
What are the main mental health CPT codes?
| Code | Service | Time / notes |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | Not timed; intake evaluation by a therapist, psychologist, or prescriber |
| 90792 | Psychiatric diagnostic evaluation with medical services | Not timed; for prescribers such as psychiatrists and psychiatric nurse practitioners |
| 90832 | Psychotherapy, 30 minutes | 16–37 minutes |
| 90834 | Psychotherapy, 45 minutes | 38–52 minutes |
| 90837 | Psychotherapy, 60 minutes | 53 minutes or more |
| 90833 / 90836 / 90838 | Psychotherapy add-on to an E/M service | Same time ranges as 90832 / 90834 / 90837; billed only with the E/M code |
| 90839 / 90840 | Psychotherapy for crisis | 90839 for the first 30–74 minutes; 90840 for each additional 30 minutes |
| 90846 | Family psychotherapy without the patient | 50-minute code; reportable from 26 minutes |
| 90847 | Family psychotherapy with the patient | 50-minute code; reportable from 26 minutes |
| 90853 | Group psychotherapy (other than multiple-family group) | Per patient, per session |
| 90785 | Interactive complexity add-on | With 90791, 90792, psychotherapy, or group codes when documented communication factors complicate the visit |
What is the difference between 90834 and 90837?
Both are individual psychotherapy codes; the difference is time. 90834 covers 38–52 minutes and 90837 covers 53 minutes or more. A 50-minute session is 90834, even if the appointment was booked for an hour.
Because 90837 pays more, some payers review practices that bill it heavily. That is no reason to under-code — it is a reason to document accurately: start and stop times, the psychotherapy provided, and why the session length was clinically needed.
How do prescribers bill therapy with medication management?
When a psychiatrist, psychiatric nurse practitioner, or other prescriber provides a medically necessary E/M service and psychotherapy on the same day, the visit is billed as an E/M code (for example, 99213 or 99214) plus a psychotherapy add-on — 90833, 90836, or 90838 — chosen by psychotherapy time using the same ranges as the standalone codes. Time spent on the E/M service cannot also count toward psychotherapy time.
Add-on codes are never billed without the E/M code, and the E/M level must stand on its own, usually on medical decision making. See medical coding accuracy for how coding reviews catch these errors before submission.
Who can bill psychotherapy codes?
Psychiatrists and other physicians, psychiatric nurse practitioners, clinical psychologists, licensed clinical social workers, licensed professional or mental health counselors, and marriage and family therapists can bill psychotherapy codes, subject to state licensure and each payer’s credentialing rules. Since January 1, 2024, Medicare also pays marriage and family therapists and mental health counselors directly.
90792 and the E/M codes are for prescribers only. Before a new clinician sees payer patients, confirm they are credentialed with each payer — including any carve-out — using the credentialing guide.
Why do behavioral health claims go to a different payer?
Many health plans hand mental health and substance use disorder benefits to a separate behavioral health organization — a carve-out. The member’s card may show the medical plan, but claims, authorizations, and credentialing go to the carve-out. Sending the claim to the medical plan is one of the most common, and most avoidable, behavioral health denials. Confirm which organization manages the benefit during eligibility verification.
Federal parity law (MHPAEA) generally requires group health plans and insurers to apply financial requirements and treatment limits to mental health and SUD benefits no more restrictively than to medical and surgical benefits. When a visit limit or authorization rule looks stricter than the medical side, it is worth asking the plan how it complies.
How is telehealth therapy billed?
- Place of service — 10 when the patient is at home, 02 when the patient is somewhere else. Some commercial payers instead want the in-person place of service with modifier 95.
- Modifiers — modifier 95 for synchronous audio-video visits is common; modifier 93 marks audio-only services where the payer covers them.
- Audio-only — coverage for phone-only therapy varies widely by payer and state.
- Licensure — the clinician generally must be licensed in the state where the patient is located during the session.
Telehealth rules change often. Check each payer’s current policy instead of applying one rule to every claim.
Common mental health billing denials and how to prevent them
| Denial | Typical cause | Prevention |
|---|---|---|
| Wrong payer (often CARC 109) | Claim sent to the medical plan when a carve-out manages the benefit | Verify the behavioral health payer before the first visit |
| No authorization (CARC 197) or visit limit reached (CARC 119) | Authorization missing, expired, or used up | Track authorized visits against sessions delivered |
| Time does not support the code | No start/stop or total time in the note, or time below the code’s range | Document time in every note and code from it |
| Same-day conflicts | Diagnostic evaluation and psychotherapy billed together, or a standalone psychotherapy code billed with an E/M | Use E/M plus add-on codes; follow payer same-day rules |
| Provider not credentialed | Clinician not enrolled with the payer or the carve-out | Credential every clinician before scheduling payer patients |
| Telehealth mismatch | Wrong place of service or missing modifier for that payer | Apply a payer telehealth matrix in claim scrubbing |
For the full prevention method, see how to reduce claim denials.
How LRx Healthcare supports behavioral health practices
LRx Healthcare’s behavioral health billing services verify benefits with the organization that actually manages them, track authorized visits, check codes and time requirements before submission, apply payer-specific telehealth rules, and work denials and A/R through to payment. Practices that also bill ABA should read the ABA billing codes guide. A free billing audit shows where behavioral health revenue is leaking.
This guide is general information about healthcare billing operations, not legal, tax, or compliance advice. Payer rules and regulations change — confirm current requirements with the payer or a qualified advisor.