Understanding Mental Health Billing Codes
Mental health billing uses a range of CPT and HCPCS codes depending on the service provided.
The correct code should reflect the service actually performed and meet applicable payer requirements.
CMS's Medicare mental-health resources identify many commonly used psychiatric and psychotherapy codes.
Common Mental Health CPT Codes
CPT General description ———————————– ——————————————————— 90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90832 Psychotherapy, 30 minutes
90834 Psychotherapy, 45 minutes
90837 Psychotherapy, 60 minutes
90833 Psychotherapy with E/M, 30 minutes
90836 Psychotherapy with E/M, 45 minutes
90838 Psychotherapy with E/M, 60 minutes
90839 Psychotherapy for crisis, first 60 minutes
90840 Additional 30 minutes of crisis psychotherapy
90846 Family psychotherapy without patient
90847 Family psychotherapy with patient
90853 Group psychotherapy
96127 Brief emotional/behavioral assessment
CMS's current Medicare materials provide corresponding descriptions for these codes, with payer-specific requirements applying to actual claim submission.
Don't Choose a Code Based Only on Appointment Length
One of the most important billing principles is:
The scheduled appointment length isn't necessarily the same as the billable service.
The code must be supported by the service performed, documentation and applicable payer requirements.
Documentation Matters
For time-based psychotherapy services, documentation should support the applicable time requirements.
CMS guidance currently states that start/stop times or total times should be documented for 90832, 90834 and 90837.
Payer Rules Matter
A code may be valid CPT coding but still encounter payment problems because of:
- Payer policy
- Provider eligibility
- Authorization
- Diagnosis
- Frequency
- POS
- Modifier
- Documentation
- Coverage
That's why a billing company should not simply look at the CPT code.
It should look at the entire claim.
The Mental Health Medical Billers Approach
Our role is to help practices manage the complete billing workflow around their services.
That can include:
Eligibility
→ Claims
→ Denials
→ Payment Posting
→ A/R
→ Credentialing
→ Reporting
The goal is to help providers spend less time dealing with billing administration and more time running their practices.
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