Mental Health Billing CPT Codes: 90791, 90832, 90834, 90837, 90846, 90847, 90853 and Add-Ons

Diagnostic evaluation

• 90791 — psychiatric diagnostic evaluation without medical services. Used by psychologists, social workers, counselors and other non-prescribers, and by prescribers when no medical component is performed.
• 90792 — psychiatric diagnostic evaluation with medical services (prescribers). Includes a medical assessment and may include prescribing.

Most payers allow one evaluation per provider per episode, with some permitting a second on a different day for complex cases. Billing 90791 at every new-year reassessment is a frequent denial source; check the payer’s frequency rule.

Individual psychotherapy

Time is face-to-face with the patient (and family, where part of the treatment). Several payers scrutinize a high proportion of 90837 relative to 90834; some require notes to justify the longer session. The defense is simple: document the minutes.

Psychotherapy with E/M (prescribers)

When a psychiatrist or psychiatric nurse practitioner performs medication management and psychotherapy in the same visit, bill the E/M code (99212–99215) for the medical work and an add-on psychotherapy code for the therapy time:

• 90833 — psychotherapy 30 minutes, add-on to E/M (16–37 minutes)
• 90836 — 45 minutes, add-on (38–52)
• 90838 — 60 minutes, add-on (53+)

The E/M level is selected by medical decision-making only (time cannot be used for the E/M when a psychotherapy add-on is billed), and the psychotherapy time must be separately documented and distinct from the E/M work.

Family, group and crisis

• 90846 — family psychotherapy without the patient present (50 minutes).
• 90847 — family psychotherapy with the patient present (50 minutes).
• 90853 — group psychotherapy (other than multiple-family group).
• 90839 — psychotherapy for crisis, first 60 minutes (30–74 minutes); 90840 each additional 30 minutes.

Add-ons and assessments

• 90785 — interactive complexity, added when communication factors complicate delivery (for example a child with a caregiver, an interpreter, or emotional family involvement). Not for routine sessions.
• 96127 — brief emotional or behavioral assessment with a standardized instrument (PHQ-9, GAD-7), per instrument; payer limits apply.
• 96130–96139 — psychological and neuropsychological testing, by evaluation and test-administration time.
• 99484, 99492–99494 — behavioral health integration and collaborative care management, billed by the medical practice, per calendar month.

Telehealth

Psychotherapy and evaluation codes are broadly covered by telehealth with modifier 95 and place of service 10 (home) or 02; audio-only with modifier 93 is covered by Medicare for behavioral health and by many commercial payers. See the telehealth billing guide for the details that vary by payer.

Documentation that holds up

• Session start and stop times, or total minutes, on every note
• Modality (in person, video, audio-only) and location
• Diagnosis supported by the evaluation, updated as treatment progresses
• Treatment plan with measurable goals, reviewed on a schedule, and progress against it in each note
• For 90785, the specific complicating factor
• For crisis codes, the nature of the crisis and the interventions

Denials specific to behavioral health

• Session limits or authorization requirements exhausted; track visits used against the authorization.
• Provider type not covered for the code (some plans do not pay certain license types for 90791 or 96127).
• Carve-outs: the behavioral benefit is administered by a different company than the medical card shows. Bill the carve-out vendor.
• Diagnosis excluded under the plan (for example a Z-code as the only diagnosis).
• Frequency: two sessions on one day without a distinguishing modifier and documentation.

Behavioral health is one of the largest parts of Core MB’s work, with billing teams dedicated to it. See behavioral health billing, mental health billing and psychiatry billing.