Mental Health Billing Codes Guide: CPT Codes Every Therapist Should Know (2026)

Individual Psychotherapy Codes: 90832, 90834, 90837

These three codes form the backbone of mental health billing. They are time-based — the code you select depends on how many minutes of face-to-face psychotherapy you delivered.

CPT 90832 — 30-Minute Psychotherapy (16-37 Minutes)

Use 90832 when your face-to-face psychotherapy time falls between 16 and 37 minutes. This code is appropriate for brief therapy sessions, follow-up supportive counseling, or shorter check-in appointments.

• Medicare reimbursement (2026): Approximately $79-81 (non-facility, national average)
• Commercial insurance range: $65-$120, depending on payer and region
• Documentation requirement: Start and stop times demonstrating at least 16 minutes of face-to-face psychotherapy

Important: if the session is shorter than 16 minutes, it does not meet the threshold for 90832 and should not be billed under this code. Sessions under 16 minutes may be billed as an E/M service if medically appropriate.

CPT 90834 — 45-Minute Psychotherapy (38-52 Minutes)

90834 is the most commonly billed mental health CPT code nationally. It covers 38-52 minutes of face-to-face psychotherapy — the standard therapy session.

• Medicare reimbursement (2026): Approximately $128-$135 (non-facility, national average)
• Commercial insurance range: $110-$180, depending on payer, region, and provider credentials
• Documentation requirement: Start and stop times demonstrating 38-52 minutes of face-to-face psychotherapy, specific interventions used, and patient response

A common billing error: clinicians who routinely schedule 50-minute sessions sometimes let sessions run to 53 minutes without adjusting their billing. If your documentation shows 53+ minutes, you should bill 90837 instead. Some payers flag providers who bill 90834 with documented times above 52 minutes, viewing this as potential undercoding.

CPT 90837 — 60-Minute Psychotherapy (53+ Minutes)

Use 90837 for extended therapy sessions of 53 minutes or more. This code captures longer sessions needed for trauma processing, complex case formulation, or intensive therapeutic work.

• Medicare reimbursement (2026): Approximately $154-$160 (non-facility, national average)
• Commercial insurance range: $130-$210, with Blue Cross Blue Shield plans in high-cost states (Illinois, New Jersey, Massachusetts) often at the upper end
• Documentation requirement: Start and stop times demonstrating at least 53 minutes, clinical justification for the extended session, interventions and patient response

Payer scrutiny is highest on 90837. Some commercial insurers and Medicare Administrative Contractors (MACs) will audit providers who bill 90837 on more than a certain percentage of claims (thresholds vary, but 50-70% is a common trigger). This does not mean 90837 is inappropriate — but your documentation must clearly justify the extended time for every session billed under this code.

Psychiatric Diagnostic Evaluation: 90791, 90792

These codes cover the initial comprehensive assessment of a patient — typically the first visit or a re-evaluation after a significant break in treatment.

CPT 90791 — Psychiatric Diagnostic Evaluation (Without Medical Services)

90791 covers a comprehensive diagnostic interview that includes a complete psychiatric history, mental status examination, and development of a diagnosis and treatment plan. It does not include medical evaluation and management services.

• Medicare reimbursement (2026): Approximately $137-$173 (varies by MAC locality)
• Commercial insurance range: $150-$250
• Who can bill: Psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, and other qualified mental health professionals as defined by state scope-of-practice laws and payer credentialing
• Frequency limitation: Generally limited to the initial evaluation and may be repeated after an extended break in treatment (approximately 6 months from the last visit) or if the patient requires psychiatric hospitalization

CPT 90792 — Psychiatric Diagnostic Evaluation (With Medical Services)

90792 covers the same comprehensive diagnostic evaluation as 90791, plus medical services — specifically, a physical examination, medication review, prescription of medications, or ordering of diagnostic tests.

• Medicare reimbursement (2026): Approximately $159-$202 (varies by MAC locality)
• Commercial insurance range: $175-$300
• Who can bill: Physicians (psychiatrists, primary care physicians) and advanced practice providers (psychiatric nurse practitioners, physician assistants) — practitioners who are licensed to perform medical evaluations
• Key distinction from 90791: The medical services component is what separates these codes. If the evaluation includes prescribing, physical exam, or lab orders, use 90792

Do not bill 90791 or 90792 with an E/M code on the same day for the same patient. The diagnostic evaluation codes are comprehensive and include the evaluation component.

E/M Codes for Psychiatry: When and How to Use Them

Evaluation and Management (E/M) codes are used in psychiatry primarily for medication management visits — encounters where the psychiatrist or prescriber assesses the patient's response to medications, adjusts dosages, and monitors for side effects, without delivering a formal psychotherapy service.

Commonly Used E/M Codes in Psychiatry

E/M Code Selection Criteria (2021 Guidelines, Still Current)

Since the 2021 E/M guideline revisions, code selection for outpatient E/M services (99202-99215) is based on either medical decision-making (MDM) complexity or total time — the provider chooses whichever method supports the higher code.

• MDM-based selection: Consider the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications or morbidity
• Time-based selection: Total time includes both face-to-face and non-face-to-face time on the date of the encounter (chart review, care coordination, documentation). Important: when psychotherapy add-on codes are also billed, time cannot be used as the basis for E/M code selection

For most psychiatry medication management visits, 99214 is the most commonly appropriate code — the visit typically involves moderate medical decision-making (multiple medication adjustments, comorbidity management, or new prescriptions with monitoring requirements).

Add-On Codes: 90785, 90833, 90836, 90838

Add-on codes cannot be billed alone — they must be reported alongside a primary service code. Understanding when and how to use these codes prevents some of the most common billing errors in behavioral health.

CPT 90785 — Interactive Complexity

This add-on code reflects the additional clinical complexity of managing communication difficulties during a session. It can be added to any primary psychotherapy code (90791, 90792, 90832, 90834, 90837) or psychotherapy add-on code (90833, 90836, 90838).

Bill 90785 when the session involves:

• Patients with third parties legally responsible for their care (minors, guardians) who are involved in the session
• Use of interpreter services or communication aids for patients with language barriers or sensory impairments
• Involvement of external agencies (child welfare, probation, schools) that complicate the therapeutic process
• Patients experiencing emotional or behavioral dysregulation that requires the clinician to use additional techniques to maintain the therapeutic interaction

• Medicare reimbursement (2026): Approximately $13-$16 (add-on)
• Documentation requirement: Specify which interactive complexity factor(s) were present and how they affected service delivery

Psychotherapy Add-On Codes for E/M Visits: 90833, 90836, 90838

These codes are used when psychotherapy is performed during the same encounter as an E/M service — the most common scenario in psychiatry practices where medication management and therapy are combined.

Critical rules for psychotherapy add-on codes:

• Never bill a standalone psychotherapy code (90832, 90834, 90837) with an E/M code — you must use the add-on versions (90833, 90836, 90838) instead
• Add modifier 25 to the E/M code to indicate the E/M service was a separately identifiable service
• Time spent on E/M activities does not count toward psychotherapy time — these are separate clocks
• When billing E/M + psychotherapy add-on, time cannot be used as the basis for E/M code level selection. E/M code level must be selected based on medical decision-making complexity
• Prolonged services codes cannot be reported on the same date as psychotherapy add-on codes

Family Therapy and Group Therapy Codes

CPT 90846 — Family Psychotherapy Without the Patient Present

Used when the therapist meets with the patient's family members without the patient present for the purpose of treating the patient's mental health condition. Common scenarios include parent guidance for child/adolescent patients, psychoeducation for family members of patients with severe mental illness, and caregiver coordination sessions.

• Medicare reimbursement (2026): Approximately $120-$135
• Duration: Approximately 50 minutes
• Documentation: Must document which family members were present, the patient's diagnosis being addressed, therapeutic interventions provided, and how the session benefits the patient's treatment

CPT 90847 — Family Psychotherapy With the Patient Present

Used when the therapist meets with the patient and one or more family members together. The session must be focused on treating the patient's mental health condition through family dynamics and interaction.

• Medicare reimbursement (2026): Approximately $140-$155
• Duration: Approximately 50 minutes
• Key distinction from couples therapy: 90847 is specifically for treating a diagnosed patient's mental health condition. Couples counseling for relationship issues (without a mental health diagnosis) is generally not covered by insurance

CPT 90853 — Group Psychotherapy

Covers group therapy sessions where multiple patients participate in a therapeutic group facilitated by a qualified mental health professional. The code is billed once per patient per session.

• Medicare reimbursement (2026): Approximately $30.39 per patient
• Commercial insurance range: $25-$65 per patient
• Typical group size: 4-12 patients (some payers have minimum requirements)
• Documentation per patient: Group topic or therapeutic focus, the individual patient's participation and response, duration of the session, and number of participants

Important: 90853 cannot typically be billed on the same day as individual therapy (90832, 90834, 90837) for the same patient under most payer policies. Check your payer-specific rules before scheduling individual and group therapy on the same day.

Crisis Intervention Codes: 90839, 90840

CPT 90839 — Psychotherapy for Crisis (First 30-74 Minutes)

This code is used for urgent, crisis-level psychotherapy when the patient presents with a life-threatening or complex situation requiring immediate attention. The presenting problem must be of high severity — active suicidal ideation, acute psychotic episode, severe trauma response, or other emergent psychiatric conditions.

• Medicare reimbursement (2026): Approximately $148-$155
• Time range: 30-74 minutes of crisis psychotherapy
• Documentation requirements: Nature and severity of the crisis, specific crisis interventions used, safety assessment and plan, disposition (e.g., referral, hospitalization, safety contract), start and stop times

CPT 90840 — Psychotherapy for Crisis (Each Additional 30 Minutes)

This is an add-on code to 90839 for crisis sessions extending beyond 74 minutes. Report 90840 for each additional 30-minute increment (minimum 16 additional minutes to qualify).

• Medicare reimbursement (2026): Approximately $72-$78 per 30-minute increment
• Usage rule: Can only be billed with 90839 as the primary code
• Audit note: Crisis codes are among the most audited behavioral health codes. Overuse, or use without clear documentation of crisis-level severity, is a common compliance trigger

Telehealth Modifiers and Place of Service Codes

Telehealth has become a permanent feature of behavioral health service delivery. Billing telehealth services correctly requires the right combination of modifier and Place of Service (POS) code.

Modifier 95 — Synchronous Telehealth

Modifier 95 is the standard telehealth modifier for most payers, including Medicare and most commercial insurers. It indicates that the service was delivered via real-time audio and video telecommunication. Apply modifier 95 to any CPT code delivered via telehealth (90832-90837, 90791, 90792, 90847, 90853, E/M codes, etc.).

Modifier GT — Telehealth (Legacy)

The GT modifier was the original telehealth indicator. Medicare stopped requiring GT in 2018, transitioning to modifier 95. However, some state Medicaid programs still require GT instead of or in addition to modifier 95. Check your state Medicaid billing manual before defaulting to modifier 95 for Medicaid claims.

Place of Service Codes

The reimbursement difference between POS 10 and POS 02 is significant. For CPT 90837, for example, the non-facility Medicare rate is approximately $154-160, while the facility rate may be $110-130. For most outpatient therapy telehealth sessions where patients connect from home, POS 10 + modifier 95 is the correct configuration.

Audio-Only Services

Medicare and many commercial payers now cover certain behavioral health services delivered via audio-only telephone when video is not available or clinically appropriate. When billing audio-only:

• Use modifier FQ (or modifier 93, depending on the payer) to indicate audio-only delivery
• POS 10 is typically used for audio-only sessions when the patient is at home
• Not all CPT codes are eligible for audio-only billing — check the CMS telehealth services list and your commercial payer's telehealth policy
• Document why audio-only was used (e.g., patient lacks video capability, clinical appropriateness)

HCPCS Codes for Substance Use Disorder (SUD) Services

HCPCS "H" codes are primarily used for Medicaid-funded SUD treatment services. Commercial payers generally prefer standard CPT codes even for SUD services, but Medicaid programs in most states require H codes for specific service types. Always verify with your state Medicaid program which codes are accepted.

Common HCPCS Modifiers for SUD Services

• HF: Substance abuse program — indicates the service was delivered in an SUD treatment context
• HG: Opioid addiction treatment program
• HH: Integrated mental health/substance abuse program
• U1-U9: State-defined modifiers used by some Medicaid programs for specific service or level-of-care distinctions

For a deeper analysis of revenue cycle challenges specific to behavioral health and SUD treatment, including authorization management and payer-specific billing rules, see our behavioral health revenue cycle guide.

Quick Reference: All Mental Health Billing Codes at a Glance

The table below consolidates the most commonly used mental health CPT codes with 2026 Medicare reimbursement estimates. Print or bookmark this for quick reference during billing.

Note: Medicare reimbursement rates are estimates based on the CY 2026 Physician Fee Schedule national rates. Actual payment varies by MAC locality, provider type, and facility/non-facility setting. Commercial insurance rates vary widely by payer, contract, region, and provider credentials.

Documentation Requirements by Code

Insufficient documentation is the leading cause of mental health claim denials. Every claim requires documentation that justifies the code billed — and payers are increasingly using automated tools to flag documentation deficiencies. For strategies on improving coding accuracy and reducing denials, see our charge capture and coding accuracy guide.

Universal Documentation Elements (All Codes)

Regardless of which CPT code you bill, every mental health progress note should include:

• Date of service
• Start and stop times — for time-based codes, this is the single most critical documentation element
• Patient identifiers — name, date of birth, medical record number
• ICD-10 diagnosis code(s) — must support the medical necessity of the service
• Presenting problem or reason for the session — what brought the patient in or what was addressed
• Specific interventions used — "psychotherapy provided" is insufficient. Document the modality (CBT, DBT, motivational interviewing, psychodynamic, EMDR) and specific techniques applied
• Patient response and progress — observable changes, patient-reported outcomes, behavioral indicators, or validated assessment scores
• Treatment plan alignment — how the session's interventions relate to documented treatment plan goals
• Plan for continued treatment — next steps, follow-up schedule, referrals
• Provider signature, credentials, and date

Code-Specific Requirements

90791/90792 (Diagnostic Evaluation):

• Comprehensive psychiatric history (personal, family, social, substance use, medical)
• Mental status examination
• Diagnostic formulation with DSM-5 diagnosis
• Treatment recommendations and preliminary plan
• For 90792: physical exam findings, medication review, and any prescriptions written or lab orders placed

90837 (60-Minute Psychotherapy):

• Start and stop times clearly showing 53+ minutes of face-to-face psychotherapy
• Clinical justification for extended session length — why was 53+ minutes medically necessary for this patient on this date?
• Specific therapeutic interventions (not generic descriptions)
• Measurable progress indicators

90839/90840 (Crisis):

• Description of the crisis event — what is the life-threatening or acute situation?
• Risk assessment (suicidality, homicidality, psychosis, substance intoxication/withdrawal)
• Specific crisis interventions employed
• Safety plan development and documentation
• Disposition — outcome of the crisis intervention (stabilized, hospitalized, referred, etc.)

E/M + Psychotherapy Add-On (99214 + 90836, etc.):

• Separate documentation for the E/M component (medical decision-making, medication management) and the psychotherapy component
• Distinct time accounting — E/M time and psychotherapy time must not overlap
• MDM documentation supporting the E/M level selected (since time cannot be used for E/M selection when add-on codes are billed)

Common Denial Reasons and How to Prevent Them

Mental health claims are denied at higher rates than many other medical specialties. Understanding the most common denial triggers lets you build preventive workflows into your billing process.

For a comprehensive framework for managing behavioral health revenue cycle from patient intake through collections, including strategies for reducing denial rates below 5%, see our behavioral health revenue cycle management guide.

Frequently Asked Questions

What is the difference between CPT codes 90834 and 90837?

CPT 90834 covers 38-52 minutes of individual psychotherapy, while 90837 covers 53 minutes or more. The key difference is the time threshold: if your face-to-face psychotherapy time is 52 minutes or less, bill 90834; if 53 minutes or more, bill 90837. Medicare reimburses approximately $131 for 90834 and $154-160 for 90837 in 2026, making the per-minute reimbursement rate roughly similar. Documentation must include the exact start and stop times to support the billed code.

Can I bill an E/M code and psychotherapy on the same visit?

Yes, but you must use the psychotherapy add-on codes (90833, 90836, or 90838) instead of the standalone psychotherapy codes (90832, 90834, or 90837). Bill the appropriate E/M code (99213-99215 for established patients, 99203-99205 for new patients) with modifier 25, then add the psychotherapy add-on code that matches the therapy time. Time spent on E/M activities cannot be counted toward psychotherapy time. This is common in psychiatry practices where medication management and therapy occur in the same visit.

What is the correct place of service code for telehealth therapy sessions?

Use Place of Service (POS) 10 when the patient is at home and POS 02 when the patient is at a clinical site (such as a satellite office or skilled nursing facility). POS 10 typically reimburses at the non-facility rate (equivalent to in-office), while POS 02 triggers the lower facility rate. For most telehealth therapy sessions where patients connect from home, POS 10 combined with modifier 95 is the correct billing configuration.

What are the most common reasons mental health claims get denied?

The five most common denial reasons are: (1) incomplete or insufficient documentation — missing start/stop times, treatment plan goals, or progress indicators; (2) coding errors — wrong CPT code for the session duration or incorrect modifier usage; (3) missing or expired prior authorization — especially for intensive outpatient, partial hospitalization, and residential treatment; (4) patient eligibility issues — expired coverage, session frequency limits, or out-of-network status; and (5) medical necessity challenges — payer determines the level of care is not supported by the clinical documentation.

What HCPCS codes are used for substance use disorder treatment?

Key HCPCS codes for SUD treatment include: H0001 (alcohol/drug assessment), H0004 (individual behavioral health counseling, per 15 minutes), H0005 (group alcohol/drug counseling, per session), H0015 (intensive outpatient services, per day — minimum 3 hours/day, 3 days/week), and H0020 (methadone administration in OTP settings). Modifier HF indicates services delivered in a substance use disorder treatment context. Reimbursement varies significantly by state Medicaid program and commercial payer contract.

How do I bill for group therapy sessions?

CPT 90853 is the standard code for group psychotherapy (not including family therapy). Bill 90853 once per patient per session. Medicare reimburses approximately $30.39 per patient in 2026. Documentation must include: the group topic or therapeutic focus, each patient's individual response and participation, duration of the session, and the number of participants. For substance use disorder group counseling, use HCPCS code H0005 instead. Group therapy cannot be billed on the same day as individual therapy (90832/90834/90837) for the same patient under most payer policies.

What documentation is required for CPT code 90837?

CPT 90837 requires: exact start and stop times showing at least 53 minutes of face-to-face psychotherapy; the presenting problem or reason for the session; treatment plan goals being addressed; specific therapeutic interventions used (e.g., CBT, DBT, motivational interviewing — not just "psychotherapy provided"); the patient's response to interventions and measurable progress indicators; a plan for next steps or continued treatment; and the provider's signature and credentials. Claims are frequently denied when documentation lacks specific intervention descriptions or does not clearly link interventions to treatment plan goals.