CPT Codes for Mental Health Billing
CPT codes describe the mental health services provided by psychiatrists, psychologists, and therapists.
Common Mental Health CPT Codes
90791 – Psychiatric diagnostic evaluation (no medical services)
90792 – Psychiatric diagnostic evaluation with medical services
90832 – Psychotherapy, 30 minutes
90834 – Psychotherapy, 45 minutes
90837 – Psychotherapy, 60 minutes
90846 – Family psychotherapy without patient
90847 – Family psychotherapy with patient
Correct session time documentation is mandatory for these codes.
Medication Management CPT Codes
Medication management is commonly billed by psychiatrists and qualified providers.
90863 – Pharmacologic management (used with psychotherapy)
99201–99215 – E/M codes for medication management visits
ICD-10 Diagnosis Codes for Mental Health Billing
ICD-10-CM codes justify the medical necessity of mental health services.
Common Mental Health ICD-10 Codes
F32.9 – Major depressive disorder, single episode
F33.1 – Major depressive disorder, recurrent
F41.1 – Generalized anxiety disorder
F43.10 – Post-traumatic stress disorder (PTSD)
F90.9 – Attention-deficit hyperactivity disorder (ADHD)
Accurate diagnosis coding is essential for successful mental health claims.
Mental Health Telehealth Billing
Telehealth mental health billing has expanded significantly in the US.
Telehealth CPT Codes and Modifiers
Use standard psychotherapy CPT codes
Modifier 95 – Telehealth services
Place of Service (POS) 10 or 02
Medicare and commercial payers may have different telehealth rules, so payer-specific verification is required.
Medicare Rules for Mental Health Billing
Medicare Part B covers outpatient mental health services when medically necessary.
Key Medicare Mental Health Billing Guidelines
- Provider must be enrolled with Medicare
- Services must be medically necessary
- Correct CPT and ICD-10 pairing
- Proper documentation of session time
- Telehealth compliance
Medicare audits mental health claims more frequently due to improper billing.
Medicaid Mental Health Billing
Medicaid mental health billing rules vary by state but generally include:
- Prior authorization requirements
- Limited covered services
- Provider credentialing
- State-specific billing guidelines
Billing staff must follow state Medicaid manuals closely.
Common Mental Health Billing Modifiers
Modifiers play a major role in mental health billing.
25 – Significant, separately identifiable E/M service
59 – Distinct procedural service
95 – Telehealth service
GT – Telemedicine (used by some payers)
Mental Health Billing Documentation Requirements
Documentation must include:
- Session start and end times
- Type of therapy provided
- Patient progress notes
- Treatment plans
- Medical necessity justification
Incomplete documentation can result in payment recoupment.
Common Mental Health Billing Errors
Avoid these frequent mistakes:
- Billing wrong session length
- Missing diagnosis codes
- Incorrect telehealth modifiers
- Lack of medical necessity
- Billing non-covered services
- Credentialing or enrollment issues
These errors significantly impact revenue.
Mental Health Billing and Denial Management
Effective denial management is critical in mental health medical billing.
Common Denial Reasons
- Authorization missing
- Invalid diagnosis
- Incorrect CPT code
- Telehealth non-compliance
Role of RCM in Mental Health Billing
Mental health billing is part of a broader revenue cycle management (RCM) process.
RCM includes:
- Provider credentialing and enrollment
- Eligibility verification
- Charge capture
- Claim submission
- Payment posting
- AR follow-up
Outsourcing Mental Health Billing Services
Many US practices outsource mental health billing to specialized billing companies.
Benefits of Outsourcing
- Higher claim acceptance rate
- Reduced administrative burden
- Compliance expertise
- Faster reimbursements
- Scalable billing operations
Compliance and Audit Risks in Mental Health Billing
Key risk areas include:
- Overbilling session time
- Inadequate documentation
- Improper telehealth billing
- Diagnosis upcoding
Regular internal audits reduce compliance risk.
Best Practices for Mental Health Medical Billing
- Verify insurance eligibility before visits
- Follow payer-specific billing rules
- Document thoroughly and consistently
- Use certified mental health coders
- Perform monthly billing audits
Final Thoughts
Mental health billing requires a deep understanding of CPT codes, ICD-10 diagnosis codes, modifiers and payer-specific rules. For US mental health providers, accurate billing ensures stable revenue, regulatory compliance and reduced audit risk.
By implementing best practices and leveraging professional mental health billing services, practices can improve efficiency and maximize reimbursement while focusing on quality patient care.
