Psychiatry & Mental Health Billing Services
Psychiatry billing combines complex psychotherapy codes, medication management, telehealth regulations, and insurance parity compliance. Our specialists understand psychiatry-specific reimbursement challenges and maximize revenue while ensuring compliant billing practices.
Critical Psychiatry Billing Challenges
Psychotherapy CPT Code Selection Errors
Psychotherapy codes (90832-90838) require precise selection based on session length and modality. Incorrect code selection (billing 90834 when 90837 is appropriate, or vice versa) causes systematic underpayment. Additionally, many practices fail to bill add-on codes (90833-90838 modifiers) for combined psychotherapy with evaluation/management, leaving significant revenue uncaptured.
Medication Management E/M Coding Confusion
Medication management-only visits (90862-90865) are frequently miscoded as psychotherapy or full psychiatry evaluation codes. These visits don't include psychotherapy but require proper documentation of medication review, side effects assessment, and medication adjustment. Incorrect coding or failing to bill separate medication management visits results in significant underpayment for medication-only appointments.
Group Therapy Billing Complexity
Group psychotherapy (90853-90858) has specific documentation and billing requirements often misunderstood. Group codes require clear identification of participant number, group composition, and whether psychotherapy or pharmacologic management is provided. Incorrect group code selection or failure to document group participation properly triggers denials and creates audit risks.
Telehealth/Telemedicine Coding Challenges
Post-COVID telehealth expansion created complex reimbursement rules that vary by payer and modality (synchronous vs. asynchronous, virtual vs. phone, etc.). Using wrong codes, missing required modifiers (-95 for synchronous, -GT for virtual), or failing to verify telehealth coverage for specific patients and codes results in denials or recoupments of significant telehealth revenue.
Insurance Parity Compliance Documentation
Mental Health Parity and Addiction Equity Act (MHPAEA) requires non-discriminatory treatment of mental health benefits. Practices frequently fail to maintain parity compliance documentation, use outdated benefit information, or don't appeal denied claims appropriately. Non-compliant billing and inadequate appeals leave mental health claims underpaid relative to medical/surgical claims.
Session Note Documentation Deficiencies
Psychiatry documentation must support the billed code/complexity. Inadequate psychiatric evaluation documentation, insufficient detail on psychotherapy content, or missing medication review details can't support higher-level codes. This results in downcoding during audit or claim denials. Insurance companies scrutinize psychiatry documentation more heavily than many specialties.
Our Psychiatry Billing Expertise
- Our psychiatry billing specialists maintain current expertise in psychotherapy CPT codes (90832-90838), medication management codes (90862-90865), and combination code application. We ensure correct code selection based on session length, modality, and clinical content to maximize reimbursement.
- We implement comprehensive documentation requirements specific to psychiatry, ensuring session notes support the billed code complexity and meet insurance company scrutiny standards. Our quality assurance specifically targets psychiatry documentation deficiencies.
- We handle complex group therapy billing with proper code selection, participant documentation, and multi-provider scenarios. Our team understands group composition rules, modifiers, and documentation requirements specific to different payer policies.
- We maintain current knowledge of telehealth coverage policies across major payers, properly apply telehealth modifiers (-95, -GT), and verify coverage before services are provided. We track rapid telehealth policy changes and adapt billing accordingly.
- We ensure MHPAEA compliance through systematic benefits verification, appropriate appeals for denied mental health claims, and documentation of parity compliance efforts. We advocate for appropriate mental health reimbursement.
- We provide expertise in Medicare and Medicaid psychiatry billing, including complex rules around pharmacologic management, psychiatric evaluation codes, and different reimbursement mechanisms across plans. We maximize reimbursement within each program's unique requirements.
Common Psychiatry CPT Codes
| CPT Code | Description |
|---|---|
| 90834 | Psychotherapy, 30 minutes (face-to-face with patient) |
| 90837 | Psychotherapy, 45 minutes (face-to-face with patient) |
| 90832 | Psychotherapy, 16-37 minutes |
| 90833 | Psychotherapy, 38-52 minutes |
| 90836 | Psychotherapy, 53+ minutes |
| 90838 | Psychotherapy, 60+ minutes (extended) |
| 90862 | Pharmacologic management, 15-20 min initial visit |
| 90863 | Pharmacologic management, 15-20 min established patient |
| 90865 | Psychotherapy w/medical evaluation, 45-50 min |
| 90846 | Family psychotherapy, 50 minutes, all parties |
| 90847 | Family psychotherapy, 50 min, patient present |
| 90853 | Group psychotherapy (up to 8 patients) |
Psychiatry Practice Performance Metrics
Psychotherapy Session Length & CPT Code Guide
| Session Length | CPT Code | Documentation Notes |
|---|---|---|
| 16-37 minutes | 90832 | Entry-level psychotherapy. Include brief assessment, limited psychotherapy content. Rare to use; most patients get 30+ min sessions. |
| 30 minutes (typical) | 90834 | Most common psychotherapy code. Requires documented psychiatric evaluation, psychotherapy content, and medication review if combined with med management. |
| 38-52 minutes | 90833 | Extended psychotherapy for complex cases. Requires documentation supporting extended length, more complex clinical issues, or combination with evaluation. |
| 45 minutes (standard) | 90837 | Traditional psychotherapy session length. Clearly the most frequently billed psychotherapy code. Requires same documentation as 90834. |
| 53+ minutes | 90836 | Extended session for highly complex cases or combination with other services. Requires documentation justifying extended time. |
| 60+ minutes (full hour) | 90838 | Full-hour psychotherapy for very complex presentations. Rarely appropriate. Requires extensive documentation of complexity. |
Telehealth/Telemedicine Psychiatry Billing
Post-COVID telehealth expansion significantly changed psychiatry billing. Key considerations for telehealth psychiatry:
- Modifier -95: Synchronous, real-time telehealth visit (video or phone). Required by most payers when billing standard psychotherapy codes via video/phone.
- Codes 99421-99423: Async telemedicine (store-and-forward video, patient portal messaging). Lower reimbursement; typically for established patients only.
- Coverage Verification: Telehealth coverage varies widely by payer and patient state. Verify coverage BEFORE service delivery to prevent claim denial.
- Virtual Restrictions: Many payers still restrict telehealth to established patients or specific conditions. Some restrict telehealth psychiatry entirely.
- State Variations: Some states have specific telehealth regulations. Prescribing privileges vary by state; confirm authorization before telemedicine prescriptions.
- Documentation: Document explicitly that visit was conducted via [video/phone] and that patient provided informed consent for telehealth. This supports modifier use.
Co-Therapy and Co-Provider Billing
When two psychiatrists/therapists provide joint psychotherapy in a single session:
- ✓Both co-providers can bill their individual psychotherapy codes for time participated
- ✓Document clearly which provider was present for which duration
- ✓Ensure combined provider time doesn't exceed the documented session length
- ✓Each provider bills their own code based on actual time (e.g., both bill 90834 if both attended 30-min session)
- ✓Cannot bill individual psychotherapy codes AND group therapy for same patient in same session
- ✓Insurance company may reimburse both providers or require coordination
- ✓Requires clear documentation in billing system tracking provider participation time
Psychiatry Billing FAQs
What's the difference between psychotherapy codes (90832-90838)?
Psychotherapy codes are differentiated by time: 90832 (16-37 min), 90834 (typically 30 min), 90833 (38-52 min), 90837 (typically 45 min), 90836 (53+ min), and 90838 (60+ min). Time must be documented in the session note (actual time spent in psychotherapy, not total visit time). Choose the code that matches documented session time. Don't round up or down; use the code matching actual time spent.
How do I bill when combining psychotherapy with medication management?
When combining psychotherapy with medication review/adjustment in a single visit, you can bill either: 1) Psychotherapy code only if medication management is brief, or 2) Both psychotherapy AND medication evaluation codes if sufficient time and documentation supports both. However, you cannot bill both 90834 and 90865; the 90865 code specifically includes psychotherapy. Document time spent in each component separately to support billing both codes when appropriate.
What are medication management codes and when do I use them?
Medication management codes (90862-90865) are for medication review, adjustment, and monitoring without significant psychotherapy. 90862 and 90863 are 15-20 minute medication-only visits. 90865 combines psychotherapy with psychiatric evaluation and medication management (45-50 min). Use 90862/90863 for brief med checks; use 90865 for combined psychotherapy + med management. Requires documentation of medications reviewed, side effects assessed, and adjustments made.
How do I bill group psychotherapy correctly?
Group psychotherapy codes (90853-90858) require clear documentation of: number of participants, group composition, whether treatment is psychotherapy or pharmacologic management, and each patient's participation. The code used depends on group size (up to 8 patients vs. 9+ patients). You must bill each group member separately with the appropriate group code. Cannot bill more than one group therapy code per patient per date.
What documentation is required for psychiatry visits?
Psychiatry documentation must include: presenting problem/chief complaint, psychiatric history, review of medications and side effects, mental status examination findings, assessment/diagnosis, treatment plan, and time spent in visit. For psychotherapy visits, document specific psychotherapy interventions/content. For medication management, document medication review, changes, and patient response. Inadequate documentation is a major source of denials and audits.
How do telehealth codes differ from in-person codes?
Telehealth psychotherapy uses the same CPT codes (90832-90838) but requires modifier -95 (synchronous telehealth) if using established codes, or specific telehealth codes may apply depending on your EHR and payer. Real-time video/phone visits use standard codes with -95 modifier. Asynchronous telehealth (store-and-forward video, messaging) uses different codes (99421-99423). Verify payer's specific telehealth coverage before service; many payers restrict telehealth to established patients.
What's the Mental Health Parity and Addiction Equity Act (MHPAEA)?
MHPAEA requires insurance companies to provide mental health benefits on par with medical/surgical benefits. This means mental health claims shouldn't be denied more frequently, have stricter limits, or have different authorization requirements than medical claims. If your mental health claims are being denied more than comparable medical claims, the payer may be violating parity. Document parity violations and appeal denied claims emphasizing parity compliance requirements.
How do I handle co-therapy and co-provider billing?
When two providers conduct psychotherapy together, both can bill for their participation. Each provider bills their own psychotherapy code for the time they participated. Document which provider did what (e.g., 'Dr. A and Dr. B conducted joint psychotherapy session, 45 minutes'). Ensure both providers' times don't exceed the session length. Cannot bill full code twice for same service; each bills based on actual time participated.
Are there special Medicare considerations for psychiatry billing?
Medicare has specific psychiatry billing rules: psychotherapy codes require specific time intervals (CPT-defined), no stacking of codes (can't bill 90834 + 90862 in same visit), and psychiatric evaluation codes (99203-99205) are sometimes appropriate instead of psychotherapy for initial visits. Medicare pays lower rates for telehealth in many cases. Requires documentation supporting time-based billing. Medicare is more restrictive; verify coverage before service.
How do I document adequate session notes to support higher-level codes?
Higher-level codes require documentation of increased complexity: 90834 (30 min) vs. 90837 (45 min) requires different documentation depth. Include specific psychotherapy interventions, patient response, clinical progress, medication adjustments, and time spent. 'Patient discussed feelings' is insufficient; document specific therapeutic techniques used, issues addressed, and clinical progress. Many denials result from insufficient documentation; detailed notes support billing accuracy.
What should I know about psychiatry coding for Medicaid?
Medicaid psychiatry billing varies significantly by state. Some states reimburse lower rates, have frequency limits, or restrict telehealth. Prior authorization is often required. Documentation requirements are typically stricter. Always verify your state's Medicaid rules before billing. Some states use specific coding guidelines that differ from CPT standards. Staying current with state-specific Medicaid updates is critical for appropriate reimbursement.
Medicare & Medicaid Psychiatry Billing Considerations
Medicare Psychiatry Rules:
- Psychotherapy codes require documented time intervals
- Cannot stack psychotherapy + medication mgmt codes in same visit
- Psychiatric evaluation codes (99203-99205) may apply for initial visits
- Telehealth rates are often lower than in-person
- Requires detailed documentation supporting time-based billing
- Medicare Advantage plans have variable coverage; verify before service
Medicaid Psychiatry Rules:
- Varies significantly by state; some states reimburse lower rates
- Frequency limits may apply (e.g., max 1 visit/week)
- Prior authorization often required
- Documentation requirements typically stricter than commercial
- Telehealth coverage varies by state
- Stay current with state-specific Medicaid updates
Maximize Your Psychiatry Practice Revenue
Let our psychiatry billing specialists handle complex psychotherapy coding, telehealth compliance, parity requirements, and payment optimization while you focus on patient mental health care.