Psychiatry billing demands mastery of time-based psychotherapy codes, psychiatric E/M documentation, and the complex rules governing when to bill therapy alone versus therapy paired with a medical evaluation. VeriMedix brings deep psychiatric billing expertise to protect your revenue and keep your practice audit-ready.
Psychiatry billing occupies a unique position in medicine: it is the only specialty where physicians routinely bill either standalone psychotherapy codes (90832/90834/90837) or evaluation-and-management codes with add-on psychotherapy (E/M + 90833/90836/90838) for the same type of encounter. The choice depends entirely on whether a formal medical evaluation is performed. When a psychiatrist sees a patient solely for psychotherapy, the standalone codes apply. When the visit includes a formal medical E/M (reviewing systems, medications, mental status exam with documentation meeting MDM criteria), the psychiatrist bills the E/M code (e.g., 99214) plus the appropriate add-on psychotherapy code (90833, 90836, or 90838). A critical documentation requirement: the time spent on E/M activities cannot be counted toward the psychotherapy time component—both must be documented separately.
Psychiatric diagnostic evaluations—90791 (without medical services) and 90792 (with medical services)—are the starting point for most new patients. CPT 90792 is billed by physicians, NPs, or PAs who may manage medications as part of the evaluation. It reimburses higher than 90791 and is the standard code for initial psychiatric consultations where prescribing authority is exercised. Subsequent sessions for medication management alone (without psychotherapy) are billed as standard E/M codes (99212–99215) based on MDM or time. Sessions combining medication management and psychotherapy use the E/M + add-on structure.
Telehealth has become the dominant delivery modality in psychiatry. CMS permanently extended most telehealth flexibilities for psychiatric services, and the in-person visit requirement for mental health services (previously required within 6 months prior to initiating telehealth) was suspended through at least September 30, 2025. Psychiatrists should use modifier -95 with POS 02 or POS 10 for synchronous video visits; audio-only is allowed under Medicare when video is not feasible, with specific documentation requirements. Interstate licensing compacts (PSYPACT equivalents, pending state adoption for psychiatry) are gradually expanding telehealth practice across state lines. Parity law enforcement continues to make commercial reimbursement for telepsychiatry more consistent with in-person rates.
Below are commonly billed codes our certified coders manage for psychiatry practices. Always confirm payer-specific coverage and current code values.
| Code | Description | Billing note |
|---|---|---|
90792 | Psychiatric diagnostic evaluation with medical services | Initial psychiatric evaluation by prescribing provider (MD/DO/NP/PA); includes medication assessment; higher value than 90791 |
90791 | Psychiatric diagnostic evaluation without medical services | Initial evaluation by non-prescribing providers (psychologists, LCSWs); typically billed once per episode of care |
99214 | Office/outpatient E/M, established patient, moderate complexity (30–39 min or moderate MDM) | Common psychiatry E/M for medication management visits without psychotherapy |
90833 | Psychotherapy, 30 min add-on with E/M (16–37 min therapy component) | Add-on to E/M when 16–37 minutes of distinct psychotherapy is performed; document therapy time separately from E/M time |
90836 | Psychotherapy, 45 min add-on with E/M (38–52 min therapy component) | Add-on for 38–52 minutes of therapy concurrent with E/M; most common psychiatrist combined-session add-on |
90838 | Psychotherapy, 60 min add-on with E/M (53+ min therapy component) | Highest-value add-on; requires 53+ minutes of distinct documented therapy time alongside the E/M |
90837 | Psychotherapy, 60 minutes (53+ minutes), standalone without E/M | Used when visit is solely psychotherapy with no formal medical evaluation component |
90839 | Psychotherapy for crisis, initial 30–74 minutes | Crisis intervention code; cannot be billed on same day as routine psychotherapy codes for same patient |
90785 | Interactive complexity add-on (with 90791, 90792, 90832, 90834, 90837 or E/M + add-on) | Used when communication is unusually complex (e.g., severe agitation, third-party involvement, interpreter needs) |
Our standard operating procedures for psychiatry revenue cycle management — the step-by-step workflow we follow on every claim:
These are the issues we see most often in psychiatry billing — and exactly how we resolve them:
Billing 99214 + 90837 on the same claim is incorrect; 90837 is a standalone code. Fix: When both an E/M and psychotherapy are performed, bill the E/M code plus the applicable add-on (90833, 90836, or 90838) based on the documented therapy time.
Adding E/M time to therapy time to reach a higher-paying therapy code is a compliance violation. Fix: Implement documentation templates that capture therapy start/stop time as a separate field from total encounter time; train providers that only face-to-face therapy time counts toward the psychotherapy code.
Payers deny 90792 when the rendering NP or PA is credentialed only as a primary care provider and not specifically for psychiatric services. Fix: Credential NPs and PAs under behavioral health/psychiatry taxonomy codes (e.g., NUCC 193400000X for NP-Psychiatry/Mental Health) with all relevant payers.
CMS and most payers prohibit 90839 from being billed on the same date as standard psychotherapy codes (90832/90834/90837) for the same patient. Fix: Build a claim edit that flags any claim with both 90839 and a routine therapy code; document crisis services separately with clinically distinct notes.
Some practices incorrectly deny telehealth scheduling to new patients based on the CMS in-person visit requirement, which was suspended through at least September 30, 2025. Fix: Monitor CMS telehealth policy updates and communicate current requirements to scheduling staff; document each telehealth encounter's compliance basis.
Verimedix works inside the systems psychiatry practices already use, including:
Bill 90837 (standalone psychotherapy, 53+ minutes) when the entire session is psychotherapy with no formal medical evaluation. Bill 99214 + 90836 when the session includes both a formal E/M service (medication review, MDM-level assessment meeting 99214 criteria) AND 38–52 minutes of distinct psychotherapy. The key distinction is whether a formal medical evaluation was performed; if yes, use the E/M + add-on structure.
The note must clearly document two distinct services: (1) the E/M component—chief complaint, medication review, mental status exam, MDM elements (problem complexity, data reviewed, risk); and (2) the psychotherapy component—start/stop time or total therapy time, therapeutic techniques used, patient response, and treatment plan updates. Time spent on E/M cannot be counted toward the therapy time.
Yes. Nurse Practitioners who are enrolled in Medicare under a psychiatric/mental health taxonomy and have the appropriate state licensure can bill psychiatric codes (90791, 90792, 90832–90838, 99212–99215) under their own NPI. They do not bill 'incident to' a physician for outpatient mental health services under Medicare.
CMS suspended the requirement that patients must have an in-person visit within 6 months prior to initiating telehealth mental health services through at least September 30, 2025. After that date, policymakers may extend, modify, or allow the requirement to take effect. Practices should monitor CMS guidance and current law closely.
Group psychotherapy is billed with CPT 90853 per patient per session. The note must document the group setting, the session's therapeutic focus, each patient's individual participation and response, and the duration. Some payers cap the group size or require prior authorization for group therapy. Group therapy cannot be billed on the same day as individual therapy for the same patient unless there is clear clinical justification and separate documentation.
High-volume psychiatric ICD-10 codes include F32.1 (major depressive disorder, single episode, moderate), F33.1 (major depressive disorder, recurrent, moderate), F41.1 (generalized anxiety disorder), F41.0 (panic disorder), F20.9 (schizophrenia, unspecified), F31.9 (bipolar disorder, unspecified), F90.0 (ADHD, predominantly inattentive), and F43.10 (post-traumatic stress disorder, unspecified). Diagnosis specificity supports medical necessity and helps avoid generic code denials.
Verimedix handles the entire psychiatry revenue cycle — coding, submission, denials, and A/R — so your team can focus on patients.