The billing process for therapists on an insurance panel is often tedious, but the Current Procedural Terminology (CPT) guidelines are intended to make it easier.
The CPT billing codes for mental health can seem intimidating at first glance, as there are over 8,000 codes in the entire system. As a psychotherapist, you’re only likely to use a small number of these codes.
In this guide, we’ll cover the most common CPT billing codes for mental health.
What Are CPT Billing Codes For Mental Health?
Current Procedural Terminology (CPT) codes are set codes used by healthcare professionals to denote certain services. The simple codes indicate a service a therapist might be expected to provide, creating an easy-to-use system for describing patient care.
CPT codes are most often used for billing and filing for reimbursement from health insurance companies. The codes can be used for both private insurance and government insurance providers.
Acting as a shorthand, they streamline the filing system and reduce the risk of miscommunication.
CPT codes do undergo periodic changes, designed to reflect the growing field of psychology. CPT codes are reviewed annually (although they don’t necessarily change annually), so stay aware of any updates that might affect your practice.
Why Do You Need To Know Billing Codes?
If you’re on an insurance panel, or you provide your patients with superbills, you need to know your CPT codes. Knowing your codes can streamline the billing process, ensuring you get paid the correct amount in a timely manner.
Several factors determine just how much an insurance panel will reimburse you, but the CPT codes are a key part of the equation. The CPT codes describe the exact service that you need to receive reimbursement for.
Getting the wrong CPT code can lead to an incorrect reimbursement. Potentially, using the wrong codes can also trigger an audit. Using the wrong code, even by accident, can have serious financial repercussions.
Learning the CPT billing codes can seem like an intimidating prospect, but it doesn’t have to be. With repeated use, you’ll naturally start to memorize the codes that come up frequently, while growing familiar with the codes you use less often.
Categories Of Billing Codes For Mental Health
CPT Codes fall into three broad categories, with the Category I codes used most often.
- Category I codes are 5-digit CPT that identify established procedures. The codes refer to specific practices that generally fall under the care of an insurance provider.
- Category II codes are information-gathering codes. They describe the quality of care provided and can act as a measure of performance. These codes aren’t used for billing purposes.
- Category III codes are the newest additions to the CPT. These describe newer technologies and services, and they’re often used for data collecting.
Some Category III codes are used for billing (specifically for services that aren’t covered by Category I), but they’re less common in daily practice.
Common CPT Billing Codes For Mental Health
There are over 8000 CPT codes, but you can relax, you don’t need to know them all. There are only 24 designated psychotherapy codes, and realistically, you’ll only use a small handful of them.
The code you’ll probably use most is 90834. This refers to psychotherapy with a patient, lasting for roughly 45 minutes (between 38 minutes and 52 minutes).
You might also use 90837 (psychotherapy with a patient for over 53 minutes) if you conduct longer sessions, or 90832 (psychotherapy with a patient for roughly 30 minutes) if you have shorter sessions.
The most common CPT billing codes for mental health are:
- 90791: Psychiatric Diagnostic Evaluation.
- 90792: Psychiatric Diagnostic Evaluation with medical services.
- 90832: Psychotherapy, 30 minutes with the patient (16 to 37 minutes duration).
- 90834: Psychotherapy, 45 minutes with the patient (38 to 52 minutes duration).
- 90837: Psychotherapy, 60 minutes with the patient (53 minutes and over duration).
- 90839: Psychotherapy for crisis, 60 minutes (30 to 74 minutes)
- 90846: Family or couples psychotherapy, without the patient present (50 minutes duration).
- 90847: Family or couples psychotherapy, with the patient present (50 minutes duration).
- 90853: Group Psychotherapy (not including family psychotherapy).
The following CPT codes aren’t from the initial block of psychotherapy codes, but they are still frequently used by mental health practitioners. These codes are:
- 97803: Medical nutrition therapy, face-to-face with patient for reassessment or intervention (15 minutes).
- 99214: Office or outpatient management of an established patient who requires medical examination or moderate decision making.
Add-On Codes
These CPT codes are used in addition to the procedural codes. Common add-on CPT codes are:
- 90840: Used with 90839, an additional 30 minutes of psychotherapy for crisis (75 minutes and over).
- 90785: Can be used with any primary procedure (codes 90791, 90832, 90834, 90837, 90835), this code denotes an interactive complexity. A client must display one of four complicating factors outlined in the CPT manual, related to a struggle to communicate.
- 90863: Used with primary procedures, this code refers to pharmacological management, including prescribing or reviewing medication, performed alongside a psychotherapy service.
- -95: Used with the primary procedures (most commonly 90834 and 90837), this code denotes a telehealth service.
Add-on codes are a quick way to signify exactly what you’re billing an insurance company for.
CPT Code Updates
The CPT is reassessed annually, to keep it up to date with contemporary medical practices. As there are over 8,000 codes in the CPT, with applications across all medical fields, many of the changes won’t affect your billing process.
However, it’s important to stay alert to any changes.
The code reassessment ensures the CPT is in line with development in the healthcare industry. For example, the 2022 update included new codes related to Covid-19 vaccination programs.
When a new code is released, check the changes to see if any of them are relevant to your practice. Using an outdated code can greatly slow down the billing process, and might prevent you from getting a full reimbursement.
Final Thoughts
The CPT code might seem like an intimidating document at first, but it helps insurance panel therapists get payment promptly. Learn the codes that are most relevant to your practice, so you can streamline the billing process.
