Psychiatric Diagnostic Evaluations

• 90791: Psychiatric Diagnostic Evaluation Without Medical Services
  This code is used for initial evaluations focusing solely on assessing the mental health condition without including any medical interventions like prescriptions.

• 90792: Psychiatric Diagnostic Evaluation With Medical Services
  Used when the initial evaluation involves both a psychiatric assessment and medical services such as medication management.

Psychotherapy

• 90832: Psychotherapy, 30 Minutes
  For individual psychotherapy sessions lasting approximately 30 minutes. Includes assessment and therapeutic intervention.

• 90833: Psychotherapy, 30 Minutes With E/M Service
  This add-on code is used for 30-minute therapy sessions that occur alongside an evaluation and management (E/M) service.

• 90834: Psychotherapy, 45 Minutes
  For sessions lasting about 45 minutes, providing ample time for individual therapy.

• 90836: Psychotherapy, 45 Minutes With E/M Service
  Used in combination with E/M codes for 45-minute sessions.

• 90837: Psychotherapy, 60 Minutes
  Used for extended therapy sessions lasting approximately 60 minutes, allowing for comprehensive therapy.

• 90838: Psychotherapy, 60 Minutes With E/M Service
  Used in combination with E/M codes for 60-minute sessions.

Group and Family Therapy

• 90845: Psychoanalysis
  This code is used specifically for psychoanalytic therapy.

• 90846: Family Psychotherapy Without Patient Present
  Used for therapy sessions with family members without the patient present.

• 90847: Family Psychotherapy With Patient Present
  Used when family therapy sessions include the patient, focusing on family dynamics and interactions.

• 90849: Multiple-Family Group Psychotherapy
  Used for group therapy sessions involving multiple families, providing a shared therapeutic experience.

• 90853: Group Psychotherapy
  This code is used for group therapy sessions, where a therapist treats multiple patients in a shared setting.

Interactive Complexity

• 90785: Interactive Complexity
  This add-on code is used when factors complicate the delivery of psychotherapy services, such as working with children or patients with special needs requiring additional communication.

Crisis Intervention

• 90839: Psychotherapy for Crisis, Initial 60 Minutes
  For emergency therapy sessions addressing acute psychological crises, lasting at least 60 minutes.

• 90840: Psychotherapy for Crisis, Each Additional 30 Minutes
  Used alongside 90839 to account for additional time spent on crisis intervention.

Psychiatric Evaluation and Management Services

• 99201-99205: New Patient Office or Other Outpatient Visits
  Codes for initial evaluations of new patients, ranging from minimal to comprehensive complexity.

• 99211-99215: Established Patient Office or Other Outpatient Visits
  Used for follow-up visits with established patients, reflecting varying levels of complexity and time.

Behavioral Health Screening and Assessment

• 96110: Developmental Screening
  Used for brief assessments of developmental milestones in children.

• 96112: Developmental Test Administration, First Hour
  Used for administering developmental tests and assessments for an hour.

• 96113: Developmental Test Administration, Each Additional 30 Minutes
  Add-on code used for additional time spent on developmental assessments.

• 96116: Neurobehavioral Status Exam, First Hour
  For evaluating a patient’s neurocognitive and emotional functioning, lasting an hour.

• 96121: Neurobehavioral Status Exam, Each Additional Hour
  Used for extended evaluations of neurocognitive functioning beyond the initial hour.

Psychological Testing

• 96130: Psychological Testing Evaluation Services, First Hour
  Used for evaluating psychological tests and measures over a one-hour session.

• 96131: Psychological Testing Evaluation Services, Each Additional Hour
  Add-on code for additional time spent evaluating psychological tests.

• 96136: Psychological or Neuropsychological Test Administration, First 30 Minutes
  Used for administering tests and assessments for cognitive or emotional functioning, lasting 30 minutes.

• 96137: Psychological or Neuropsychological Test Administration, Each Additional 30 Minutes
  For continued administration of tests beyond the initial 30 minutes.

Health and Behavior Assessment/Intervention

• 96150: Health and Behavior Assessment, Initial Assessment
  Used for evaluating the psychological factors affecting a patient’s physical health and treatment plan.

• 96151: Health and Behavior Assessment, Re-assessment
  Used for re-evaluating the psychological factors impacting health management.

• 96152: Health and Behavior Intervention, Individual
  For individual interventions addressing psychological factors affecting health.

• 96153: Health and Behavior Intervention, Group
  Used for group interventions focusing on health-related psychological issues.

• 96154: Health and Behavior Intervention, Family With Patient
  Used for family interventions that include the patient, focusing on health-related behavior changes.

• 96155: Health and Behavior Intervention, Family Without Patient
  Used for family interventions without the patient present, focusing on health-related behaviors.

Other Behavioral Health Services

• 99080: Special Reports or Forms
  Used for providing documentation or reports beyond standard services, such as filling out detailed forms or insurance paperwork.

• 99401-99404: Preventive Medicine Counseling
  Codes for individual counseling sessions focused on preventing disease and promoting health, ranging from 15 to 60 minutes.

• 99411-99412: Group Preventive Medicine Counseling
  Used for group sessions providing preventive health counseling.

• 99441-99443: Telephone Services
  For providing evaluation and management services over the phone, ranging from 5 to 30 minutes.

Important Considerations

Time-Based Billing

Many behavioral health codes are time-based, requiring precise documentation of the duration of services. Accurate time tracking ensures compliance with billing standards and maximizes reimbursement.

Modifiers

Utilizing appropriate modifiers is crucial for distinguishing unique circumstances or additional services provided during therapy sessions. For example, the 95 modifier indicates telemedicine services.

Documentation

Comprehensive documentation supports the use of specific CPT codes and protects against audits or claim denials. Records should detail the nature of services provided, patient progress, and any additional interventions or complexities.

Conclusion

A thorough understanding of behavioral health CPT codes is essential for accurate billing and optimal reimbursement. By using the appropriate codes and ensuring detailed documentation, practices can improve their billing processes and support their financial health. 

At Certified Healthcare Billing, we specialize in behavioral health billing services. We offer expert solutions to streamline your billing processes and maximize your practice’s revenue.

FAQ Section

How do I choose the right psychotherapy code based on session length?

Psychotherapy codes are time-based. Use 90832 for 30-minute sessions, 90834 for 45-minute sessions, and 90837 for 60-minute sessions.

What is the difference between 90791 and 90792?

90791 is for diagnostic evaluations without medical services, while 90792 includes medical services like prescriptions.

When should I use the interactive complexity add-on code 90785?

Use 90785 when communication during therapy is complicated by factors such as language barriers or treating young children.

What codes are used for telephone services in behavioral health?

Use codes 99441 to 99443 for telephone evaluation and management services, with varying durations from 5 to 30 minutes.

How does accurate documentation impact behavioral health billing?

Accurate documentation supports code selection and helps prevent claim denials by detailing services provided and patient progress.