Top CPT Codes for Mental Health Billing: A Comprehensive Guide

Precision in using CPT codes for mental health billing might not seem like a priority, but it plays a crucial role in the smooth operation of your practice. Proper coding ensures two important outcomes. Firstly, timely claim acceptance, which helps maintain cash flow and secondly, avoiding audits and potential fines from incorrect billing.

This comprehensive guide will help you understand the most important CPT codes for mental health billing, their correct usage, and how they can impact your practice.

Table of Contents

What Are CPT Codes for Mental Health?

CPT Codes (Current Procedural Terminology) are a set of standardized codes used to describe tests, evaluations, treatments, and other healthcare procedures. Published and updated annually by the American Medical Association (AMA), the codes help track healthcare trends and facilitate the insurance claim submission process.

Mental health CPT codes, specifically in the 90785-90899 range, cover various mental health services. These codes are used by both medical professionals, like psychiatrists, and non-medical professionals, such as:

Licensed Clinical Psychologists
Licensed Professional Counselors
Licensed Marriage and Family Therapists
Licensed Clinical Social Workers

Accurate CPT coding ensures providers are appropriately reimbursed for the services they deliver, improving cash flow and reducing the likelihood of rejected claims.

Categories of Mental Health CPT Codes

Mental health CPT codes can be categorized into four main types. Knowing which category your service falls under will streamline the billing process.

1. Psychiatric Diagnostic Interview

90801: Psychiatric diagnostic interview examination.
90802: Interactive psychiatric diagnostic interview examination.

These codes are used to bill for initial evaluations of patients, focusing on mental status and diagnostics.

2. Psychiatric Therapeutic Services

Codes 90804-90809: Insight-oriented, behavior-modifying, and supportive psychotherapy.
Codes 90810-90815: Interactive psychotherapy.

These codes cover individual therapy sessions aimed at modifying behavior, improving insight, and providing therapeutic support.

3. Family Medical Psychotherapy

90846: Family psychotherapy (without the patient present).
90847: Family psychotherapy (with the patient present).
90849: Multiple-family group psychotherapy.

Family therapy plays a significant role in treating mental health issues, and these codes are specifically designed to bill such sessions.

4. Group Psychotherapy

90853: Group psychotherapy (non-family group).
90857: Interactive group psychotherapy.

These codes apply to group therapy sessions where multiple clients interact, providing support and treatment to each other under the guidance of a therapist.

Common Mental Health CPT Codes You Should Know

Knowing the most common CPT codes can save you time and improve accuracy in your billing processes. Here are the CPT codes that mental health professionals use most frequently:

90837 — Psychotherapy, 60 minutes
Used for individual psychotherapy sessions lasting 60 minutes (or between 53 and 60 minutes).
Time: 60 minutes.
90834 — Psychotherapy, 45 minutes
Individual psychotherapy lasting between 38 and 52 minutes.
Time: 45 minutes.
90791 — Psychiatric diagnostic evaluation without medical services
This code covers an initial psychiatric evaluation without medical intervention. It includes the patient’s history and a mental status examination.
Time: Not time-based.
90847 — Family psychotherapy (with client present), 50 minutes
Used for family therapy sessions where the client is present. It can also apply to couples therapy.
Time: 50 minutes.
90853 — Group psychotherapy (non-family group)
This code covers group psychotherapy sessions where the interactions between members help with individual pathology.
Time: Not time-based.
90846 — Family psychotherapy (without client present), 50 minutes
Covers family therapy sessions without the client being present, aimed at helping treat the client.
Time: 50 minutes.
90832 — Psychotherapy, 30 minutes
For individual psychotherapy lasting 30 minutes (or functionally between 16 and 37 minutes).
Time: 30 minutes.
90838 — Psychotherapy, 60 minutes, with E/M service
Psychotherapy sessions combined with an evaluation and management (E/M) service.
Time: 60 minutes.
99404 — Preventive medicine, individual counseling, 60 minutes
Counseling and risk-reduction interventions aimed at preventing mental health issues.
Time: 60 minutes.

Understanding CPT Code Modifiers for Mental Health

CPT code modifiers provide additional context to a payer. They clarify specific scenarios in which services are provided, making sure the claims reflect the exact nature of the services. Here are the key modifiers used in mental health billing:

Modifier 25: Used when a separate Evaluation and Management (E/M) service is performed on the same day as a psychotherapy session. This modifier ensures that both services are billed correctly.
Modifier 59: This is for distinct non-E/M services done on the same day. Ensure documentation supports the distinct services.
Modifier GT: Used for telehealth services that involve interactive video and audio. With telehealth growing rapidly, especially after the COVID-19 pandemic, this modifier is critical.
Modifier UT: Used when the provider sees a patient in crisis, making it essential for accurately coding emergency situations.

Correct use of modifiers can improve claim approval rates, and failure to use them properly can result in denied claims or underpayment.

Telehealth CPT Codes for Mental Health Services

As telehealth has become more prevalent, particularly in mental health, knowing which CPT codes apply to virtual sessions is essential. Here are some key telehealth-related CPT codes:

90834 for individual psychotherapy can be used for telehealth sessions when combined with the GT modifier.
90837 is another common code for telehealth, especially for longer virtual therapy sessions.

It’s essential to stay updated with telehealth billing guidelines, as telehealth services are growing and regulations continue to evolve.

Why Accurate Coding Matters for Behavioral Health Practice

Accurate CPT coding isn’t just about getting paid quickly—it’s also about ensuring the long-term success of your practice. There are several reasons of why accuracy is required when billing for mental health and some of them are listed below:

Improved Cash Flow: Accurate billing means claims are processed quickly, reducing delays and ensuring consistent income.

Avoiding Audits and Fines: Incorrect coding can trigger audits. In some cases, improper billing practices can result in fines or penalties.

Better Practice Management: Using correct codes minimizes billing errors, reduces rejections, and helps streamline operations, giving you peace of mind.

Best Practices for Mental Health Billing

Stay Updated: The American Medical Association updates CPT codes yearly, so make sure you’re aware of any changes that may affect your billing.
Use Practice Management Software: Invest in software, such as Practice Mate, that simplifies the billing process, ensuring you’re always using the correct CPT codes and modifiers.
Regular Training: Ensure that your team is regularly trained on CPT codes and billing practices to avoid costly mistakes.

Conclusion: More Accurate Coding Means a Healthier Practice

Understanding and utilizing the correct CPT codes for mental health billing is critical for the success of your practice. Accurate coding means fewer rejected claims, faster payments, and a significantly lower chance of being audited.

Ready to streamline your mental health billing? Practice Mate offers a comprehensive, easy-to-use billing solution that ensures accurate claims every time. Book free consultation today and improve your practice’s billing efficiency.

Additional Resources (Optional):

How to Appeal Denied Claims Due to Incorrect CPT Codes
The Role of Documentation in Mental Health CPT Coding
Telehealth Billing Guidelines for 2024

By using this comprehensive guide and incorporating these best practices, your mental health practice can optimize its billing processes, reduce errors, and enhance financial performance. Practice Mate is here to help you achieve that goal.