While precision in how you use CPT codes may not seem of utmost significance, in fact, using the correct CPT codes for the mental health services you provide is important for two major reasons. When your claims include the right codes, they’ll be accepted in a more timely manner, ensuring you have the necessary cash flow to operate your practice. Perhaps more urgently, coding mistakes could cause your practice to be audited, and errors could result in fines. In this post, we’ll cover what you need to know about using CPT codes and the most common codes you should become familiar with.
What are CPT Codes for Mental Health?
The Current Procedural Terminology (CPT) code set describes tests, evaluations, treatments, and other medical procedures used in the spectrum of healthcare. The set contains over 8,000 codes and is published and updated annually by the American Medical Association. It was created to track healthcare trends and issues as well to use in the claims submission process. The codes communicate to payers what procedures you need to be reimbursed for as a provider.
The codes related to mental health (codes 90785-90899) are found in the Psychiatry section of the CPT code set and cover services provided by medical professionals, such as psychiatrists, as well as services that can be delivered by non-medical professionals such as licensed clinical psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers.
Categories of Mental Health CPT Codes
The mental health CPT codes used by therapists are organized into four distinct categories. These categories make it easier to find the code you’re looking for.
Psychiatric Diagnostic Interview
- Code 90801: Psychiatric diagnostic interview examination
- Code 90802: Interactive psychiatric diagnostic interview examination
Psychiatric Therapeutic Services
- Codes 90804-90809: Insight-oriented, behavior modifying and/or supportive psychotherapy
- Codes 90810-90815: Interactive psychotherapy
Family Medical Psychotherapy
- 90846: Family psychotherapy (without the patient present)
- 90847: Family psychotherapy (with the patient present)
- 90849: Multiple-family group psychotherapy
Group Psychotherapy
- 90853: Group psychotherapy (other than a multiple-family group)
- 90857: Interactive group psychotherapy
Common Mental Health CPT Codes
While there are many codes that may be applicable to mental health services more broadly, in a therapy setting, you’ll probably find yourself using only a relatively small subset of these codes. Learning the most common CPT codes for mental health will help you choose the best code for each service you provide. Here are the most common codes that you’ll encounter as a therapist.
90837 — Psychotherapy, 60 minutes
Description: Individual psychotherapy, 60 minutes, with client and/or family member.
Time: 60 minutes (functionally between 53 and 60 minutes)
90834 — Psychotherapy, 45 minutes
Description: Individual psychotherapy, 45 minutes, with client and/or family member.
Time: 45 minutes (functionally between 38 and 52 minutes)
90791 — Psychiatric diagnostic evaluation without medical services
Description: Initial diagnostic interview exam that does not include any medical services. Includes a chief complaint, history of present illness, family and psychosocial history, and complete mental status examination. (Use code 90792 for an initial evaluation with medical services.)
Time: Not time-based
90847 — Family psychotherapy (with client present), 50 minutes
Description: Family psychotherapy (conjoint psychotherapy) (with client present). (Can also be used for couples therapy.)
Time: 50 minutes
90853 — Group psychotherapy (other than of a multiple-family group)
Description: Group psychotherapy (other than of a multiple-family group). Relies on the use of interactions of group members to examine the pathology of each individual within the group. The dynamics of the entire group are noted and used to modify behaviors and attitudes of the client members. (Used to report per-session services for each group member.)
Time: Not time-based
90846 – Family psychotherapy (without client present), 50 minutes
Description: Therapy session intended to aid the treatment of the client, where the family of a client is present without the client being present.
Time: 50 minutes
90875 – Under other psychiatric services or procedures
Description: Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the client), with psychotherapy (e.g., insight-oriented, behavior modifying, or supportive psychotherapy).
Time: 20-30 minutes
90832 – Psychotherapy, 30 minutes
Description: Individual psychotherapy, 30 minutes
Time: 30 minutes (functionally between 16 – 37 mins)
90838 – Psychotherapy, 60 minutes, with E/M service
Description: Individual psychotherapy, 60 minutes with client and/or family member when performed with an evaluation and management (E/M) service.
Time: 60 minutes (functionally between 53 and 60 minutes)
99404 — Under preventive medicine, individual counseling services
Description: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)
Time: 60 minutes (functionally between 53 and 60 minutes)
CPT Code Modifiers
Code modifiers provide additional information to a payer. Modifiers can describe the license level of provider, when services were provided, and how the services were provided, among other things. Here are four modifiers that you may encounter.
- Modifier 25 — Typically, a single code will accurately describe a session. But occasionally, you may find that a fully separate E/M service is needed (performed by the same provider) on the same day. Modifier 25 is used in these situations, as it calls out that service as separate and reimbursable. Note that you can only attach modifier 25 to codes 99201-99215, 99341-99350.
- Modifier 59 — Similar to modifier 25, this modifier is used to describe a distinct non-E/M procedural service done on the same day. Note that your documentation must support a separate session.
- Modifier GT — Used for telehealth sessions involving interactive audio and video.
- Modifier UT — Used when the provider sees a patient in crisis.
More Accurate Coding Means a Healthier Practice
When you understand how CPT codes work and have a firm knowledge of the codes you’ll use most often in your therapy practice, you’ll increase your claims submission rate and reduce the likelihood of being flagged for inappropriate coding. Beyond the practicality of improving cash flow, accurate coding delivers peace of mind since you won’t have to worry about whether or not you’re using CPT codes correctly.