When a mental health provider treats a patient, they use specific CPT codes for billing. Diagnostics, therapy, and treatment of mental and behavioral health illnesses are all part of mental health care. Mental health professionals who use CPT codes include psychologists, psychiatrists, and certified clinical social workers.

The psychiatry segment of the CPT code set contains the mental health codes (90785–90899) covering services rendered by medical and non-medical providers. These codes can be found in the CPT code set. CPT codes are used by mental health practitioners when submitting claims to insurance companies.

Your healthcare practitioner will submit a claim with the relevant CPT codes to your insurance carrier after you receive mental health care. The insurance carrier uses these codes to calculate the amount reimbursed to your mental health practitioner.

Classification of Mental Health CPT Codes

There are four main groups within which clinicians can locate the mental health CPT codes they need. These categories simplify code search.

  • Mental Health Diagnostic Interview

  1. Code 90801: Psychological or Psychiatric Diagnostic Interview and Evaluation
  2. Code 90802: Diagnostic Interview-Based Psychological Test

  • Mental Health Therapeutic Services

  1. Codes 90804–90809 indicate psychotherapy focusing on insight, behavior modification, and emotional support.
  2. Codes 90810 through 90815: Engaging psychotherapy

  • Mental Health Counseling for Families

  1. 90846: Counseling for families (without the patient present)
  2. 90847: Family counseling (with the patient present)
  3. 90849: Group treatment for several families

  • Therapeutic Group Sessions

  1. 90853: Group counseling (other than a multiple-family group)
  2. 90857: Participatory group treatment

Standard CPT codes for mental health

Although numerous codes may be relevant to mental health services, you will likely use only a limited portion of these codes in therapy. You can select the most appropriate CPT code for each service you offer by being familiar with the most frequent ones for mental health.

The most prevalent codes for therapists are listed below.

90837 — One hour of psychotherapy
  • Explanation: Individual therapy for an hour with the client and a family member
  • Duration: 1 hour (functionally between 53 and 60 minutes)
90834 — 45 minutes of psychotherapy
  • Explanation: 45-minute sessions for clients and family members in individual psychotherapy.
  • Duration: 45 minutes (functionally between 38 and 52 minutes)
90791 — Psychological diagnostic assessment without medical care
  • Explanation: This is the first diagnostic interview test without any associated medical treatments. Includes a thorough mental stability assessment, a major complaint, a history of the current disease, a family background, and psychosocial information. (For an initial evaluation with medical services, use code 90792.)
  • Duration: Not dependent on time
90847 — 50-minute family therapy session (with the client in attendance)
  • Explanation: family therapy (sometimes called concurrent therapy) (with the client present). (It may be applied to couples’ therapy as well.)
  • Duration: 50 minutes
90853 – Psychotherapy in a group setting (other than of a multiple-family group)
  • Explanation: Group counseling (other than a multiple-family group). Focuses on the utilization of group interactions to investigate the pathology of each member of the group. Analyzing group dynamics and acting on such information influences clients’ actions and perspectives. (Reported services on a per-member basis.)
  • Duration: Not dependent on time
90846: 50 minutes of family therapy without the client’s presence.
  • Explanation: Psychotherapy is meant to enhance the client’s treatment in situations where the client’s family is present but the client is not.
  • Duration: 50 minutes
90875 – Under various mental health treatments or services
  • Explanation: Integrating biofeedback training (directly observing client behavior) into an individual psychotherapeutic session (e.g., insight-oriented, behavior modifying, or supportive psychotherapy).
  • Duration: 20 to 30 minutes
90832: 30 minutes of psychotherapy
  • Explanation: Half an hour of individual counseling
  • Duration: 30 min (functionally between 16 – 37 mins)
90838—60-minute psychotherapy using E/M service
  • Explanation: 60 minutes of individual psychotherapy with the client or a family member combined with an assessment and management (E/M) session.
  • Duration: 1 hour (functionally between 53 and 60 minutes)
99404 — Individual psychotherapy services for preventative medicine
  • Explanation: Individualized preventive medicine counseling and risk factor reduction (separate procedure)
  • Duration: 60 minutes (functionally between 53 and 60 minutes)

Modifiers for CPT Code

Payers can gain more insight with the use of code modifiers. In addition, modifiers can specify the provider’s license status, the time the services were rendered, and how they were delivered. These are four such modifiers that you can run into.

  • 25th Modifier —

Usually, a session can be correctly described by a single code. But occasionally, you can discover that an entirely different E/M service—performed by the same provider—is required on the same day. In these circumstances, modifier 25 is utilized to identify the service as distinct and reimbursable. Remember that only the codes 99201-99215 and 99341-99350 can have modifier 25 attached.

  •  59th Modifier —

This Modifier, like modifier 25, designates a unique non-E/M procedural service performed on the same day. Remember that your documentation must support a special session.

  • GT Modifier —

They are used for telemedicine sessions integrating audio and video interaction.

  • The UT Modifier —

They are used when a doctor observes a patient in distress.

Conclusion

While seeking mental illness treatment, solid knowledge of mental health CPT codes is essential. Understanding mental health CPT codes and how they are billed will help you manage the mental health care system and get the required treatment. Consult your mental health practitioner or insurance company if you have any queries regarding the CPT codes for mental health.

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