Current procedural terminology (CPT) codes are the backbone of accurate medical billing and coding processes. It is used to identify different types of mental health services, ranging from psychiatric evaluation to psychotherapy sessions and medication management. Being familiar with complex mental health medical billing is crucial for providers and therapists, not only to claim reimbursement accurately but also to ensure smooth claim processing.
In this blog, we will cover everything you need to know about CPT codes for mental health billing. Categories of mental health codes are discussed in detail. In addition, this blog makes you familiar with the most common CPT codes used in mental health.
What are the CPT Codes for Mental Health?
Mental health CPT codes aim to recognize and cover the services required for diagnosing, treating, and managing mental health conditions. These codes (codes 90785–90899) fall within the Psychiatry section of the CPT code set and encompass services provided by medical professionals.
Examples are psychiatrists and non-medical professionals such as licensed clinical psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers.
Moreover, CPT codes simplify the billing and reimbursement process for mental health services that healthcare providers render. Thus, it ensures organized and consistent service delivery. Additionally, they provide communication between healthcare providers, insurance companies, and regulatory agencies. Furthermore, these codes help in the streamlining of administrative processes and in the proper utilization of mental health resources.
Also Read: How are Modifiers 59, 25, and 91 used in Medical Billing?
Categories of Mental Health CPT Codes
CPT codes for mental health services are categorized into various groups depending on the type of procedures and services rendered. This includes:
Evaluation and Assessment
It encompasses codes for initial psychiatric assessments, diagnostic assessments, and re-assessments to find out the kind and state of mental health conditions.
Psychotherapy Services
These codes cover different varieties of psychotherapy, including individual, group, and family psychotherapy, with a focus on emotional, behavioral, or cognitive aspects.
Medication Management
This class covers the relevant codes for the management of psychiatric medications, such as prescribing, monitoring, and adjustments of medication regimens to achieve the desired treatment results.
Crisis Intervention
Healthcare providers use such codes for services rendered in urgent or crisis situations where they need immediate interventions, such as addressing acute psychological distress or the risk of harm.
Psychological Testing and Assessment
These codes encompass the management, administration, scoring, and interpretation of standardized psychological tests to evaluate cognitive skills, emotional functioning, personality traits, and other relevant factors.
Collaborative Care Management
This category encompasses the codes allocated for collaborative care services. This involves coordination between primary care providers, mental health specialists, and other health professionals. Furthermore, such collaborative care ensures complete and integrated treatment for patients with mental health conditions.
Telepsychiatry and Telehealth Services
As technology has advanced, patients can now access mental health services more conveniently and easily thanks to telecommunication platforms.
Other Mental Health Services
This class aims to include the codes that fall into the mental health services not covered in the aforementioned categories, such as health and behavior assessment and intervention services or psychotherapy for urgent situations beyond the ordinary sessions.
The above mentioned categories provide the basis for the organization and coding of mental health services. It allows healthcare providers to describe in detail the treatment provided and to obtain reimbursement from payers.
Common Mental Health CPT Codes
CPT codes for mental health services can be different based on the exact type of service. Here are some examples of CPT codes commonly used in mental health:
Initial Psychiatric Diagnostic Evaluation codes
90832: Psychotherapy, 30 minutes with the patient and/or family member
Healthcare providers use the code for billing individual therapy sessions lasting 30 minutes. It can also be used for family therapy.
90834: Psychotherapy, 45 minutes with the patient and/or family member
The code 90832 is designed for individual or family therapy sessions, but these codes represent 45-minute sessions.
90837: Psychotherapy, 60 minutes with the patient and/or family member.
This is only for sessions of individual or family counseling that last 60 minutes.
90839: Psychotherapy for crisis, first 60 minutes
Specifically, this code is what you use in the psychotherapy sessions that you would administer in a crisis situation with a maximum run period of 60 minutes. It is usually used by medical professionals to provide short-term therapies that target immediate psychological distress or assess the risk of harm.
90840: Each additional 30 minutes of Psychotherapy for a Crisis
If the crisis psychotherapy session extends beyond 60 minutes, providers will bill this code to cover each additional 30-minute increment.
Psychiatric Evaluation with Medical Services
90792: Psychiatric Diagnostic Evaluation with Medical Services
Providers use this code for the first comprehensive examination of a patient’s mental health condition, which classifies into two groups: psychiatry and medicine. This process usually includes a thorough interview with history-taking, a mental status examination, and, if necessary, a review of the medical services provided, such as a physical examination or review of the medical records.
90863: Pharmacologic Management, including Prescription and Review of Medication, when performed with Psychotherapy Services
This code is utilized when co-management of medications and psychotherapy sessions are delivered at the same time. It covers activities like prescribing drugs, adjusting dosage regimens, and assessing effectiveness as well as side effects.
Psychological Testing
96130: Psychological testing evaluation services by a physician or other healthcare professional who is qualified. This includes the incorporation of patient data, interpretation of standardized test results, clinical data, clinical decision-making, treatment planning, and the production of a report and interactive feedback to the patient, family member, or other caregiver when provided in the first 60 minutes.
96131: Physician or other qualified healthcare professional evaluation of psychological testing and integration of patient data, interpretation of standardized test results and clinical data, clinical decision-making, treatment planning, and reporting and interactive feedback to patients, family, or caregivers when done in 30 minutes each.
Medication Management
90863: Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
This code is used when medication management services are also conducted during the psychotherapy sessions. It comprises activities like prescribing medications, modifying medications’ regimens, monitoring medication effectiveness, and reviewing their possible side effects.
90865: Medication management (pharmacotherapy) services, with the face-to-face encounter
This code is applicable to medication management services that the practitioner offers the patient one-on-one during a face-to-face encounter. Later, it becomes medication supervision, prescription, monitoring, and education.
What is the difference between 90792 and 99205?
Below is a table that outlines the key differences between CPT code 90792 and 99205:
| Aspect | 90792 | 99205 |
| Description | Psychiatric diagnostic evaluation with medical services | Outpatient visit to a new patient for the evaluation and management of the medical condition. |
| Setting | Usually, they are provided in psychiatric or mental health centers. | Commonly carried out in outpatient clinics, offices, or other clinical environments. |
| Provider Speciality | Mostly psychiatrists, mental health professionals use it. | Either used by primary care physicians, specialists, or other healthcare providers |
| Patient Type | Can be used for the new patients or the old ones. | Specifically for new patients |
| Purpose | Full mental health status assessment, including psychiatric evaluation and medical services | Comprehensive health appraisal/checkup for the new patients |
| Components | The thorough examination of the history, mental status and may include the medical services such as a physical examination or review of medical records. | Detailed history taking, general examination and thorough application of medical decision-making for different medical disorders. |
Conclusion
In the end, mental health billing, including CPT codes, requires accuracy, attention to detail, and abiding by the changing rules and regulations. Accurate documentation and coding by mental health providers are critical to preventing claim denials and maintaining financial stability. In addition, in-house billing management can be complex and time-consuming. Therefore, outsourcing to a medical billing company like Medheave can be very helpful.
Outsourcing enables mental health practitioners to have a team of billing professionals who are experts in CPT codes for mental health billing and reimbursement requirements. Moreover, they can handle the complexities of mental health billing, like proper coding for psychiatric evaluation, psychotherapy sessions, medication management, and other related services. Through billing outsourcing to seasoned professionals, mental health providers can expedite their revenue cycle management, reduce mistakes, and enhance reimbursements.
Contact us today for further details.