Complete Guide to Behavioral Health CPT Codes: Maximizing Reimbursement in 2024
For mental health professionals, understanding Current Procedural Terminology (CPT) codes is fundamental to running a successful practice. These standardized codes determine how you bill for services and ultimately how much you get paid. This comprehensive guide covers everything you need to know about behavioral health CPT codes in 2024.
What Are CPT Codes?
CPT codes are five-digit numeric codes developed and maintained by the American Medical Association (AMA). They serve as a universal language for describing medical, surgical, and diagnostic services.
Why CPT Codes Matter
- Standardization: Create consistency across the healthcare system
- Reimbursement: Determine payment amounts from insurers
- Documentation: Provide clear records of services rendered
- Analytics: Enable tracking of utilization patterns
- Compliance: Ensure proper billing practices
Most Common Behavioral Health CPT Codes
Individual Psychotherapy Codes
90832 - Psychotherapy, 30 minutes
Description: Individual psychotherapy session with patient and/or family member, approximately 30 minutes face-to-face time.
Typical Use Cases:
- Brief check-in sessions
- Medication management follow-ups
- Crisis intervention
- Patient request for shorter sessions
Average Reimbursement Range: $60-$95
Documentation Requirements:
- Must document 16-37 minutes of face-to-face time
- Note therapeutic interventions used
- Document patient progress or lack thereof
90834 - Psychotherapy, 45 minutes
Description: Individual psychotherapy, approximately 45 minutes face-to-face with patient and/or family member.
Typical Use Cases:
- Standard weekly therapy sessions
- Most common code for outpatient therapy
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Solution-focused therapy
Average Reimbursement Range: $90-$140
Documentation Requirements:
- Must document 38-52 minutes of face-to-face time
- Record presenting problem and treatment focus
- Note interventions and patient response
- Document progress toward treatment goals
Pro Tip: This is the workhorse code for most therapists. Understanding average reimbursement rates in your area is crucial for financial planning.
90837 - Psychotherapy, 60 minutes
Description: Individual psychotherapy, approximately 60 minutes face-to-face with patient and/or family member.
Typical Use Cases:
- Intensive therapy sessions
- Complex trauma work
- EMDR therapy
- Initial assessments
- Patients requiring extended processing time
Average Reimbursement Range: $120-$180
Documentation Requirements:
- Must document 53+ minutes of face-to-face time
- Justify need for extended session
- Document complex interventions
- Note patient's therapeutic needs requiring longer session
Important Note: Many insurers won't automatically reimburse more for 90837 versus 90834 despite the longer session time. Always verify rates before assuming higher payment.
Family Therapy Codes
90846 - Family Psychotherapy Without Patient Present
Description: Family or couples therapy session conducted without the identified patient present.
Typical Use Cases:
- Parent guidance sessions
- Couples therapy when one partner unavailable
- Family consultations
- Psychoeducation for family members
- Treatment planning with family
Average Reimbursement Range: $90-$150
Clinical Scenarios:
- Parents learning behavior management strategies
- Addressing family dynamics affecting patient
- Providing support to caregivers
- Coordinating family involvement in treatment
90847 - Family Psychotherapy With Patient Present
Description: Family or couples therapy with the identified patient participating.
Typical Use Cases:
- Traditional family therapy
- Couples counseling
- Parent-child sessions
- Multi-family group sessions
- Family conflict resolution
Average Reimbursement Range: $95-$160
Documentation Tips:
- List all participants present
- Note family dynamics observed
- Document interventions specific to family system
- Record progress toward family-focused goals
Group Therapy
90853 - Group Psychotherapy
Description: Group psychotherapy session conducted with multiple patients simultaneously.
Typical Use Cases:
- Process groups
- Skills training groups (DBT, CBT)
- Support groups
- Intensive outpatient program (IOP) groups
- Partial hospitalization program (PHP) groups
Average Reimbursement Range: $30-$60 per person
Key Considerations:
- Each patient's time is billed separately
- Group size typically 4-10 participants
- Duration usually 60-90 minutes
- Must maintain therapeutic focus (not simply support)
Financial Math: With 8 participants at $40 each, a 90-minute group generates $320 - potentially more efficient than individual sessions.
Add-On Codes
90785 - Interactive Complexity Add-On
Description: Add-on code for services involving interactive complexity such as:
- Maladaptive communication
- Caregiver emotions affecting treatment
- Evidence of abuse
- Use of play equipment or interpreter
Additional Reimbursement: $15-$30
When to Use:
- High-conflict family situations
- Cases involving interpreters
- Play therapy with young children
- Severe patient dysregulation affecting session
Important: This is an add-on code only; must be billed with a primary psychotherapy code.
Evaluation Codes
90791 - Psychiatric Diagnostic Evaluation
Description: Comprehensive psychiatric diagnostic evaluation without medical services.
Typical Use Cases:
- Initial intake assessments
- Comprehensive diagnostic evaluations
- Treatment planning sessions
- New patient evaluations
Average Reimbursement Range: $150-$250
Documentation Requirements:
- Complete psychiatric history
- Mental status examination
- Diagnostic assessment
- Treatment recommendations
- Risk assessment
90792 - Psychiatric Diagnostic Evaluation With Medical Services
Description: Comprehensive evaluation including medical components such as prescription management.
Typical Use Cases:
- Psychiatric evaluations by prescribers
- Integrated assessments with medical review
- Medication management evaluations
Average Reimbursement Range: $180-$280
Who Can Bill: Typically only psychiatrists, psychiatric nurse practitioners, or other prescribing providers.
Medication Management Codes
99212-99215 - Office Visits (Evaluation and Management)
For medication management appointments, psychiatrists and prescribers often use E&M codes:
- 99212: Straightforward, 10-19 minutes
- 99213: Low complexity, 20-29 minutes
- 99214: Moderate complexity, 30-39 minutes
- 99215: High complexity, 40-54 minutes
Average Ranges: $75-$200 depending on complexity
Time Requirements for Psychotherapy Codes
Accurate time documentation is critical. Here's the official guidance:
| CPT Code | Minimum Time | Time Range | Maximum Time Before Next Code | |----------|--------------|------------|-------------------------------| | 90832 | 16 minutes | 16-37 minutes | 37 minutes | | 90834 | 38 minutes | 38-52 minutes | 52 minutes | | 90837 | 53 minutes | 53+ minutes | No maximum |
Important: Times reflect face-to-face therapeutic contact, not total appointment time including notes or billing.
Telehealth and CPT Codes
Since the COVID-19 pandemic, telehealth billing has evolved significantly:
Current Telehealth Guidelines
- Most psychotherapy codes can be billed for telehealth services
- Use appropriate modifiers (95, GT, or place of service code)
- Reimbursement typically matches in-person rates
- HIPAA-compliant platforms required
- Check state licensure requirements
Telehealth-Specific Considerations
Audio-Only Services: Some states allow audio-only psychotherapy; check current regulations.
Technology Requirements:
- Real-time, two-way audio-video connection
- HIPAA-compliant platform
- Secure, private location for both parties
Documentation: Note telehealth modality in session notes.
Reimbursement Rate Variations
CPT code reimbursement varies significantly based on multiple factors:
Geographic Location
Insurance reimbursement rates differ dramatically by state and region:
- Urban vs Rural: Rural areas often have higher rates to attract providers
- State Averages: Some states mandate higher mental health reimbursement
- Cost of Living: Higher COL areas generally see higher rates
Example: 90834 reimbursement might range from $90 in Arkansas to $150+ in New York City.
Insurance Payer
Different insurers reimburse at vastly different rates:
- Commercial Plans: Generally highest reimbursement
- Medicare: Set federal rates with geographic adjustments
- Medicaid: Often lowest rates, varies by state
- Self-Pay: Whatever you negotiate with patients
Provider Credentials
Your credentials can affect reimbursement:
- MDs/DOs: Typically highest rates
- PhDs/PsyDs: Similar to psychiatrists for therapy codes
- Master's-Level: May see 85-95% of doctoral rates
- Trainees: Reduced rates during supervision
In-Network vs Out-of-Network
- In-Network: Negotiated contracted rates
- Out-of-Network: Can set own fees (subject to usual and customary limits)
Common Billing Mistakes to Avoid
1. Incorrect Time Documentation
Problem: Billing 90837 for a 47-minute session
Solution: Use 90834 for 38-52 minutes; 90837 requires 53+ minutes
2. Upcoding
Problem: Automatically using 90837 for all sessions regardless of time
Solution: Bill appropriate code matching actual face-to-face time
3. Missing Modifiers
Problem: Forgetting telehealth modifiers for virtual sessions
Solution: Add modifier 95 or GT for telehealth services
4. Inadequate Documentation
Problem: Progress notes not supporting billed code
Solution: Document time, interventions, and medical necessity clearly
5. Incorrect Family Therapy Coding
Problem: Using 90834 for a couples session
Solution: Use 90847 for family/couples therapy with patient present
Strategies to Maximize Reimbursement
1. Verify Insurance Benefits Upfront
Before seeing patients:
- Check CPT code coverage
- Verify reimbursement rates
- Confirm session limits
- Understand deductible status
2. Know Your Contracted Rates
- Review contracts with all payers
- Track actual reimbursement received
- Compare to local averages
- Negotiate better rates when possible
3. Accurate Time Tracking
- Start/stop timer during sessions
- Document exact face-to-face time
- Don't round up inappropriately
- Keep consistent records
4. Proper Documentation
- Note specific therapeutic interventions
- Document medical necessity
- Record patient progress
- Support complexity when billing higher codes
5. Use Add-On Codes When Appropriate
- Bill 90785 for interactive complexity
- Document justification clearly
- Understand payer-specific policies
6. Consider Group Therapy
- More financially efficient per hour
- Serves more patients
- Generates multiple billings per session
- Check market demand
7. Optimize Session Length
- Align session length with reimbursement
- If 90834 and 90837 pay similarly, consider shorter sessions
- Balance clinical needs with financial realities
- Communicate clearly with patients about session structure
How to Research Reimbursement Rates
Use Transparency in Coverage Data
Thanks to federal TIC rules, you can now access actual negotiated rates:
- Check Insurer Websites: Download machine-readable files
- Use Aggregation Tools: Platforms like Deciphered Health compile data
- Search by CPT Code: Look up specific codes in your area
- Compare Across Payers: Identify best and worst reimbursing insurers
Check with Professional Associations
- American Psychological Association (APA)
- American Counseling Association (ACA)
- National Association of Social Workers (NASW)
- State-level associations
Network with Colleagues
- Local provider groups
- Online forums (being careful about antitrust concerns)
- Supervision groups
- Professional meetups
Looking Ahead: 2024 and Beyond
Upcoming Changes
- CPT Code Updates: AMA periodically revises codes
- Reimbursement Adjustments: Annual rate changes from Medicare and commercial payers
- Telehealth Policy: Ongoing evolution of permanent telehealth coverage
- Mental Health Parity: Increased enforcement may improve rates
Industry Trends
- Growing recognition of mental health importance
- Increased demand for services
- Provider shortage driving up rates in some areas
- Value-based care models emerging
Conclusion
Mastering behavioral health CPT codes is essential for financial sustainability in mental health practice. Understanding which codes to use, how to document properly, and what to expect for reimbursement empowers you to make informed business decisions while providing excellent patient care.
Stay informed about rate changes, maintain accurate documentation, and don't hesitate to negotiate better contracts as you understand your true value in the healthcare marketplace.
Ready to see what insurers actually pay for your services? Search our database of 1M+ reimbursement rates to find negotiated prices for CPT codes 90832, 90834, 90837, and more across all major insurers and all 50 states.