Billing Code for Family Therapy Without Patient Present

Mental Health CPT Codes: The Definitive Guide [2022]

CPT (Electric current Procedural Terminology) is a standardized medical codeset maintained by the AMA. CPT codes are 5 digit numeric codes describing everything from surgery to radiology to psychotherapy.

CPT Codes are different from Diagnosis Codes or ICD10 F-Codes for billing and coding your insurance claims. Here'south our mental health diagnosis code listing if y'all need to look one up.

For therapists that are on managed intendance panels or provide superbills to their clients, knowing your CPT codes is paramount to getting paid in total and avoiding insurance audits.

The amount insurance companies will reimburse depends on a number of different factors (professional person credentials, geographic location, etc.), just using the correct CPT Code and add-on code(southward) to express the exact service is an of import office to the whole process and in ultimately determining your payment!

Errors, adventitious or otherwise, will straight impact insurance company'south payment of services. If you demand help with making sure your billing and coding is mistake-free, our mental health billing service tin assistance.

Think about reaching out if the rest of this article hurts your feelings.

Commodity Index:

Most Common Mental Health CPT Codes
Improver CPT Codes for Mental Wellness Billing
Mental Health CPT Code Cheat Sheet [PDF]
Testing & Evaluation CPT Codes
Psych and Evaluation and Management (Eastward/M) Codes
Sample Reimbursement Rates by License Type
Sample Reimbursement Rates past CPT Code

The Well-nigh Mutual Mental Health CPT Codes

The most mutual CPT Codes used past therapists and behavioral health professionals:

Outpatient Mental Wellness Therapist Diagnostics, Evaluation, Intake CPT Code:

90791 – Psychiatric Diagnostic Evaluation (normally just i/client is covered)

Outpatient Mental Wellness CPT Codes:

90832 – Psychotherapy, 30 minutes (xvi-37 minutes).
90834 – Psychotherapy, 45 minutes (38-52 minutes).
90837 – Psychotherapy, hour (53 minutes and over).
90846 – Family or couples psychotherapy, without patient present.
90847 – Family or couples psychotherapy, with patient present.
90853 – Group Psychotherapy (non family).
98968 – Telephone therapy (non-psychiatrist) – limit three units/hours per application.

Outpatient Mental Health Crisis CPT Codes:

90839 – Psychotherapy for crunch, 60 minutes (30-74 minutes).
+90840 – Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 90839.

Other Behavioral Health CPT Codes:

+90785 – Interactive Complexity add together-on code. Covered below.
90404 – Cigna / MHN EAP CPT Lawmaking. These two companies use a unique CPT code for EAP sessions.
96101 – Psychological testing, interpretation and reporting by a psychologist (per Hr)
90880 – Hypnotherapy – limit 10 units/hours per application
90876 – Biofeedback
90849 – Multiple family group psychotherapy
90845 – Psychoanalysis

Mental Health Add-On CPT Codes

Here is a curt list of the most mutual Addition codes for routine outpatient mental health billing.

Add-On CPT Code 90785 – Interactive complexity. Case: play therapy using dolls or other toys. This is an interactive complexity addition code that is not a payable expense. This code only indicates that the treatment is complex in nature.
Addition CPT Lawmaking 90863 – Pharmacologic Management subsequently therapy.
Addition CPT Lawmaking 99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the function is unremarkably closed.
Improver CPT Lawmaking 99051 – Services provided in the function during regularly scheduled evening, weekend, or holiday office hours.
Add-On CPT Code 99354 – Additional time after the additional time of 74 minutes. Adding another thirty minutes. (But use if the duration of your session is at least 90 minutes for 90837 or 80 minutes for 90847).
Add-On CPT Lawmaking 99355 – Additional time after offset 60 minutes. First boosted xxx to 74 minutes.
Add together-On CPT Code 90840 – 30 additional minutes of psychotherapy for crisis. Used only in conjunction with CPT 90839.
Add-On CPT Code 90833 – 30 minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, and then has 30 infinitesimal session.
Add-on CPT Code 90836 – 45 minute psychotherapy addition. Example: Clinical Nurse Specialist evaluates medication response, then has 45 minute session.

If you're wondering how to handle billing add-on codes, we can help make this process simple and automatic. Learn how nosotros tin assist by inquiring about our billing service.

Outpatient Psychiatry Diagnostics / Evaluation / Client Intake CPT Lawmaking:

90792 – Psychiatric Diagnostic Evaluation with medical services (usually simply one/client is covered)

Outpatient Psychiatry CPT Codes:

99201 – East/M – New Patient Part Visit – 10 Minutes
99202 – E/M – New Patient Function Visit – 20 Minutes
99203 – East/M – New Patient Office Visit – 30 Minutes
99204 – E/M – New Patient Function Visit – 45 Minutes
99205 – E/K – New Patient Function Visit – threescore Minutes
99211 – E/M – Established Patients – 5 Minutes
99212 – Eastward/Thou – Established Patients – 10 Minutes
99213 – East/G – Established Patients – 15 Minutes
99214 – E/Grand – Established Patients – 25 Minutes
99215 – E/M – Established Patients – xl Minutes
99443 – Telephone therapy (psychiatrist), – limit iii units/hours per awarding

Mental Health CPT Lawmaking Crook Sheet

Download a copy of our PDF Behavioral Health CPT Code Cheat Sheet!

CPT Coding for Therapy

CPT coding for psychotherapy doesn't have to be hard! There are an overwhelming corporeality of total CPT Codes (~viii,000), however simply 24 are specifically designated for psychotherapy and other mental health services.

To make matters even simpler, nearly all therapists volition regularly use an even smaller subset of these 24.

CPT is a large and dynamic code set that changes year to twelvemonth, but the psychotherapy codes seldom change.

The most contempo change for psychotherapy codes took place in 2019, and then 2013, and previously 1998.

To ensure your coding is current and upward to date, consider using a billing service instead of having to remember all the codes.

Behavioral Wellness CPT Add-On Codes

A CPT Improver Code is a lawmaking describing a service performed in in conjunction with a primary service. Many of these add-on codes are associated with a specific CPT Code or a small-scale set of CPT Codes and cannot be used otherwise.

For case, the behavioral health CPT Lawmaking for interactive complexity (+90785) tin be used for a diagnostic (90791, 90792) or a normal psychotherapy session (90832, 90834, 90837) but non a crisis psychotherapy session (90839).

Improver Codes are identified past a + sign in front of the number, i.east. +90840 is an add together-on lawmaking for actress time in the case of crisis psychotherapy.

On CMS 1500 forms CPT Add-on codes are merely added on a new line.

Add-on codes are extremely of import to employ in order to nigh accurately draw the services existence renderedandto ensure your services are maximized per session.

Nosotros aid the mental health providers that work with us in our billing service practice all of this for every appointment.

Mental Health Testing CPT Codes [2020]

These codes are only constructive January 1st, 2019.

Assessment of Aphasia and Cognitive Operation Testing CPT Codes

CPT Code 96105

Cess of aphasia (includes assessment of expressive and receptive speech and language role, language comprehension, oral communication production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour

CPT Code 96125

Standardized cerebral functioning testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional's time, both contiguous time administering tests to the patient and fourth dimension interpreting these examination results and preparing the report

Developmental/Behavioral Screening and Testing

CPT Code 96110

Developmental screening (due east.one thousand., developmental milestone survey, spoken language and linguistic communication delay screen), with scoring and documentation, per standardized musical instrument

CPT Code 96112

Developmental examination administration (including cess of fine and/or gross motor, language, cognitive level, social, memory, and/ or executive functions by standardized developmental instruments when performed), by dr. or other qualified wellness care professional, with interpretation and report; first hour

Improver CPT Code + 96113 – Each additional thirty minutes (List separately in add-on to code for primary process)

CPT Code 96127

Brief emotional/behavioral assessment (e.g., depression inventory, attending-arrears/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

Psychological/Neuropsychological Testing CPT Codes

These codes take changed in 2019.

Neurobehavioral Status Examination CPT Codes

CPT Code 96116

Neurobehavioral condition exam (clinical assessment of thinking, reasoning and judgement, eastward.g., caused cognition, attention, language, memory, planning and problem solving, and visual spatial abilities), past physician or other qualified wellness care professional, both faceto-confront time with the patient and time interpreting examination results and preparing the report; kickoff hour

Addition CPT Code +96121 – Each additional hour (List separately in addition to lawmaking for primary procedure)

Test Evaluation Services CPT Codes

CPT Code 96130

Psychological testing evaluation services by dr. or other qualified health care professional, including integration of patient information, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(south) or caregiver(s), when performed; outset 60 minutes

Improver CPT Code +96131 – Each additional hour (List separately in addition to code for main procedure)

CPT Code 96132

Neuropsychological testing evaluation services by physician or other qualified wellness care professional, including integration of patient data, estimation of standardized examination results and clinical data, clinical determination making, treatment planning and report and interactive feedback to the patient, family unit member(south) or caregiver(due south), when performed; first 60 minutes

Improver CPT Code +96133 – Each additional hour (List separately in addition to code for principal procedure)

Test Administration and Scoring CPT Codes

CPT Lawmaking 96136

Psychological or neuropsychological test administration and scoring by physician or other qualified health intendance professional person, two or more tests, any method, first 30 minutes

Addition CPT Lawmaking +96137 – Each boosted xxx minutes (Listing separately in addition to code for primary procedure)

CPT Code 96138

Psychological or neuropsychological exam administration and scoring past technician, 2 or more than tests, whatsoever method; first 30 minutes

Add-on CPT Code +96139 – Each additional 30 minutes (List separately in addition to code for primary procedure)

Automated Testing and Result CPT Codes

96146 – Psychological or neuropsychological exam administration, with single automated instrument via electronic platform, with automated result only

Mental Health Evaluation & Management (Eastward/K) Codes

In that location are also E/M (evaluation & management) in conjunction with psychotherapy, used by authorized prescribers, psychiatrists, and MDs.

Coding E/M is trickier, harder to certificate and more vulnerable to inspect but ordinarily results in greater reimbursement.

There'south too a series of E/One thousand codes that are used without the psychotherapy component.

For more in-depth coverage on E/M coding for psychotherapy at that place are some good gratis webinars released past AACAP on Eastward/M CPT Codes.

Add-on CPT Code +90833 – East/M code for 30 minutes of psychiatry (used with 90832).
Add-on CPT Lawmaking +90836 – Due east/G lawmaking for 45 minutes of psychiatry (used with 90834).
Improver CPT Lawmaking +90838 – E/M code for lx minutes of psychotherapy (used with 90837).

Key Points

Psychotherapy must exist at least sixteen minutes.
Fourth dimension is very important and should be rounded to the nearest CPT Lawmaking.
Outpatient vs. Inpatient is not important.
E/Grand codes can simply be used by prescribers (MD, DO, APN, PA).

Medicare 2022 Reimbursement Rates by CPT Code

CPT Code	Description	Medicare Reimbursement Rate 2020	Medicare Reimbursement Rate 2021	Medicare Reimbursement Rate 2022
90791	Psychological Diagnostic Evaluation	$140.19	$180.75	$195.46
90792	Psychological Diagnostic Evaluation with Medication Management	$157.49	$201.68	$218.ninety
90832	Private Psychotherapy, 30 Minutes	$68.47	$77.81	$85.07
90833	Private Psychotherapy with Evaluation and Management Services, thirty minutes	$71.00	$71.18	$77.88
90834	Individual Psychotherapy, 45 Minutes	$91.xviii	$103.28	$112.29
90836	Individual Psychotherapy with Evaluation and Management Services, 45 minutes	$89.74	$90.02	$98.30
90837	Individual Psychotherapy, 60 Minutes	$136.95	$152.48	$164.84
90838	Private Psychotherapy with Evaluation and Direction Services, 60 minutes	$118.57	$119.33	$129.xxx
90839	Individual Crisis Psychotherapy initial 60 min			$157.66
90840	Private Crisis Psychotherapy initial sixty min, each boosted 30 min			$78.64
99201	Evaluation and Management Services, Outpatient, New Patient	$46.49	Not Covered	Not covered
99202	Evaluation and Management Services, Outpatient, New Patient	$77.48	$73.97	$eighty.91
99203	Evaluation and Direction Services, Outpatient, New Patient	$109.92	$113.75	$124.39
99204	Evaluation and Management Services, Outpatient, New Patient	$166.86	$169.93	$185.26
99205	Evaluation and Direction Services, Outpatient, New Patient	$209.75	$224.36	$244.99
99211	Evaluation and Management Services, Outpatient, Established Patient	$23.07	$23.03	$25.71
99212	Evaluation and Management Services, Outpatient, Established Patient	$45.77	$56.88	$62.76
99213	Evaluation and Direction Services, Outpatient, Established Patient	$75.32	$92.47	$100.57
99214	Evaluation and Management Services, Outpatient, Established Patient	$110.28	$131.20	$141.78
99215	Evaluation and Management Services, Outpatient, Established Patient	$147.76	$183.19	$200.00
99354	Prolonged Services	$132.26	$132.09	$140.26
99355	Prolong Services with E/M	$100.91	$100.33	$101.32
90846	Family psychotherapy without patient, 50 minutes	$103.58	$99.10	$107.37
90847	Family psychotherapy with patient, l minutes	$107.19	$102.59	$111.xv
96105	Cess of aphasia and cognitive performance		$101.54	$109.26
96112	Developmental testing administration by a physician or qualified wellness care professional, 1st hr		$131.55	$141.02
96113	Developmental testing administration by a physician or qualified health care professional person, each boosted hour		$58.62	$66.54
96116	Neurobehavioral status examination performed by a physician or qualified health professional, commencement hour		$97.00	$104.73
96121	Neurobehavioral status exam performed past a physician or qualified health professional, additional hour		$82.35	$87.34
96125	Standardized cognitive performance examination administered by health intendance professional		$107.12	$115.69
96127	Cursory emotional and behavioral assessment		$4.89	$5.29
96130	Psychological testing and evaluation past a physician or qualified health care professional, get-go hr		$120.73	$132.70
96131	Psychological testing and evaluation past a md or qualified wellness care professional, each additional hour		$91.42	$98.68
96132	Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour		$133.29	$144.80
96133	Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour		$103.98	$112.29
96136	Neuropsychological or psychological test assistants and scoring past a doc or qualified health care professional, first hour		$46.76	$49.xv
96137	Neuropsychological or psychological exam administration and scoring past a dr. or qualified health care professional, each boosted hr		$41.87	$44.24
96138	Neuropsychological or psychological examination administration and scoring by a technician, first hour		$37.34	$38.56
96139	Neuropsychological or psychological examination administration and scoring by a technician, each additional hour		$37.34	$$39.32

(Source)

Interactive Complexity (+90785): Criteria and How to Nib

+90785 is ane of the new add-on codes in the most recent CPT update in 2013.

This code is used every bit an umbrella add-on code and tin be used for four different criteria. The most common scenarios usually involve children, although this is not necessarily always the case.

Common Examples of Interactive Complexity:

The apply of play equipment with immature children.
Interpreters/translators.
Involvement of parents with discordant views that complicate the treatment plan.
Report of abuse/neglect.

Interactive complexity can be used in conjunction with the primary CPT Codes for diagnostics, psychotherapy, or group therapy and cannot be used for couple/family therapy or crunch codes.

+90785, tin be used with: 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90853.

Unsure when to use the interactive complexity code? Need help asking if information technology will be approved? Our billing service exclusively for mental health providers is here to help.

Am I Being Underpaid? Was I Paid the Right Corporeality?

Here's typical rates depending on the therapist's credentials:

Typical Reimbursements by Type of Therapist

Type of Therapist	Reimbursement/Session
Social Workers	~$55-60
Marriage Family Therapists	~$60-65
Counselors	~$60-65
Psychologists	~$70-fourscore

These rates can vary significantly therapist to therapist but are good benchmarks for comparing.

How virtually CPT Codes? How exercise they touch on the rate of reimbursement? This is a difficult and complex adding, depending on the level of education, location, and license. The AMA has created a lawmaking search feature on their website that shows payment based off CPT Code and location.

This information is somewhat incomplete and is based off medicare payments and does not specify a number of other of import factors. Withal, this tool is still very useful to compare the relative value CPT Codes against one some other.

Individual insurance will be correlated with some divergence from these numbers.

Reimbursement by CPT Code (Iii Dissimilar Geographies)

Reimbursement (Residuum of CA)Reimbursement (Los Angeles)Reimbursement (WA)

Lawmaking	California	Los Angeles	Washington
90791	$137.10	$141.17	$132.98
90792	$147.84	$152.sixteen	$143.39
90832	$66.fourteen	$68.03	$64.25
+90833	$67.69	$69.69	$65.70
90834	$87.66	$ninety.15	$85.eighteen
+90836	$85.71	$88.21	$83.18
90837	$131.28	$134.95	$127.54
+90838	$113.07	$116.42	$109.75
90846	$106.46	$109.51	$103.38
90847	$109.75	$112.82	$106.60
90853	$26.99	$27.83	$26.21
90839	$137.22	$141.04	$133.28
+90840	$65.75	$67.61	$63.89
+90785	$fourteen.67	$15.08	$fourteen.24

Data from AMA Codemanager. These numbers are useful for relative comparison of individual CPT Codes and geography.

Therapist Reimbursement Rates for 2022

Read our definitive guide with 2022 reimbursement rates for mental health CPT codes.

Downcoding Claims

Downcoding (including less services on the merits than actually provided) will usually mean you lot get paid less, while upcoding (including more services on the claim than actually provided) can get you in problem with your managed care panels.

It'south also important to notation that information technology might be tempting to maximize your CPT codes to earn higher reimbursements.

This is highly recommended against and can become you flagged, audited and removed from insurance panels. Fifty-fifty if this is your biller's error, the therapist is the i who ultimately bears the responsibleness and will be the one penalized.
Here's a video guide we did of this article!

Distilled Guide to Mental Wellness CPT Codes

If you are only starting out or just beginning to deal with managed care, keep it simple.

CPT Codes appear far more than complex from the outside looking in. Make a quick cheatsheet.

Don't worry about memorizing all the CPT Codes (in that location'south alot!) or even all of the mental health ones. You will probable merely use just a few individual codes.

Memorize the relevant codes and apply google or other references to discover the correct CPT codes for more than unique scenarios.

Call to verify eligibility and benefits and make sure those codes volition exist canonical with that client's coverage.

And if all of that sounds like too much trouble, offload the work to us. You won't have to know one CPT code from another to get your billing paid in total.

Additional Resources

- Medicare Reimbursement by CPT Code & Expanse
- CPT Reimbursement Lookup & RVU (Relative Value Unit) Overview
- Crosswalk of 2012 to 2013 CPT Codes
- CPT 2013 Standard Edition [Probably Unnecessary]
- Insurance Reimbursement Comparison Tool

Consider Outsourcing Your Billing

Don't desire to acquire any of this stuff? We are your team of billing experts hither to interpret all of this gibberish into English! Reach out about our billing service if yous are a licensed mental health provider (we only piece of work with licensed mental health providers).

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