Behavioral Health Billing Cheat Sheet (2026)
Behavioral health billing is audited on time and units more than almost any specialty. Psychotherapy is decided by recorded minutes, testing is billed in technician and evaluation units that get miscounted, and parity gives you an appeal lever most practices never use.
Quick reference for behavioral health billers. Last updated .
Top Behavioral Health CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | $173.35 | $137.28 | 5.19 |
| 90792 | Psychiatric diagnostic evaluation with medical services | $202.08 | $159.32 | 6.05 |
| 90832 | Psychotherapy, 30 minutes | $85.84 | $69.47 | 2.57 |
| 90834 | Psychotherapy, 45 minutes | $113.90 | $91.85 | 3.41 |
| 90837 | Psychotherapy, 60 minutes | $167.00 | $135.27 | 5.00 |
| 90838 | Psychotherapy, 60 min add-on to E/M | $136.61 | $110.22 | 4.09 |
| 90847 | Family psychotherapy with patient present | $109.55 | $102.87 | 3.28 |
| 90853 | Group psychotherapy | $30.39 | $24.38 | 0.91 |
| 96130 | Psychological testing evaluation, first hour | $123.92 | $99.53 | 3.71 |
| 99213 | Established patient office visit, low MDM | $95.19 | $57.45 | 2.85 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Behavioral Health billing services page.
Modifiers That Prevent Behavioral Health Denials
Synchronous audio and video telehealth; pair with the payer's required place of service, often POS 10 for the patient's home.
Audio-only telehealth where the payer allows it, increasingly required to distinguish from video.
A significant, separately identifiable E/M on the same day as a psychotherapy add-on (90833, 90836, 90838).
Distinct services by different providers or sessions on the same day that the payer would otherwise bundle.
Provider-level designators (master's, bachelor's) some Medicaid and MCO plans require for the correct fee schedule.
Specialty provider designators (psychiatrist, clinical psychologist) where the payer requires them for adjudication.
Top Behavioral Health Denials → Quick Fix
Record total face-to-face minutes or start and stop times. 90832 is 16 to 37 minutes, 90834 is 38 to 52, 90837 is 53 or more.
96130 and 96131 are evaluation units by the hour; 96136 and 96137 are administration units. Document time per component; do not collapse them into one line.
Append modifier 25 to the E/M and keep a separate psychotherapy note with its own time for the add-on (90833, 90836, 90838).
Document medical necessity and invoke MHPAEA parity in the appeal when the behavioral limit is stricter than the medical and surgical benefit.
Link a covered diagnosis and document progression and the clinical rationale for 90837 or testing batteries. Maintenance therapy without progress notes is denied.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 90791 | 0362T | CPT Manual or CMS manual coding instruction |
| 90791 | 0373T | CPT Manual or CMS manual coding instruction |
| 90792 | 0362T | CPT Manual or CMS manual coding instruction |
| 90792 | 0373T | CPT Manual or CMS manual coding instruction |
| 90832 | 0362T | CPT Manual or CMS manual coding instruction |
| 90832 | 0373T | CPT Manual or CMS manual coding instruction |
| 90834 | 0362T | CPT Manual or CMS manual coding instruction |
| 90834 | 0373T | CPT Manual or CMS manual coding instruction |
Documentation That Holds Up on Appeal
Total face-to-face minutes or start and stop times, since the code is time-defined.
Evaluation time and administration time separately, by professional versus technician, with the instruments used.
A standalone E/M note and a separate psychotherapy note with its own time. They cannot share documentation.
Full biopsychosocial assessment; 90792 additionally requires the medical and prescriber components.
Modality, patient location, and consent, supporting the 95 or 93 modifier and place of service.
Revenue Behavioral Health Practices Leave on the Table
Defaulting sessions to 90834 when documented time supports 90837.
Collapsing psychological testing into one code instead of billing the evaluation and administration units actually performed.
Not billing the E/M plus psychotherapy add-on for prescribers who do both in one visit.
Accepting parity-driven frequency denials instead of appealing them under MHPAEA.
Behavioral Health Billing FAQ
How is psychological testing billed in 2026?
By units split across evaluation (96130, 96131) and administration and scoring (96136, 96137), with technician administration (96138, 96139) separate. Document time per component; a single collapsed line is a CO-16 denial.
Can a prescriber bill an E/M and therapy together?
Yes. Bill the E/M plus the psychotherapy add-on (90833, 90836, 90838) with modifier 25 on the E/M and a separate therapy note with its own time.
What is the parity lever on frequency denials?
Under MHPAEA, a payer cannot apply a stricter visit limit to behavioral health than to comparable medical and surgical benefits. Document necessity and cite parity in the appeal rather than refiling.
Which telehealth modifier applies?
95 for synchronous audio and video, 93 for audio-only where allowed. The modifier has to agree with the place of service or the claim auto-denies.
Stop Losing Behavioral Health Revenue to Preventable Denials
Our AAPC-certified behavioral health coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.