Mental Health Billing Cheat Sheet (2026)
Time is the whole game in mental health billing. Whether a session bills as 90832, 90834, or 90837 comes down to the minutes you record, and payers audit that number harder than almost anything else in the chart. Below are the time thresholds, the add-on rules, and the modifiers that keep telehealth and parity claims from bouncing.
Quick reference for mental health billers. Last updated .
Top Mental 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 |
| 90847 | Family psychotherapy with patient present | $109.55 | $102.87 | 3.28 |
| 90853 | Group psychotherapy | $30.39 | $24.38 | 0.91 |
| 90839 | Psychotherapy for crisis, first 60 minutes | $160.32 | $129.60 | 4.80 |
| 99213 | Established patient office visit, low MDM | $95.19 | $57.45 | 2.85 |
| 99214 | Established patient office visit, moderate MDM | $135.61 | $84.50 | 4.06 |
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 Mental Health billing services page.
Modifiers That Prevent Mental Health Denials
Synchronous telehealth delivered by real-time audio and video. Pair it with the payer's required place of service, often POS 10 for the patient's home.
Audio-only telehealth by telephone where the payer permits it. Plans increasingly require this to tell audio-only apart from video visits.
A significant, separately identifiable E/M (99213 or 99214) on the same day as a psychotherapy add-on (90833, 90836, or 90838).
Distinct services by different providers or in separate sessions on the same day, such as individual followed by group, that the payer would otherwise bundle.
Employee-assistance (HJ) or substance-use-program (HF) funding designators that some Medicaid and MCO plans require for correct routing.
Rendering-provider type (clinical social worker or clinical psychologist) where the payer requires it for the differential fee schedule.
Top Mental Health Denials → Quick Fix
Record actual start and stop times or total session minutes. 90837 requires 53 minutes or more of face-to-face time. Without a recorded duration the payer defaults to the lower code.
Append modifier 25 to the E/M and document it as a separately identifiable service distinct from the psychotherapy add-on (90833, 90836, or 90838).
Align the place of service (10 home or 02 other) with modifier 95 or 93 per the payer's current telehealth policy. Mismatches auto-deny.
Link a covered diagnosis and document the rationale for 90837 or crisis 90839. Routine maintenance therapy without progress notes is denied.
Track each payer's session cap. When it is clinically exceeded, document medical necessity and raise MHPAEA parity in the appeal rather than refiling.
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. 90832 is 16 to 37 minutes, 90834 is 38 to 52, and 90837 is 53 or more.
The crisis presentation, the risk assessment, and that 30 minutes or more of the session addressed the crisis state.
A standalone E/M note and a separate psychotherapy note with its own time. They cannot share documentation.
A full biopsychosocial assessment. 90792 additionally requires the medical and E/M components and prescriber involvement.
The modality (audio-video or audio-only), the patient location, and consent. This is the audit trail for the 95 or 93 modifier.
Revenue Mental Health Practices Leave on the Table
Defaulting every session to 90834 when documented time supports 90837, on every visit.
Not billing the E/M plus psychotherapy add-on (90833, 90836, 90838) for prescribers who do both in one visit.
Dropping group (90853) and family (90847) sessions out of bundling fear instead of using the correct distinct-service modifier.
Under-using interactive complexity (90785) when it is documented, such as an interpreter, caregiver involvement, or high-conflict dynamics.
Mental Health Billing FAQ
What time supports 90837 versus 90834?
90834 covers a 45-minute session, meaning 38 to 52 minutes face-to-face. 90837 covers a 60-minute session at 53 minutes or more. The recorded duration in the note is the only thing that defends the higher code on audit.
Can I bill an E/M and psychotherapy on the same day?
Yes, for prescribers. Bill the E/M plus the psychotherapy add-on (90833, 90836, or 90838, not the standalone 90832, 90834, or 90837) with modifier 25 on the E/M and separate documentation for each.
Which modifier applies to audio-only therapy?
Modifier 93 for audio-only where the payer allows it, and modifier 95 for synchronous audio and video. The wrong one against the place of service is a common auto-denial.
How do parity limits affect denials?
When a payer applies a session cap stricter than its medical and surgical benefits, document medical necessity and cite MHPAEA parity in the appeal. These CO-151 frequency denials are frequently overturned.
Stop Losing Mental Health Revenue to Preventable Denials
Our AAPC-certified mental health coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.