Psychiatry Billing & Coding Guide
Psychotherapy 90832-90838 add-on to E/M, medication management, telehealth POS 02 vs 10.
Common Psychiatry CPT Codes
Ranked by claim frequency, with current MPFS work RVUs and global periods.
| Code | Description | Work RVU | Total RVU | Global |
|---|---|---|---|---|
| 90791 | Psych diagnostic evaluation | 3.84 | 5.19 | XXX |
| 90792 | Psych diag eval w/med srvcs | 4.16 | 6.05 | XXX |
| 90832 | Psytx w pt 30 minutes | 1.94 | 2.57 | XXX |
| 90833 | Psytx w pt w e/m 30 min | 1.71 | 2.44 | ZZZ |
| 90834 | Psytx w pt 45 minutes | 2.56 | 3.41 | XXX |
| 90836 | Psytx w pt w e/m 45 min | 2.17 | 3.09 | ZZZ |
| 90837 | Psytx w pt 60 minutes | 3.78 | 5.00 | XXX |
| 90838 | Psytx w pt w e/m 60 min | 2.86 | 4.09 | ZZZ |
| 90839 | Psytx crisis initial 60 min | 3.58 | 4.80 | XXX |
| 90840 | Psytx crisis ea addl 30 min | 1.71 | 2.31 | ZZZ |
| 90846 | Family psytx w/o pt 50 min | 2.74 | 3.17 | XXX |
| 90847 | Family psytx w/pt 50 min | 2.86 | 3.28 | XXX |
| 90849 | Multiple family group psytx | 0.67 | 1.21 | XXX |
| 90853 | Group psychotherapy | 0.67 | 0.91 | XXX |
| 90863 | Pharmacologic mgmt w/psytx | 0.48 | 0.78 | XXX |
| 99213 | Office o/p est low 20 min | 1.30 | 2.85 | XXX |
| 99214 | Office o/p est mod 30 min | 1.92 | 4.06 | XXX |
| 99215 | Office o/p est hi 40 min | 2.80 | 5.76 | XXX |
| 99203 | Office o/p new low 30 min | 1.60 | 3.52 | XXX |
| 99204 | Office o/p new mod 45 min | 2.60 | 5.31 | XXX |
What Psychiatry practices are leaving on the table
High-value services that consistently get under-billed across the specialty. Each one is rooted in current 2026 fee schedule and policy updates.
90863 (pharmacologic management add-on, 0.48 RVU, ~$22 Medicare) is chronically under-billed when psychiatrist manages meds during therapy visit. If 40% of your therapy visits include med review and you're not billing 90863, this is $8,800 annual impact per 100-patient panel. Implement template in EMR: separate 'Med Check' section in every therapy note documenting med changes, adherence, side effects.
90792 (new patient evaluation with medical services, 4.16 RVU vs 90791 3.84 RVU) is often coded as 90791 when patient requires medication initiation. 90792 is appropriate whenever evaluation includes psychiatric medication management. Dollar swing per eval: ~$15 (difference in RVU). If you do 10 new evals/month, this is $1,800 annual revenue. Train intake staff to flag 'medication started at visit' = code 90792.
Family psychotherapy codes (90846, 90847) are rarely billed in many Psychiatry practices despite high utilization. These codes have 2.74-2.86 RVU each. If your practice conducts family sessions as part of treatment plan, audit last 6 months for unbilled family sessions. One family session per week = $3,500 annual missed revenue.
Modifier 95 (telehealth) parity billing: Practices that still reduce fees for telemedicine or don't bill telehealth at all are leaving 10-15% of revenue on table. CMS and most commercial plans (UHC, Anthem, Cigna) pay telehealth at parity since 2023. Shift any 90832-90837 conducted via secure video to modifier 95 without fee reduction. Average impact: 25% of your therapy volume at full RVU recovery = $12,000-$20,000 annual for mid-size practice.
Code pairs that auto-bundle to CO-97
From the National Correct Coding Initiative for Psychiatry. The rationale tells you when a modifier legitimately bypasses the edit and when it cannot.
Initial diagnostic eval (90791) and psychotherapy (90832) on same day bundle unless eval documents distinct, medically necessary separate session. Modifier 59 only defensible if separate appointment slots and documented clinical reason for both same day.
60-minute psychotherapy (90837) and pharmacologic management add-on (90863) do NOT bundle. 90863 is always separately billable as add-on for medication review/adjustment, but documentation must show distinct med management work beyond the therapy session.
Psychotherapy with E/M (90833, global ZZZ) and established patient office visit (99214, global XXX) are mutually exclusive on same day. Choose one based on primary service; if both clinically necessary, modifier 25 applies to E/M with documentation of distinct problem addressed.
Family psychotherapy with patient (90847) and family psychotherapy without patient (90846) cannot be billed same day. These are mutually exclusive; documentation must clarify whether patient attended or not, not both on same claim.
Modifier Guidance for Psychiatry
When each modifier legitimately applies in this specialty, with denial-pattern context and audit-defense documentation.
Modifier 25 appends to E/M (99213-99215) when significant, separately identifiable E/M is performed same day as psychotherapy (90832, 90834, 90837). Example: Patient with anxiety presents for scheduled 45-minute therapy (90834); during visit, new acute chest pain requires separate H&P, EKG review, and medical decision-making (99214-25). Documentation must show two distinct problem sets and time allocations.
Modifier 59 on psychotherapy codes (90832-90840) is NOT standard in Psychiatry since no inherent bundling exists between these codes and E/M codes in NCCI. Use 59 only if payer-specific bundling edit exists and clinical documentation supports distinct procedural services (e.g., separate sessions on same day with different chief complaints). Risk of denial is high without prior payer authorization.
Modifier 95 (synchronous telemedicine) appends to any psychotherapy or evaluation code when rendered via real-time audio-video. No reduction in RVU; Medicare and most commercial plans pay 95-modifier claims at parity with in-person since 2023 permanent telehealth expansion. Ensure documentation shows synchronous (not store-and-forward) and secure HIPAA-compliant platform.
Modifier KX (requirements met per policy) is required by some MACs when billing psychotherapy codes beyond frequency limits or when medical policy requires authorization. Check MAC LCDs before submitting; missing KX can trigger automatic denial on claims flagged for frequency edit.
Modifier 26 (professional component) does not apply to Psychiatry codes; these are pure physician work with no technical component split. Appending 26 to 90791-90863 results in denial and RAC audit flag for misuse of modifier.
Documentation requirements
What needs to live in the encounter note for these codes to survive a payer audit.
- Chief complaint and reason for visit documented in narrative (supports medical necessity and prevents unbundling denial).
- Time spent in face-to-face service with patient recorded in minutes (90832-90840 RVU assignment based on time thresholds; auditors verify via chart timestamp correlation).
- Psychiatric symptoms, mental status findings, and treatment response noted (demonstrates psychotherapy component beyond simple E/M, defends against bundling audit).
- Medications reviewed, changed, or continued with clinical rationale if 90863 billed (separates med management from psychotherapy work RVU).
- Plan/next steps and follow-up interval documented (satisfies medical necessity and reduces risk of frequency-of-service denials on RAC audit).
- For 90833/90836/90838 (therapy with E/M), distinct medical decision-making separate from therapy documented in separate section (prevents denial that E/M was incidental to psychotherapy).
OIG and audit triggers in Psychiatry
Patterns that show up in OIG Work Plans, RAC audits, and CERT improper payment reviews. Build internal compliance checks around these.
OIG Work Plan 2024-2026 targets Psychiatry billing for psychotherapy code upcoding (billing 90837 when 90832 time documented). Auditors cross-reference chart timestamps and session notes to actual minutes billed. Defense requires contemporaneous time documentation; estimate-based billing is indefensible.
RAC pattern: Bundling denial of 90863 (pharmacologic management) into 90837 (psychotherapy) when both billed same day without separate med review note. MAC assumes add-on was administrative. Defense requires separate section in chart titled 'Medication Management' with clinical assessment, change rationale, and follow-up monitoring plan distinct from therapy.
CMS 2024 guidance restricts 90833/90836/90838 (psychotherapy with E/M) billing when combined code is used. Some MACs interpret these as inclusive of E/M and deny the +25 modifier. Verify your MAC's LCD; if bundled in your region, use base psychotherapy code (90832/90834/90837) + separate E/M only if modifier 25 documentation is robust.
Frequency-of-service audits flag practices billing 90832-90840 more than 2 times per week per patient. Expect RAC request for medical records justifying frequency. Crisis codes (90839/90840) are exception but require emergency documentation and diagnosis justification.
Payer-specific billing notes
Where the major payers diverge from generic Medicare rules in Psychiatry.
ME Medicare +
CMS LCD varies by MAC region; check your specific MAC (e.g., Novitas for Mid-Atlantic, Palmetto for Southeast). Most MACs bundle 90833/90836/90838 (psychotherapy with E/M) into base codes and deny modifier 25. Safer to bill base psychotherapy code + separate E/M with full modifier 25 documentation. Prior authorization is not required for 90791-90863 in 2025-2026, but frequency limits (typically 2x/week for ongoing therapy) are enforced via post-pay audit. Telehealth codes (modifier 95) are paid at parity through end of 2026 per CMS final rule.
UN UnitedHealthcare +
UHC uses Optum's medical policy requiring prior authorization for psychotherapy exceeding 20 visits per benefit period; no edit on codes themselves but claim denial post-submit is common. Implement pre-auth workflow: submit auth request at visit 15 with clinical justification. UHC pays modifier 25 straightforwardly if E/M and psychotherapy have distinct time/problem documentation. Telehealth paid at parity (modifier 95). Group therapy (90853) and family codes (90846/90847) require separate prior auth in some UHC plans; verify plan design upfront.
AN Anthem +
Anthem BlueCross uses AIM (Anthem Integrated Messaging) for prior auth on psychiatric services in select regions; check state-specific plan rules. Anthem medical policy requires 'psychological testing' (not in this database) to be billed separately and will deny bundling into evaluation codes. Anthem pays 90863 (pharmacologic management) freely when billed with psychotherapy. Telehealth codes (modifier 95) paid at parity. Denial rate on family psychotherapy (90846/90847) is elevated; recommend attaching operative report or clinical narrative explaining family participation rationale.
CI Cigna +
Cigna delegates psychiatry/psychology authorization to eviCore in some regions; check before submitting claims. Cigna policy pays 90791/90792 as new patient codes only once per patient lifetime, then subsequent evals must be billed as E/M (99203-99205) not re-eval psychiatry codes. Cigna explicitly bundles 90833/90836/90838 into base codes and requires modifier 25 for any E/M appended; modifier 25 denial rate is low if documentation shows distinct medical decision-making. Pharmacologic management (90863) paid as add-on without restriction. Telehealth paid at parity (modifier 95) across all Cigna plans.
Standard Psychiatry coding workflow
Step 1: Verify patient status (new vs. established) and select evaluation code (90791 new w/o meds, 90792 new with meds, or E/M 99203-99205). Step 2: Document face-to-face time and chief complaint. Step 3: Code psychotherapy by time-based CPT (30 min = 90832, 45 min = 90834, 60 min = 90837). Step 4: Add 90863 only if distinct medication management documented beyond therapy. Step 5: Append modifiers (25 if E/M distinct, 95 if telehealth, KX if payer policy requires) and submit with time/problem-level documentation screenshot.
Get the full PayerReady toolkit
Credentialing + billing/coding tools built for Psychiatry, free access with enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Verified against CMS 2026 code set, current NCCI Quarterly Updates, and the X12 Claim Adjustment Reason Code reference. Last updated April 15, 2026. See data sources and methodology.
Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team