Psychotherapy is billed by time
Individual psychotherapy codes are chosen by the time spent face to face with the patient (and family, when present), and the note has to show that time. A session is reported with the code whose time range it falls into:
| Code | Service | Time reported |
|---|---|---|
| 90832 | Psychotherapy, 30 minutes | 16–37 minutes |
| 90834 | Psychotherapy, 45 minutes | 38–52 minutes |
| 90837 | Psychotherapy, 60 minutes | 53 minutes or more |
| 90791 / 90792 | Diagnostic evaluation (without / with medical services) | Not time-based |
| 90839 + 90840 | Psychotherapy for crisis, first 60 minutes + each additional 30 | 30–74 minutes for 90839 |
| 90853 | Group psychotherapy | Per patient, per session |
Some commercial plans limit how often 90837 is paid or ask for justification of 60-minute sessions, so the clinical reason for the longer session belongs in the note.
Psychiatric visits with psychotherapy
When a psychiatrist or prescribing clinician provides medication management and psychotherapy in the same visit, the E/M code is reported with a psychotherapy add-on (90833, 90836 or 90838). The two services must be separately identifiable, and the psychotherapy time cannot include the time spent on the E/M service. Interactive complexity (90785) can be added when communication factors genuinely complicate the session, but not with crisis codes.
Who can bill, and under which number
Behavioral health practices often combine psychiatrists, psychiatric nurse practitioners, psychologists, licensed clinical social workers, professional counselors and marriage and family therapists. Each payer sets which of these it credentials and at what rate. Medicare began enrolling marriage and family therapists and mental health counselors in 2024. “Incident to” billing has its own supervision rules and is not a substitute for credentialing each clinician — see credentialing services.
Telehealth
Much behavioral health care is delivered by video or, in some cases, audio only. Claims must carry the place of service the payer expects (02 or 10 for telehealth, depending on the patient’s location and payer policy) and the right modifier (95 for synchronous video; FQ or 93 where audio-only is allowed). Telehealth rules differ between Medicare, Medicaid programs and commercial plans and have changed often, so they are checked by payer rather than applied once.
Carve-outs, parity and authorizations
- Behavioral health carve-outs: many health plans route mental health claims and authorizations to a separate managed behavioral health organization with its own payer ID. Claims sent to the medical plan are denied.
- Authorizations are common for intensive outpatient, partial hospitalization, psychological testing and, with some plans, ongoing therapy beyond a set number of visits.
- Parity: the Mental Health Parity and Addiction Equity Act requires many plans to apply limits no stricter than for medical care; unusual limits can be questioned with the plan.