The process of invoicing for behavioral health treatments within the framework of medical billing is a difficult and complex undertaking for healthcare practitioners. Because of the rising demand for mental health medication, providers must develop a tailored billing system that can manage pertinent Medical Current Procedural Terminology (CPT) codes along with associated services. Different reimbursement and coding rules apply to behavioral health billing than to standard medical billing coding. Therefore, providers must comprehend the subtleties of behavioral health billing and implement a specialized billing system to appropriately manage the special requirements related to mental health therapies.

Why Do Practitioners Need to Know CPT Codes?

As they disturb reimbursement and the overall efficiency of the practice, CPT codes are important to handling a medical practice for doctors and other healthcare specialists. Before keeping their insurance claims to the insurance companies, clinicians require to make sure that the codes correctly show the services they delivered in order to accept the proper payment charges.

Common behavioral health CPT codes for medical billing:

Behavioral health medical billers can utilize a few CPT codes for psychiatry services, and they receive varying reimbursement rates for using them. Let us examine the following list of the most commonly used behavioral health CPT codes for services related to psychiatry:

Behavioral health CPT codes for diagnosis, evaluation, and administration:

The two most used CPT codes for diagnosis, evaluation, and intake are as follows:

CPT Code 90791: The psychiatric diagnostic assessment code is used in situations where medical services are not provided. Usually, this code just handles one client.

CPT Code 90792: Code for Psychiatric Diagnostic Assessment that includes medical services. 

Outpatient Behavioral Health CPT Codes:

The following is a list of the most common CPT codes for outpatient mental health services:

CPT Code 90832: Psychotherapy for 30 minutes (16–37 minutes).

CPT Code 90834: Psychotherapy for 45 minutes (38 to 52 minutes).

CPT Code 90837: Psychotherapy for sixty minutes (53 minutes and longer).

CPT Code 90846: Couples or family counseling (in the absence of the patient present).

CPT Code 90847: Therapy in couples or families (with the patient present).

CPT Code 90839: Crisis psychotherapy for 60 minutes (30-74 minutes).

CPT Code 90840: Use this add-on code in conjunction with 90839 to receive an additional 30 minutes (or 75 minutes or more) of psychotherapy during a crisis.

CPT codes for psychotherapy that include management and evaluation services:

The most popular CPT codes for psychotherapy that include evaluation and management services are listed below:

CPT Code 90833: Psychotherapy for 30 minutes including assessment and management.

CPT Code 90836: Psychotherapy with assessment and management for forty-five minutes.

CPT Code 90838: Psychotherapy for 60 minutes, including assessment and management.

Behavioral health add-ons CPT codes:

The most popular add-on codes for normal outpatient mental health billing services are listed below in brief order of frequency:

Add-On CPT Code 90785: Utilized to create interactive complications. Take play therapy, for example, using calming toys or dolls. This interactive difficulty add-on merely indicates that the medical care received was challenging; it is not a prepaid fee.

Add-On CPT Code 90863: The code is used for pharmacologic management following therapy.
Add-On CPT Code 99050: Used for mental health services provided outside of regular business hours or inside the office during regular business closures.
Add-On CPT Code 99051: Services provided in the psychiatry office on weekends, during vacation office hours, or on normally planned days.

Add-On CPT Code 99354: Utilized as an extension following the 74-minute extension. For 90837 or 90847, the session must last at least 90 minutes; otherwise, the code will add thirty more minutes to the payment.

Add-On CPT Code: 99355: After the initial sixty minutes, more time is added with this add-on code. Thirty to seventy-four minutes make up the first extra.

Add-on CPT Code 90840: When utilized in conjunction with CPT 90839, this add-on code represents an extra thirty minutes of crisis psychotherapy.

Add-on CPT Code 90833: This code extends the treatment by thirty minutes. A psychiatrist utilizes it, for example, when conducting a 30-minute session while keeping an eye on the patient’s response.

Add-On CPT Code 90836: This code entitles you to an extra forty-five minutes of counseling. An expert clinical nurse applies it, for example, when conducting a 45-minute visit after monitoring the pharmaceutical reaction.

Conclusion:

A proficient team, like The Medicator, understands the intricate regulations and unique aspects of billing for psychology, psychiatry, and therapy. Navigating the complex landscape of mental health billing requires expertise in laws, codes, documentation, and payment procedures. Based in Naperville, Illinois, The Medicator specializes in streamlining billing processes for mental and behavioral health services. Moreover ensuring accurate and timely reimbursement. Connect with us to modernize your billing and payment practices, so you can focus on delivering exceptional patient care. While we handle the complexities of mental health billing.