Therapy billing runs on time-based session codes. Psychiatric billing doesn't. A psychiatrist or psychiatric nurse practitioner (PMHNP) seeing a patient for medication management bills an evaluation and management (E/M) code, the same family of codes a primary care physician uses, and then may add a psychotherapy code on top of it. That combination is where most psychiatric claims are won or lost.
This article covers the codes prescribers use, how the E/M plus add-on pairing works, the intake codes, and the denial patterns we see most often when a psychiatric practice is billed like a therapy practice. For the session codes therapists use, start with our complete guide to mental health billing.
The codes psychiatric prescribers actually bill
Intake: 90792, not 90791
- 90791 is the psychiatric diagnostic evaluation without medical services. It's the intake code for therapists, psychologists, and LCSWs.
- 90792 is the psychiatric diagnostic evaluation with medical services: medication review, a physical or medical assessment, ordering labs, or prescribing. When a psychiatrist or PMHNP does the intake and addresses medication, 90792 is usually the correct code.
Some prescribers bill a new-patient E/M code (99204 or 99205) for the first visit instead. That's allowed, and depending on the payer and the complexity of the visit, it can pay more than 90792. What's not allowed is billing both on the same day for the same patient by the same provider, or adding a psychotherapy add-on to 90791 or 90792.
Follow-up visits: office E/M codes
- 99212–99215 are established-patient office visits. Most medication management follow-ups land on 99213 or 99214.
- 99202–99205 are new-patient office visits, used when the patient hasn't been seen by the practice (in the same specialty) in the past three years.
The level is chosen by either medical decision making (MDM) or total time on the date of service. In psychiatry, MDM is usually the better route: managing a chronic illness with prescription drug management already supports moderate complexity, which is the core of a 99214. Picking the level by time only works when the visit is E/M alone, as explained below.
Psychotherapy add-on codes: 90833, 90836, 90838
When the prescriber also provides psychotherapy in the same visit, they report the E/M code plus one of these add-ons:
| Add-on code | Psychotherapy time | Pairs with |
|---|---|---|
| 90833 | 16–37 minutes | An E/M code on the same claim |
| 90836 | 38–52 minutes | An E/M code on the same claim |
| 90838 | 53 minutes or more | An E/M code on the same claim |
The add-on can't be billed alone, and it can't be billed with 90791, 90792, or the standalone psychotherapy codes (90832, 90834, 90837). If the prescriber spent the visit doing therapy only, with no medication or medical work, the right claim is the standalone psychotherapy code, not an E/M.
Other codes that show up in psychiatric practices
- 90785, interactive complexity, can be added to 90833, 90836, or 90838 (and to the intake and standalone psychotherapy codes). It can't be added to an E/M by itself or to crisis codes.
- 90839 and 90840, psychotherapy for crisis, for the first 30–74 minutes and each additional 30 minutes. They aren't reported with other psychotherapy codes on the same day.
- 96372, therapeutic injection, plus the drug's J-code, for long-acting injectable antipsychotics given in the office.
- G2211, the Medicare add-on for longitudinal care of a serious or complex condition. It's reported with an office E/M when the prescriber is the patient's continuing point of care for that condition, which describes most ongoing medication management. Commercial plans vary, so check each payer before adding it.
How the E/M plus add-on pairing works
Billing 99214 + 90833 is common and legitimate, but payers audit it because it pays meaningfully more than either code alone. To hold up, the note has to show two distinct services:
- The E/M work is separately identifiable. The note documents the history, the medication review, side effects, the assessment, and the plan. That's the medical decision making that supports the E/M level.
- The psychotherapy time is documented on its own. The note states how many minutes were spent on psychotherapy and what the therapeutic intervention was (for example, CBT techniques or supportive therapy focused on a specific goal). "Discussed stressors" doesn't support an add-on.
- The time isn't counted twice. When the E/M level is chosen by time, the minutes spent on psychotherapy can't also count toward the E/M time. That's why most psychiatric practices pick the E/M level by MDM when they also bill a psychotherapy add-on.
A quick self-audit. Pull ten recent 99214 + 90833 claims and read the notes. If you can't point to the psychotherapy minutes and the intervention in each one, and separately to the medication decision, the documentation won't survive a payer review, even if the care was right.
PMHNP billing: what changes for nurse practitioners
PMHNPs bill the same CPT codes as psychiatrists. The differences are in payment and enrollment, not in coding:
- Medicare pays nurse practitioners 85% of the physician fee schedule when they bill under their own NPI. Incident-to billing under a physician can pay 100%, but it has strict supervision and plan-of-care requirements that most outpatient psychiatric practices find hard to meet consistently. Our article on who can bill for mental health services covers incident-to in more detail.
- Commercial plans set their own NP rates. Some pay NPs the same as physicians; many pay a percentage. Knowing the rate before you sign a contract matters, because it decides whether a new PMHNP hire is profitable.
- Credentialing has to cover the behavioral health carve-out too. A PMHNP credentialed with a commercial plan may still be out of network for that plan's members whose behavioral health benefits are managed by Optum, Carelon, or another MBHO. This is the single most common reason a new prescriber's first month of claims comes back denied. See our mental health credentialing guide.
The denials we see most in psychiatric billing
- Add-on billed without a valid primary code. The 90833 was submitted with 90792, with a standalone psychotherapy code, or on a separate claim from the E/M.
- E/M level not supported. A 99215 billed on a stable patient with no medication change, or a 99214 where the note doesn't show prescription drug management.
- Telehealth place of service or modifier mismatch. Payers differ on POS 02 vs. 10 and on modifier 95. Prescribers who see patients in person and by video in the same week get caught by this often. Our billing guide covers telehealth coding.
- Medication prior authorization. The visit pays, but the patient can't fill the prescription, and the follow-up visit becomes a refill emergency. Tracking medication authorizations separately from visit authorizations prevents most of this.
- Rendering provider not credentialed with the MBHO. The claim goes to the commercial plan, gets routed to the behavioral health vendor, and denies as out of network.
Most of these are fixed upstream, at claim build and at credentialing, not by appealing after the fact. If you want to know what your codes should be paying, our Medicare mental health rates by CPT code table includes the E/M and add-on codes.
When to bring in a billing partner
Psychiatric practices usually outgrow in-house billing at the same point: the second or third prescriber joins, the payer mix adds an MBHO or Medicaid plan, and nobody is checking whether the add-on claims are paying at the contracted rate. Sharp Networks Group provides mental health billing services for psychiatrists, PMHNPs, and group practices that combine prescribers and therapists, inside the EHR you already use, and handles credentialing so new prescribers are in network before their first patient. Schedule a consultation and we'll review a sample of your recent psychiatric claims with you.