Specialty billing
Mental Health Billing: What Practices Should Know
Behavioral health billing depends on accurate session times, each payer’s telehealth rules, authorizations and visit limits. It also depends on every clinician being credentialed with the right plans.
Rules to watch
- Start and stop times documented for each session
- Diagnostic evaluations (90791 / 90792)
- Interactive complexity add-on (90785)
- Separate behavioral health carve-out payers
- Supervision and incident-to rules by payer
How is mental health billing different from medical billing?
Mental health billing is mostly time-based. Psychotherapy codes are picked by the minutes spent with the patient, so start and stop times matter more than in most specialties. Diagnostic evaluations, family sessions and crisis care each have their own codes, and many insurance plans hand behavioral health to a separate carve-out company with different rules, portals and credentialing. Telehealth is common, and payers do not agree on place of service and modifiers. Since 2024, Medicare also lets marriage and family therapists and mental health counselors enroll and bill. The usual trouble spots are sessions billed in the wrong time band, missing authorizations for ongoing therapy, and claims sent to the medical plan instead of the carve-out.
What makes it different
What makes mental health billing different
Codes at a glance
Common mental health codes and what to watch
| Service | Codes | What to watch |
|---|---|---|
| Diagnostic evaluation | 90791 (without medical services), 90792 (with) | Not billed with psychotherapy on the same day by the same provider |
| Psychotherapy | 90832 (16–37 min), 90834 (38–52 min), 90837 (53+ min) | Document start and stop times |
| Interactive complexity | +90785 | Add-on; not with crisis codes |
| Crisis psychotherapy | 90839 (first 60 min), +90840 (each additional 30 min) | Time and crisis nature documented |
| Family psychotherapy | 90846 (without patient), 90847 (with patient) | Who attended is documented |
Related services
Services that matter most for mental health
FAQ
Mental Health billing questions
Which psychotherapy code should be used for a 50-minute session?
A 50-minute psychotherapy session falls in the 38–52 minute range, which is reported with 90834. Sessions of 53 minutes or more are reported with 90837. See our 90837 vs. 90834 guide.
Can licensed counselors bill Medicare?
Yes. Beginning January 1, 2024, marriage and family therapists and mental health counselors can enroll in Medicare and bill for their services.
How is CPT 90791 billed?
CPT 90791 is the psychiatric diagnostic evaluation, usually billed at the start of care. It cannot be billed on the same day as psychotherapy or an E/M service by the same provider. Our CPT 90791 billing guide covers the rules in detail.
Coding rules change every year. The code references on this page reflect general guidance at the time of writing. Payer policies and your documentation always determine what is billable.
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