Mental health CPT codes, in plain English.

The first visit: 90791 and 90792

90791 is a psychiatric diagnostic evaluation without medical services. It's the intake code for therapists, counselors, social workers, and psychologists. 90792 is the same evaluation with medical services, such as a medication review or physical exam, so it's billed by psychiatrists, psychiatric nurse practitioners, and other prescribers.

Neither code is time-based. Many insurers limit how often they'll pay for one, often once per client per provider in a period such as a year, so a second evaluation after a long break is a common denial. If a client comes back, check the plan's frequency rule before billing another.

Individual therapy: 90832, 90834, 90837

These three codes cover psychotherapy with the client present for all or part of the session. You pick the code by the time actually spent in therapy, not by the length of the appointment slot:

Write the start and end time, or the total minutes, in every note. If an insurer asks for records, the time in the note is what decides whether the code was right. Billing 90837 every week isn't wrong when the sessions really run 53 minutes or more, but some insurers flag clinicians who use it on nearly every claim, so the documentation matters more there.

Therapy during a med visit: 90833, 90836, 90838

When a psychiatrist or psychiatric NP does a medication-management visit and also provides therapy, the visit is billed as two lines on one claim: an evaluation and management (E/M) code such as 99213 or 99214, plus a psychotherapy add-on. The add-ons follow the same time bands as individual therapy: 90833 for 16–37 minutes, 90836 for 38–52, and 90838 for 53 or more.

The therapy minutes and the med-check work have to be separate and clearly documented. Time spent on therapy can't also be counted toward choosing the E/M level. A frequent outcome when this isn't clear is that the insurer pays the E/M line and denies the add-on. Because the claim shows a payment, nobody notices the missing line unless payments are checked line by line.

Family and group therapy: 90846, 90847, 90849, 90853

• 90847: family or couples therapy with the client present.
• 90846: family therapy without the client present, for example a session with parents about their child's treatment. Some insurers don't cover it at all.
• 90849: multiple-family group therapy.
• 90853: group therapy (not a multiple-family group). Bill one claim per group member, each under that member's own insurance.

90846 and 90847 are described as 50-minute services. Under CPT's general time rules, most insurers accept them once the session passes the halfway mark, 26 minutes, but check each plan's policy. Family and couples sessions are billed under one identified client: the person with the diagnosis whose treatment the session supports. Billing under a spouse or parent who isn't the client is a common reason these claims are denied.

Crisis sessions: 90839 and 90840

90839 covers the first 30–74 minutes of psychotherapy for a client in crisis. 90840 is an add-on for each additional 30 minutes beyond that. A crisis session under 30 minutes is billed with the regular time-based code instead. Crisis codes generally can't be billed by the same clinician on the same day as 90832–90838 or with 90785.

Interactive complexity: 90785

90785 is an add-on for sessions where something specific makes communication harder: for example, caregivers whose conflict gets in the way of treatment, a child who needs play equipment to communicate, or a sentinel event that requires a report to a third party such as a state agency. It goes on the same claim as 90791, 90792, a psychotherapy code, or 90853. It isn't for interpreter services or translation, and it isn't billed with crisis codes or with an E/M code alone.

Psychological testing

Testing is billed in units, often across several days: 96130/96131 for evaluation services by the psychologist, and 96136/96137 for test administration and scoring. Many insurers require prior authorization for testing. Our psychology page walks through how a multi-day testing claim comes together.

Who can bill Medicare

Since January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs, including licensed professional counselors) can enroll in Medicare and bill it directly, alongside psychiatrists, clinical psychologists, clinical social workers, and nurse practitioners. If you're an LPC or LMFT who has turned away Medicare clients, that's no longer necessary, though enrollment takes time to complete.

The mistakes that cause most denials

• Time that doesn't support the code. No start and end time, or a total that falls in a different band.
• The wrong person on the claim. Family sessions billed under someone other than the identified client.
• Codes that can't go together. Crisis codes with regular therapy on the same day, or 90785 with an E/M code alone.
• A diagnosis the insurer won't pay for. Some plans won't pay when the primary diagnosis is a Z code (such as relationship distress) rather than a mental health diagnosis.
• Missing modifiers or the wrong place of service on telehealth sessions. See telehealth billing.

Sources

• American Medical Association: CPT® overview
• CMS MLN booklet: Medicare & Mental Health Coverage (MLN1986542, March 2026)
• X12: Claim Adjustment Reason Codes

This article is general information, not legal, coding, or reimbursement advice. Payer rules change and vary by plan and state, so check each payer's current policy. CPT® is a registered trademark of the American Medical Association.