Haris Ashley
The Current Procedural Terminology (CPT) code set is used to describe tests, evaluations, treatments, and other medical procedures used in the spectrum of healthcare. CPT codes are used by insurance companies to identify and reimburse healthcare services. CPT codes for mental health services are found in the Psychiatry section of the CPT code set and cover services provided by medical professionals such as psychiatrists, as well as services that can be delivered by non-medical professionals such as licensed clinical psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers. CPT codes for behavioral services specifically can be found in the Behavioral Health Coding Guide published by the American Medical Association. These codes cover adaptive behavior services, health behavior assessment and intervention, general behavioral health integration care management, psychiatric collaborative care management, and more.
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What You'll Learn
CPT codes for mental health billing
CPT codes, or Current Procedural Terminology codes, describe tests, evaluations, treatments, and other medical procedures used in the spectrum of healthcare. The CPT code set contains over 8,000 codes and is published and updated annually by the American Medical Association.
While there are many CPT codes that may be applicable to mental health services, in a therapy setting, you will probably find yourself using only a relatively small subset of these codes. CPT codes related to mental health (codes 90785-90899) are found in the Psychiatry section of the CPT code set and cover services provided by medical professionals, such as psychiatrists, as well as services that can be delivered by non-medical professionals such as licensed clinical psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers.
The mental health CPT codes used by therapists are organized into four distinct categories, making it easier to find the code you need. CPT Add-on Codes are used to describe a service performed in conjunction with a primary service. Many of these add-on codes are associated with a specific CPT Code or a small set of CPT Codes and cannot be used otherwise. On CMS 1500 forms, CPT Add-on codes are simply added on a new line.
Modifiers provide additional information to a payer and can describe the license level of the provider, when services were provided, and how the services were provided, among other things. Modifier 25, for example, is used to indicate a separate and reimbursable service performed by the same provider on the same day. This modifier can only be attached to codes 99201-99215 and 99341-99350. Modifier 59 is used to describe a distinct non-E/M procedural service done on the same day, and your documentation must support a separate session. Modifier GT is used for telehealth sessions involving interactive audio and video, while modifier UT is used when the provider sees a patient in crisis.
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CPT code categories
Current Procedural Terminology (CPT) codes are the universal language for reporting medical services and procedures for Outpatient and Professional Fee services. CPT codes are maintained by the American Medical Association (AMA) and updated annually. They are five-digit numeric or alphanumeric codes, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have a common understanding across the clinical health care paradigm.
There are three main categories of CPT codes:
Category I CPT Codes
These are the most common codes and represent the backbone of medical coding. They encompass the vast majority of outpatient and professional fee services and procedures performed by healthcare providers. These codes have descriptors that correspond to a specific procedure or service and are generally ordered into sub-categories based on procedure/service type and anatomy. The codes range from 00100–99499.
Category II CPT Codes
These are alphanumeric tracking codes that are supplementary and used for performance measurement. They are not mandatory for billing purposes but can be valuable for internal performance monitoring and improvement initiatives within hospitals. Category II data can be used to compare a hospital's performance against national benchmarks, helping to identify areas of excellence and growth opportunities.
Category III CPT Codes
These are temporary alphanumeric codes assigned to emerging and experimental technologies, procedures, and services that are still under development or undergoing clinical trials. They are not used for billing but serve as placeholders until permanent Category I codes are established. While not directly impacting current operations, Category III codes keep hospital decision-makers informed about advancements in healthcare, allowing them to prepare for potential future integration and strategically plan for changes in coding practices and reimbursement models.
In addition to these three main categories, there are also Proprietary Laboratory Analyses (PLA) codes, which describe proprietary clinical laboratory analyses provided by a single ("sole-source") laboratory or licensed/marketed to multiple providing laboratories approved by the FDA. This category includes Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs) as defined under the Protecting Access to Medicare Act of 2014 (PAMA).
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CPT add-on codes
CPT, or Current Procedural Terminology, codes are used to describe tests, evaluations, treatments, and other medical procedures used in the spectrum of healthcare. CPT add-on codes are a special type of code that indicates to insurers that a provider has performed a secondary service in addition to a primary service. CPT add-on codes are designated by the symbol "+" in the CPT Manual.
The Centers for Medicare and Medicaid Services (CMS) have divided add-on codes into three types, depending on how contractors are required to process the codes. Type 1 AOCs have a limited number of identifiable primary procedure codes, while Type 2 AOCs are eligible for payment if an acceptable primary procedure code, as determined by the claims processing contractor, is also eligible for payment to the same practitioner for the same patient on the same date of service. Type 3 AOCs have some, but not all, specific primary procedure codes identified in the CPT Manual, and claims processing contractors are advised that these lists are not exclusive.
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CPT codes for psychotherapy
CPT (Current Procedural Terminology) codes are essential for mental health professionals to accurately bill for psychotherapy services. These standardised codes ensure proper reimbursement and streamline the billing process for insurance companies and healthcare providers. CPT codes are five-digit numeric codes that describe specific mental health services provided to patients. They are used for billing purposes and help insurance companies determine appropriate reimbursement rates for different types of therapy sessions.
The CPT codes for psychotherapy are organised into four distinct categories, making it easier to find the code you're looking for. While there are many codes that may be applicable to mental health services more broadly, in a therapy setting, you'll probably find yourself using only a relatively small subset of these codes. It's crucial for mental health professionals to stay current on CPT code updates.
- 90834: Traditional face-to-face, individual psychotherapy sessions are usually billed for 45 minutes.
- 90791: Used for an intake interview.
- 90847: Used for family therapy.
- 90785: Interactive complexity.
- 90846: Family psychotherapy without the patient present.
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CPT codes for behavioral health screening
The Current Procedural Terminology (CPT) code set describes tests, evaluations, treatments, and other medical procedures used in the spectrum of healthcare. CPT codes related to mental health (codes 90785-90899) can be found in the Psychiatry section of the CPT code set. These codes cover services provided by medical professionals such as psychiatrists, as well as services that can be delivered by non-medical professionals such as licensed clinical psychologists, licensed professional counselors, and licensed clinical social workers.
CPT code 96127 is a generic mental health screening code that is covered by all major insurances and can be used in most practices for the mental health screening of a broad group of patients. It is meant to be used as a generic screening code to uncover underlying mental health conditions and can be used for screening for any mental health condition, including depression and anxiety. Most insurance companies require the use of the generic screening code Z13.xx if the results are negative, and either Z13.xx or codes beginning with F if the results are positive.
Other CPT codes that are typically used for developmental screening and health risk assessment (HRA) include 96110, 96160, and 96161. Additionally, CPT codes for mental health billing include 90792 for an initial evaluation with medical services, and codes for family psychotherapy, group psychotherapy, and therapy sessions with the family when the client is not present.
It is important to use the correct CPT codes for mental health services as it ensures timely acceptance of claims and maintains the necessary cash flow to operate a practice. Incorrect coding may result in audits and potential fines.
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Frequently asked questions
The CPT code for a psychiatric diagnostic evaluation with medical services is 90792.
CPT codes for psychotherapy include 90832, 90834, 90837, and 90839 for crisis psychotherapy.
CPT codes for behavioral health include 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 96156, 96158, 96159, 96160, 96161, 96164, 96165, 96167, 96168, and 96170.
CPT stands for Current Procedural Terminology. CPT codes describe tests, evaluations, treatments, and other medical procedures used in the spectrum of healthcare.
