Psychiatry billing services
Medication management, psychotherapy add-ons, TMS and esketamine treatment each have their own codes and payer rules. We bill psychiatric care to each payer's rules.
Why psychiatry billing takes specialty knowledge
Psychiatry billing combines medical E/M coding with psychotherapy codes. A psychiatrist who manages medication and provides therapy in the same visit bills an E/M plus a psychotherapy add-on, and both parts need separate documentation. Behavioral health benefits are often managed by carve-out companies with their own enrollment, authorization and claim rules. Newer treatments like TMS and esketamine add prior authorization and unit tracking.
SFA Solutions bills for psychiatrists, psychiatric nurse practitioners and the therapists who work with them. We verify behavioral health benefits with the right carve-out company before the first visit, code E/M and add-on combinations correctly and track authorizations for TMS courses. We work inside your EHR, including Osmind and TherapyNotes, and aim to submit most clean claims within 24 hours of final review.
Common codes we work with in psychiatry
| Code | Description |
|---|---|
| 90792 | Psychiatric diagnostic evaluation with medical services |
| 90833 | Psychotherapy, 30 minutes with patient, with an E/M service (add-on) |
| 90836 | Psychotherapy, 45 minutes with patient, with an E/M service (add-on) |
| 99214 | Office or outpatient visit, established patient, moderate MDM or 30+ minutes |
| 90837 | Psychotherapy, 60 minutes with patient |
| 90785 | Interactive complexity (add-on) |
| 90868 | Therapeutic repetitive transcranial magnetic stimulation (TMS), subsequent delivery and management, per session |
| 99492 | Initial psychiatric collaborative care management, first 70 minutes in the first month |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where psychiatry practices lose revenue
E/M with psychotherapy add-ons
When medication management and therapy happen in one visit, the E/M (99212 to 99215) is billed with 90833, 90836 or 90838 based on psychotherapy time. The time spent on therapy cannot count toward the E/M level, so the note has to separate the two.
Evaluations and interactive complexity
A psychiatric diagnostic evaluation with medical services is 90792, and without medical services is 90791. Interactive complexity (90785) is added when communication factors, such as a caregiver who disrupts the visit, complicate care. Payers limit how often evaluations can be billed.
TMS and esketamine
TMS uses 90867 for the initial session with mapping, 90868 for subsequent sessions and 90869 for re-mapping. Most payers require documented failure of multiple medication trials. For Medicare, esketamine treatment is billed with G2082 or G2083, which bundle the drug, self-administration and the 2-hour observation, with the code chosen by dose.
Carve-outs and telehealth
Many health plans route behavioral health to separate administrators, so a claim sent to the medical plan is denied. Telehealth uses POS 10 for patients at home and POS 02 for other sites, with modifiers 95 or 93 as the payer requires. Medicare telehealth rules for mental health have changed several times, so we check current requirements.
What else affects psychiatry revenue
A/R challenges in psychiatry
Psychiatry A/R often builds up on carve-out claims, where a claim sent to the medical plan instead of the behavioral health administrator is denied and has to be resent within the filing limit. TMS and Spravato treatment runs over weeks, so an authorization that lapses midway can deny several visits at once. Out-of-network patients also leave balances that need clear statements and steady follow-up.
Credentialing considerations
Psychiatrists and PMHNPs need enrollment with medical plans and with each behavioral health carve-out, such as Optum Behavioral Health, Carelon Behavioral Health or Magellan, which keep their own networks. Since January 2024, Medicare also enrolls licensed marriage and family therapists and mental health counselors, which matters for practices adding therapists. Telehealth across state lines generally requires a license in the state where the patient is located.
Payer considerations
Federal parity rules require plans to cover behavioral health on terms comparable to medical care, but authorization rules and rates still vary widely by plan. Spravato is dispensed under an FDA REMS program and may fall under the pharmacy or medical benefit depending on the plan. For Medicare, the observed self-administration visit is billed with G2082 or G2083 based on the dose.
Psychiatry coding details that affect payment
ICD-10 considerations
Bipolar disorder codes in F31 describe the current episode and its severity, such as F31.31 for current episode depressed, mild, so the code should be updated as the patient's state changes. TMS and esketamine coverage generally require a major depressive disorder code that shows severity, such as F33.2 for recurrent severe depression without psychotic features, and unspecified depression codes can lead to denials. Substance use disorders are coded by substance, severity and remission status, such as F11.21 for opioid dependence in remission. Z79.899 for other long-term drug therapy supports monitoring labs for medications like lithium or clozapine.
Modifiers to watch
| 25 | Added to the E/M when the psychiatrist manages medications on the same day as a TMS session or other separately billed procedure. |
|---|---|
| 95 | Used by many commercial plans on video visits, together with the POS code the plan requires. |
| 93 | Applied to audio-only visits where the payer allows them, generally when the patient cannot use or declines video. |
| FS | Required by Medicare on split or shared visits in inpatient psychiatric units when a psychiatrist and an NP or PA both see the patient. |
Global periods
Global surgical periods rarely apply in psychiatry. Electroconvulsive therapy (90870) is billed per treatment with a 0-day global, and anesthesia for ECT (00104) is billed separately by the anesthesia provider.
Medicare considerations
Medicare covers TMS for major depressive disorder under MAC local coverage policies that generally require failed trials of antidepressants and psychotherapy. Psychiatric collaborative care (99492 to 99494) requires patient consent, a behavioral health care manager and a psychiatric consultant who reviews the caseload. Office-based treatment of opioid use disorder can be billed with G2086 to G2088, which bundle care management and counseling by month.
Psychiatry billing KPIs to track
- E/M and add-on pairing accuracy. Psychotherapy add-ons billed without separate time from the E/M are a common audit finding in psychiatry.
- Claims sent to the wrong carve-out. Behavioral health claims sent to the medical plan deny and must be resent within the filing limit.
- TMS authorization sessions remaining. A TMS course runs many sessions, and a lapse midway can deny a block of treatments at once.
- Collaborative care billing rate. Comparing billed 99492 to 99494 to patients enrolled in collaborative care shows unbilled monthly time.
Psychiatry billing audit checklist
- Confirm psychotherapy add-on time is documented separately from the E/M.
- Check that 90791 or 90792 frequency fits each payer's limits.
- Verify TMS claims match the authorized number of sessions and dates.
- Review esketamine claims for the correct G2082 or G2083 based on dose for Medicare patients.
- Confirm each claim went to the behavioral health administrator that manages the patient's plan.
- Check telehealth claims for the POS and modifier each payer requires.
How SFA runs psychiatry billing
We review your payer mix, carve-out arrangements and E/M with add-on claims to find denials and missed revenue.
We verify behavioral health benefits and obtain authorizations for therapy, TMS and esketamine before visits.
Coders check each note for separate E/M and therapy documentation with a 24-hour target for submitting clean claims after final review.
We follow up on denials, track authorization use and report results every month.
The services that matter most for psychiatry
Eligibility Verification & Prior Authorization
Behavioral health carve-outs and TMS authorizations have to be confirmed before treatment starts.
Learn moreCredentialing & Payer Enrollment
Psychiatrists and psychiatric NPs need enrollment with both medical plans and behavioral health administrators.
Learn moreMedical Coding
E/M plus psychotherapy add-on coding is where most psychiatry underbilling and audit risk sits.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
Psychiatry billing questions
Can a psychiatrist bill 90837 and an E/M on the same day?
No. When an E/M is billed, psychotherapy is reported with the add-on codes 90833, 90836 or 90838. 90837 is the stand-alone psychotherapy code without an E/M.
How is psychotherapy time counted with an add-on?
Only time spent on psychotherapy counts toward the add-on, and it cannot be used again to support the E/M level. 90833 requires at least 16 minutes, 90836 at least 38 minutes and 90838 at least 53 minutes.
Do psychiatric nurse practitioners bill the same codes?
Yes. PMHNPs bill E/M, evaluation and psychotherapy codes under their own NPI. Medicare pays NPs at 85% of the physician fee schedule unless incident-to rules are met.
Does insurance cover TMS?
Most commercial plans and Medicare cover TMS for major depressive disorder after documented failure of medication trials and psychotherapy. Coverage criteria differ, so we check each payer's policy before the course starts.
Do you work with Osmind and TherapyNotes?
Yes. We work inside the EHR you already use, including Osmind, TherapyNotes, athenahealth and many others.
See what your psychiatry billing is missing
Send us a few details and an RCM specialist who knows psychiatry will review where claims are denied, underpaid or left unbilled.
- A clear walkthrough of what we find
- Reply typically within one business day
- No commitment
Request your free practice audit
An RCM specialist typically replies within one business day.