Do you lose time and money when claims come back denied? Psychiatry billing can feel confusing. Small mistakes with add-on codes or time rules cause big problems. This short guide will make it easier. It tells you the right codes, how to count minutes, when to use 90785 or crisis codes, and what to write in the chart. It also includes the newest rules for telehealth and prolonged time. Read on, and you will leave with clear steps you can use today. These psychiatric billing guidelines focus on clarity and medical necessity so you can submit clean claims.
What is an add-on code? A brief explanation stating that an add-on code cannot be billed alone and must be paired with a primary code.
90833 / 90836 / 90838 — Name each add-on and its face-to-face time band (16–37, 38–52, 53+ minutes). Use these add-on codes when therapy is done with an E/M visit.
90785 (Interactive Complexity) — What it signals and examples (interpreter + major work, guardian present, high reactivity).
90839 / 90840 (Crisis Psychotherapy) — First block (90839) and 30-minute add-on (90840); note that they stand alone and must not be billed with other therapy or E/M services on the same day.
Billing pairing rule — Short line saying “always bill add-ons with the correct primary code.”
When you do both medication management (an E/M) and therapy in the same visit, you bill the E/M code (like 99202–99215) and then add the correct psychotherapy add-on (+90833, +90836, or +90838) for the therapy minutes. Do not bill a standalone therapy code (90832/90834/90837) with an E/M done by the same provider on the same day. The therapy part must be a “significant, separately identifiable” part of the visit. That means your note should indicate which actions were E/M (evaluation and management) and which parts involved true psychotherapy (techniques, counseling).
Count only psychotherapy minutes — Clarify that the add-on code is based on therapy time only, not total visit time.
Start/stop times or total minutes — Say to record exact times or a clear total (e.g., “Therapy: 30 min, 2:00–2:30 PM”).
Choose E/M by MDM (not therapy time) — Explain to pick E/M level by medical decision making when therapy add-on is billed. This is a key E/M coding step, so you do not double-count time.
No double counting / no split time — Remind that the same minutes cannot be billed twice or split.
Only use 90785 when one or more clear complexity factors exist, and they changed how the visit went. Examples are a translator plus major communication work, a parent or guardian whose behavior interrupts the visit, extreme patient agitation, or having to make a report to authorities during the visit. Don’t use 90785 just because an interpreter was present if the interpreter did routine translating only. When you use 90785, write a short note that explains the exact reason it was needed.
Use 90839 for the first 30–60+ minutes of urgent crisis therapy. Use 90840 for each extra 30-minute block after the first hour. Crisis codes stand alone. Do not add another E/M or regular therapy code on the same day with 90839/90840. If you bill crisis therapy, your note must explain why this was a crisis, what urgent steps you took, and the outcome or plan. Always record the total crisis time.
Older prolonged codes like 99354/99355 were removed. Medicare uses codes like G2212 (and other prolonged rules) to report extra time for long E/M visits. If you bill a psychotherapy add-on with an E/M on the same day, you generally cannot also bill Medicare prolonged codes for that same encounter. Prolonged add-ons are for when the E/M itself is very long, not when you have already billed therapy add-ons. If you do a very long med-management visit with no psychotherapy, you may be able to add the prolonged code, but always check payer rules and document time carefully.
Medicare and many payers still cover tele-mental health. For telehealth, use POS 10 when the patient is at home and POS 02 when the patient is at another site, like a clinic. Add modifier 95 for live audio-video telehealth. Use modifier 93 for audio-only telephone visits when allowed. Always document the telehealth type, patient location, and that the patient agreed to telehealth. A temporary rule that would have required a prior in-person visit was waived through at least late 2025, so you can usually start telepsychiatry without an initial face-to-face visit for now. Check for changes later.
As of 2024, more provider types (for example, LPCs and LMFTs for Medicare) can enroll and bill for mental health services. This change allows more clinicians to use psychotherapy codes for Medicare patients. Coverage and exact payment vary by payer, so verify each insurer’s policy.
Get the main rules right, and your billing will be cleaner. Always write exact therapy minutes and separate the therapy part from the evaluation and management (E/M) part. Pick the E/M level by medical decision making, not by therapy minutes. Use 90785 only when real communication problems arise at work. Use 90839/90840 only for true crisis care and do not bill other therapy or E/M that day. Check each payer for prolonged and telehealth rules before you bill. These psychiatric billing guidelines and clear E/M coding will help you show medical necessity and reduce denials.
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