Mental health services are in high demand, and many patients are choosing providers based on their insurance eligibility. To open your practice to non cash-pay patients, it is crucial to understand how to bill for these services. Current Procedural Terminology (CPT) codes streamline the billing process, ensuring that services are accurately recorded and reimbursed. This article will explain the intricacies of CPT codes for mental health, providing mental health providers with a comprehensive guide to effective billing practices.

How mental health CPT codes help practices 

CPT codes for mental health services are standardized codes used to describe medical, surgical, and diagnostic services. These codes are essential for documentation, billing, and reimbursement processes. By utilizing these codes, mental health providers can ensure that their services are accurately captured, facilitating smoother interactions with insurance companies and improving revenue cycle management.

CPT codes for mental health services can be billed by various types of licensed mental health providers, including counselors, social workers, therapists, psychologists, and psychiatrists. However, the ability to bill specific CPT codes may depend on several factors such as the provider's licensure, scope of practice, and the regulations of the state in which they practice. 

Mental health CPT codes cover a wide range of services, from initial evaluations to psychotherapy sessions and medication management. Accurate coding helps practices receive appropriate compensation for their services, reduces the risk of claim denials, enhances overall operational efficiency, and increases patient happiness. Additionally, using standardized codes allows for better data tracking and analysis, information that can be used to improve your business as well as patient care and outcomes.

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Changes to CPT mental health codes

CPT codes for mental health services are not static; they undergo regular updates to reflect advancements in medical knowledge and changes in clinical practices. These updates are typically released annually by the American Medical Association (AMA), ensuring that the codes remain relevant and comprehensive.

To stay current with these changes, mental health providers should regularly consult the AMA website and subscribe to relevant industry newsletters. Additionally, the Centers for Medicare & Medicaid Services (CMS) provides updates and guidelines on their website, offering valuable resources for healthcare providers. Keeping abreast of these changes is vital for maintaining accurate billing practices and ensuring compliance with the latest standards. 

Mental health assessment CPT codes

Assessment is a critical component of mental health care, serving as the foundation for the diagnosis of mental health conditions and developing effective treatment plans. Several CPT codes are used to bill for mental health assessments, each corresponding to different types of evaluations and services. Accurate use of these codes ensures that the initial assessment is adequately documented and billed, paving the way for subsequent treatment.

Here are some commonly used assessment codes:

90791: Psychiatric diagnostic evaluation without medical services.

90792: Psychiatric diagnostic evaluation with medical services.

96130: Psychological testing evaluation services by a physician or other qualified healthcare professional, first hour.

96136: Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, first 30 minutes.

96138: Psychological or neuropsychological test administration and scoring by technician, first 30 minutes.

96146: Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only.

96116: Neurobehavioral status exam (clinical assessment of thinking, reasoning, and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem-solving, and visual-spatial abilities), first hour.

Mental health CPT code list

Below is a list of the 25 most frequently used CPT codes across mental health services. These codes cover a range of services commonly provided in mental health practices. As you regularly bill for your patients’ insurance, you will become familiar with the range of codes that encompass your services. 

90832: 30-minute psychotherapy session.

90834: 45-minute psychotherapy session.

90837: 60-minute psychotherapy session.

90838: 60-minute psychotherapy session with E/M services.

90839: Crisis psychotherapy, first 60 minutes.

90840: Crisis psychotherapy, each additional 30 minutes.

90845: Psychoanalysis.

90846: Family psychotherapy without the patient.

90847: Family psychotherapy with the patient present.

90849: Multiple-family group psychotherapy.

90853: Group psychotherapy.

96101: Psychological testing by a psychologist.

96130: Psychological testing evaluation services by a physician or other qualified healthcare professional, first hour.

96136: Psychological or neuropsychological test administration and scoring, first 30 minutes.

96160: Health risk assessment.

96161: Health risk assessment, with the caregiver.

99201: Office or other outpatient visit for the evaluation and management of a new patient, 10 minutes.

99202: Office or other outpatient visit for the evaluation and management of a new patient, 20 minutes.

99203: Office or other outpatient visit for the evaluation and management of a new patient, 30 minutes.

99213: Office or other outpatient visit for the evaluation and management of an established patient, 15 minutes.

99214: Office or other outpatient visit for the evaluation and management of an established patient, 25 minutes.

99354: Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service, first hour.

99404: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure), approximately 45 minutes.

G0444: Annual depression screening, 15 minutes.

G0442: Annual alcohol misuse screening, 15 minutes.

Using Healthie's tools to bill better

Healthie is a practice management software that streamlines the billing process for mental health providers. By integrating CPT codes for mental health services into its platform, Healthie simplifies the documentation and billing processes. This integration ensures that mental health providers can easily select and apply the correct codes for their services, reducing administrative burden and minimizing errors.

Healthie's features include automated billing, insurance claim submission, and real-time tracking of claims and reimbursements. These tools help mental health providers stay organized and ensure that they are compensated accurately and promptly for their services. Additionally, Healthie offers resources and support to help providers stay updated on changes to CPT codes mental health, further enhancing their billing practices.

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