Specialty
Psychiatry billing services
Psychiatry billing services are built around a visit that is two services at once: an office visit code for the medication work and a time-based psychotherapy add-on for the therapy, each documented on its own, beside diagnostic evaluation codes that cannot be billed with either on the same day.
See where claims are getting stuck. No patient data needed.
Add telehealth from home with a 2028 in-person visit rule, collaborative care billed from care manager minutes, long-acting injectables with wastage modifiers, and plans that carve mental health out to another administrator. Remitwright gives psychiatric prescribers a dedicated biller who knows each rule, tracks the dates that matter, and works denials to the cause, serving practices remotely.
Psychiatry billing is one of Remitwright's specialty billing services, each set out with its own code families, denial reasons and payer rules.
Last reviewed by the Remitwright billing team. Editorial policy
- 90785
- 90791
- 90832
Denials
Why psychiatry claims get denied
The reasons that come up most on psychiatry remittances, with the usual cause and the fix. Code explanations are our own; the official list is maintained by X12.
| Code | Reason | Usual cause | The fix |
|---|---|---|---|
| CO-97 | Bundled, not separately payable | A diagnostic evaluation billed with an office visit or with psychotherapy on the same date, or a depression screening code billed alongside a visit that already addressed the symptoms | NCCI procedure-to-procedure edits run before release, with the evaluation and the visit on separate dates unless the record supports a separate encounter |
| CO-4 | Procedure inconsistent with the modifier or code set | A standalone psychotherapy code billed with an office visit instead of the add-on, or a telehealth modifier paired with a place of service the payer does not accept | A claim rule that converts psychotherapy to the add-on whenever an E/M is on the same claim, and a telehealth rule per payer |
| CO-16 | Claim lacks information | A long-acting injectable from a single-dose vial billed to Medicare without JW or JZ, or a rendering and supervising provider combination the Medicaid plan does not recognize | Drug units and wastage captured at administration, and provider setup checked per plan before the first claim |
| CO-197 | Authorization absent or exceeded | Transcranial magnetic stimulation, testing, partial hospitalization or intensive outpatient days, or sessions beyond the count a managed care plan allowed, performed before approval or after it lapsed | Authorized units and end dates on the schedule, with renewal requested before the last approved service |
| CO-50 | Not medically necessary | Collaborative care billed without the care manager minutes, registry entry or psychiatric consultant review the month requires, or a longer psychotherapy time without the documentation to support it | A monthly minutes log and registry export kept with the care management claim, and start and stop times for every time-based code |
| CO-B7 | Provider not eligible for this service | A marriage and family therapist or mental health counselor billing before Medicare enrollment, or services billed incident-to under a clinician whose benefit category does not allow incident-to | Each clinician enrolled with each payer before the first visit, and incident-to billed only under physicians and the practitioner types permitted to supervise it |
Codes
Common psychiatry codes and modifiers
Code families by number with our own one-line explanations. CPT descriptors belong to the AMA and are not reproduced here.
| Codes | What the family covers |
|---|---|
| 90785, 90839, 90840, 90846, 90847, 90853 | Interactive complexity add-on, crisis psychotherapy by time, family therapy with and without the patient present, and group psychotherapy |
| 90791, 90792 | Psychiatric diagnostic evaluation, with 90792 including medical services; neither is billed with an office visit code or with psychotherapy on the same date |
| 90832, 90834, 90837 | Standalone psychotherapy by session length for visits with no medical component, time-based and reviewed by payers at the longest level |
| 90833, 90836, 90838 | Psychotherapy add-ons by time for therapy delivered in the same encounter as the visit; they attach to the E/M and are never billed alone |
| 90870, 90867-90869, 96130-96139 | Electroconvulsive therapy, transcranial magnetic stimulation planning and treatment, and psychological or neuropsychological testing by time, the services most often behind an authorization |
| 96372, J-codes | Long-acting injectable antipsychotics and other drugs given in the office, billed in units from the documented dose with the discarded amount reported |
| 99202-99215 | Office visits for medication management, leveled on medical decision making or total time, the base for most prescriber encounters |
| 99492, 99493, 99494, G2214, 99484 | Psychiatric collaborative care and general behavioral health integration, billed monthly from behavioral health care manager or clinical staff minutes under a treating practitioner |
Modifiers that matter
- 95 with POS 02 or 10
- Audio and video telehealth, with place of service 10 when the patient is at home and 02 when they are somewhere else; the home is the usual case in psychiatry.
- 93 or FQ
- Audio-only telehealth where the payer allows it. Medicare permits audio-only for mental health when the patient is at home and either cannot use or does not want video, and the reason belongs in the note.
- JW and JZ
- Medicare requires one of them on every claim for a drug from a single-dose container, which includes most long-acting injectables: JW for the discarded units on a separate line, JZ when none were discarded.
- 59, XE or XU
- Family psychotherapy with the patient's individual psychotherapy on the same date, when it was a separate and distinct service in a separate time interval; the note has to show both intervals.
- GT
- Telehealth for the Medicaid programs and the critical access hospital Method II claims that still use it in place of 95.
Payers
Payer notes
- MedicareThe NCCI policy manual states that 90791 and 90792 are not separately reportable with individual, group, family, crisis or other psychotherapy on the same date, that office visit codes are not reported with either diagnostic code, that the add-on codes 90833, 90836 and 90838 are the psychotherapy codes to report with an E/M, and that family therapy may be billed with individual therapy only as a separate and distinct service in a separate time interval.1
- MedicareThe Medicare mental health coverage booklet states that Part B pays for integrated services on the same day to the same patient by the same or different professionals; that marriage and family therapists and mental health counselors may enroll and bill independently since January 1, 2024, paid at 75 percent of the clinical psychologist amount, but cannot have services billed incident-to their own; and that behavioral health services by auxiliary personnel may be billed incident-to under general rather than direct supervision, outside hospital and SNF settings.2
- MedicareThe telehealth booklet lists the patient's home as a permissible originating site for diagnosis and treatment of mental health disorders with no geographic restriction, allows audio-only technology for behavioral and mental health when the patient is at home, and points to the CMS telehealth page for the current status of each rule.3
- Medicare (telehealth, 2028 onward)CMS's October 2026 telehealth FAQ says the in-person visit requirement (within 6 months before the first mental health telehealth service, then every 12 months, with limited exceptions) applies to services after December 31, 2027, with patients established before 2028 needing only the 12-month visit. The same FAQ confirms that behavioral health telehealth has no geographic or place of service restriction, so a patient in an urban home qualifies, and that two-way audio-only is permitted for it.8
- MedicareCollaborative care is billed from behavioral health care manager minutes: 99492 for the first 70 minutes in the first month, 99493 for the first 60 minutes in a later month, 99494 for each additional 30 minutes, G2214 for the first 30 minutes in a month, and 99484 for general integration with at least 20 minutes of clinical staff time; consent may be verbal, and a new consent is needed only when the billing practitioner changes.4
- MedicarePartial hospitalization requires a physician to certify the need for a minimum of 20 hours of therapeutic services a week and to recertify at least every 30 days, while an intensive outpatient program requires a determination at least every other month that the patient needs a minimum of 9 hours a week; marriage and family therapist and mental health counselor services inside either program are not paid separately under their benefit categories.2
- MedicareCMS requires the JW modifier for discarded amounts from single-dose containers or single-use packages that are separately payable under Part B, and the JZ modifier on all such claims when nothing was discarded; the discarded units reported with JW are what the manufacturer refund program is calculated from.5
- MedicaidUnder EPSDT, states must cover any Medicaid-coverable service found medically necessary to treat, correct or reduce conditions discovered in children under 21, including mental health conditions, whether or not the state plan covers it; the service codes, modifiers and authorization triggers are set by each state and its managed care plans.6
- All payersPlace of service 02 means telehealth with the patient somewhere other than home and 10 means telehealth in the patient's home, both from the CMS code set; payers differ on whether they key off the place of service, the modifier or both, so the rule is kept per payer.7
Authorizations
Medication management visits rarely need prior authorization, but a psychiatric practice's other services do under most commercial, Medicare Advantage and Medicaid managed care plans: transcranial magnetic stimulation, electroconvulsive therapy, psychological and neuropsychological testing, partial hospitalization and intensive outpatient days, esketamine and other in-office drugs, and long-acting injectables that some plans route through the pharmacy benefit instead of the medical claim. Many plans also carve mental health out to a separate administrator that holds both the authorization and the claim. Your biller records the administrator and the trigger at eligibility, counts authorized sessions or units down on the schedule, and requests renewal before the last approved service.
Documentation traps
- Psychotherapy time not recorded separately from the medical visit, so the time-based add-on has nothing to stand on and the payer pays the visit alone
- The same minutes counted twice, once toward the visit level and once toward the psychotherapy add-on, which a reviewer separates first
- Interactive complexity added without a note explaining the communication barrier it describes
- Telehealth notes that do not record the patient's location, the modality, and for audio-only the reason video was not used, which is what the audio-only rule, and from 2028 the in-person visit rule, are checked against
- Collaborative care months without a registry entry, the consultant's review and the care manager's minutes, which are the three things a reviewer asks for
- Long-acting injectable notes missing the product, the dose given and the amount discarded, leaving the wastage line unsupported
What a specialist checks
Specialist or generalist for psychiatry billing?
A generalist biller can enter a psychiatry claim. Whether it pays turns on three things specific to psychiatry billing, and a specialty-aware biller checks each one.
Code families
Each family billed with what the chart has to show for it.
- 90785, 90839, 90840, 90846, 90847, 90853
- 90791, 90792
- 90832, 90834, 90837
Modifiers
Applied only where the note supports them, line by line.
- 95 with POS 02 or 10
- 93 or FQ
- JW and JZ
If you are moving from another billing company or an in-house biller, switching billing companies follows a plan: the old and new processes run side by side until the new one is proven, and every login and every psychiatry claim stays in your name.
What we handle
What we handle for psychiatry practices
- CredentialingEnrollment, CAQH and PECOS kept current
- Payer enrollmentNew payers and locations enrolled, tracked
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Claim submissionScrubbed, submitted and tracked to acceptance
- Denial managementEvery denial read, worked and appealed
A dedicated biller with named cover, working inside your system and reporting to you on one written page. How it works sets out the five stages.
Software
Systems psychiatry practices usually run
Your biller works inside your system as a user you create. All the systems we work in.
Questions
Questions about psychiatry billing
How do we bill a medication visit that includes psychotherapy?
The visit goes out as an office visit code with a psychotherapy add-on, 90833, 90836 or 90838, chosen by the therapy time. The standalone codes 90832, 90834 and 90837 are not used when an E/M is billed. The note needs the medical work and the psychotherapy documented apart from each other, with the therapy time stated, because the add-on is time-based.
Can we bill a psychiatric evaluation and an office visit on the same day?
Not to Medicare, and most plans follow the same edit. The NCCI manual says the office visit codes are not reported with 90791 or 90792, and that neither evaluation code is reported with psychotherapy on the same date. If medical work was done at the evaluation, 90792 is the code that includes it.
What are the telehealth rules for psychiatry under Medicare?
The patient's home counts as an originating site for mental health with no geographic restriction, and audio-only is allowed for mental health when the patient is at home. The in-person visit rule is dated: CMS's October 2026 telehealth FAQ applies it to services after December 31, 2027, with a visit within 6 months before the first telehealth service and then every 12 months, subject to limited exceptions. Patients established before 2028 need only the 12-month visit. Your biller tracks the in-person date per patient now, so the visits owed from January 1, 2028 are scheduled before the rule starts, and keeps the modifier and place of service rule per payer. Our post on Medicare telehealth billing through 2027 covers the dates.
How does collaborative care billing work?
A treating practitioner, a behavioral health care manager and a psychiatric consultant work from a registry, and the month is billed from the care manager's minutes: 99492 for the first month, 99493 for later months, 99494 for additional time, G2214 when the month is shorter, and 99484 for general integration without the full model. Consent can be verbal. The minutes log and the registry are what the claim rests on.
Which modifier goes on long-acting injectables?
For Medicare, JW on a separate line for the units discarded from a single-dose vial, or JZ when nothing was discarded; one of the two must be on the claim. The drug is billed in units from the dose given, the administration code goes with it, and the note records product, dose and wastage. Some plans want the drug through the pharmacy benefit instead, so the rule is kept per payer.
Can marriage and family therapists and counselors in our practice bill Medicare?
Yes, since January 1, 2024, once enrolled, paid at 75 percent of the clinical psychologist amount. They cannot have services billed incident-to their own, so an associate working under them is not billable to Medicare that way, and their services inside a partial hospitalization or intensive outpatient program are not paid separately.
What do you need from a psychiatry practice to start?
A signed BAA, a user for your biller in your EHR, practice management system and clearinghouse, each prescriber's and therapist's enrollment status with each plan and its behavioral health administrator, your drug purchasing records for injectables, your collaborative care registry if you run that model, and your payer contracts. Bring an aging report and a denial report to the review if you have them.
Next step
See where your psychiatry claims are getting stuck.
Three quick questions. No patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
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A written reply by email
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- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).