Behavioral Health CPT Codes: What to Bill, When to Bill & Why Claims Get Denied

Behavioral health CPT codes – the complex part of your billing for which you always need expertise, not only knowing about it is enough. And often, you did everything, use accurate CPT codes, ICD-10 and modifiers, but still claim get rejected, denials happen – it’s not because you use incorrect codes, it’s because you’re not following the payer guidelines for BHI billing accurately.

And when 2026 begins, it becomes complicated as the payer uses technology and AI to detect a minor mismatch – reject your payments.

So, if you want to pass claims on first-time acceptance, you must follow payer-specific rules, updated CPT codes, and modifiers – and most importantly, never forget to use the 18-minute rules for your therapy session.

We research for hours and create a simple yet powerful guide that would help you in these aspects.

When to use E/M codes and when to use time-based codes.
Why are billing rules more critical than CPT codes?
When you should outsource behavioral health billing services.

This blog will help you improve reimbursement rates, reduce denials, and strengthen your practice. Let’s begin with what you should know first;

Behavioral Health CPT Codes That Are Actually Used in Practice

Behind creating this guide, our main motive is to clarify these CPT codes instead of making a huge list, which doesn’t help billers and providers mainly.

So, we pick up only those behavioral health CPT codes that are often used in practices.

Diagnostic & Evaluation Codes

In psychiatric evaluation, CPT codes divided into two categories that are used heavily by billing teams.

90791 – When the psychiatric professional only assesses the mental health of a patient without any medical services, billers should use the 90791 cpt code.
90792 – When the provider assesses the patient and performs medical services as well. For example: a patient feels not well for around 2 months, and visits physicatrist. Now, the provider diagnoses a depression, and further, they see the medical history, take an assessment for 1 hour, and prescribe some medicines. Then a biller should use 90792.

Here’s what the most confusing part of behavioral billing is: time-based codes. So, remember that time-based is another thing, which we will discuss below, and doesn’t apply to these psychiatric evaluations for patients because they are measurable only based on the task provider performing – either it took 20 minutes or 60 minutes, it doesn’t matter at all.

Psychotherapy (Time-Based Codes)

Now, here’s what you should know first: time-based CPT codes mean the payer pays you based on how many minutes your therapy session lasts.

Here’s the most common psychotherapy cpt codes;

90832 – Used when mental health practitioners deliver almost 30 minutes ofa session to a patient. You can use the 90832 cpt code for a 16-37-minute duration time.
90834 – For a 45-minute therapy session, the duration must be between 38 and 52 minutes.
90837 – Bill by using the 90837 code when a 60-minute psychotherapy session is performed. If it is above 53+, then you must use the 90837 cpt code.

Always make sure that you maintain clean, clear, and accurate medical documentation, which includes your clinical notes, correct and valid cpt codes for psychotherapy sessions. Because using an incorrect code, for example, if you use 90834 for even a 37-minute therapy session, it triggers an audit, the payer rejects claims, and resubmission work starts.

Add-on Psychotherapy with E/M

We already discussed psychotherapy codes above, so you know how it counts and when to bill. Now, add-on psychotherapy codes are only used when you perform both evaluation and management services with a therapy session.

Here’s what CPT codes you should use in such a situation;

90833 – 30-minute psychotherapy session (16-37) with e/m service.
90836 – 45-minute session (38 – 52) along with e/m service.
90837 – 60-minute session (53+) besides e/m service at the same visit.

Make sure to use these add-on psychotherapy codes only when a practitioner, psychotherapist, or psychiatrist performs a therapy session along with e/m services. Your medical claim document must prove that; otherwise, denials occur.

Family & Group Therapy Codes

There are 4 commonly assigned CPT codes by billers for family and group therapy sessions.

90846 – Use this code when the patient is absent, but you demonstrate to their family about medical assessments, therapies, and what steps they should take for the improvement of the patient.
90847 – Provider delivers therapy session in the presence of one person (must be of the patient’s family) for almost 50 minutes, then uses 90847 cpt code.
90849 – When a therapist delivers a session to a multi-family group, it means patients belong to the same family, struggling with the same issue, such as an eating disorder or substance use.
90853 – You can bill the 90853 cpt code for group-therapy sessions – means there are 2-8 unrelated patients who don’t know each other but are experiencing the same problems, such as depression or anxiety.

Behavioral Health vs Mental Health CPT Codes: What Payers Really Look For

The most confusing part for medical billers is distinguishing when to use behavioral health codes and when to use mental health cpt codes.

There’s nothing you should focus on, because there’s no difference between these codes. (Don’t get us wrong, we meant that they both have different series and different timelines)

Another thing is that the providers and treatments aren’t the same. Behavioral health specialists focus on patients’ behaviors that impact physical health, such as chronic pain, ADHD, smoking, and obesity.

On the other hand, mental health providers focus on emotions and cognitive disorders—for example, depression, anxiety, bipolar disorder, and other mental illnesses.

What payers actually look for in submitted claims.

Firstly, they look for clean and clear documentation (codes, medical notes, and patients’ records).
Secondly, whether the CPT codes are used correctly based on the session time and type.

Billing Rules That Matter More Than the CPT Code Itself

Yes, we own the claim. Billing rules matter much more than the CPT codes for behavioral billing services. Why? Because without following strict compliance, payer-specific rules and HIPAA regulations, even the valid claims got denied.

So, you must balance both: billing rules and CPT codes, if you want to get your payments faster and on-time.

Some of the standard billing rules you shouldn’t avoid if you handle behavioral and mental health practices.

Session or Time-Based Documentation

Whether you’re a psychotherapist, psychiatrist, or physical therapy provider, time-based billing documentation is mandatory. Make sure to use accurate and valid therapy session codes based on the minutes rule for a fast and quick reimbursement process.

Complete Medical Necessity

For behavioral health billing, it’s mandatory to complete a medical necessity to ensure that the patient needs the service. For instance, you should use ICD-10 codes, which refer to why the patient needs this treatment, add plans, and continue progress on their mental or behavioral illness.

The payer denied the claim if the treatment plan doesn’t change, no clean notes are provided, and repetitive symptoms are mentioned – it clearly triggers aggressive medical audits, which can hurt both payments and your credibility.

Verify Provider Credential Limits

In the healthcare industry, provider credentials matter the most as they verify that you’re eligible to treat patients now. If your credentials expire when you perform service, then denials occur and can lead to high penalties.

Accurate POS (Place of Service) Codes

If you treat patients remotely, then you must follow telehealth behavioral billing rules. It refers to the use of Place of Service codes.

Must use POS 10 if the patient receives service from home, and use POS 02 if you offer telehealth service (audio or video).

When Behavioral Health Billing Should Be Outsourced

Behavioral health billing is unique and complex because of time-based cpt codes and 8-minute rules, resulting in high denial rates. If you use 90832 for 38 minute session instead of 90834, then an insurance claim rejection appears – you need to fix the issue, review the reason, and resubmit it, which costs your time, efforts, and diverts your focus from patients.

Outsourcing behavioral health billing services means you have access to a specialized medical billing team, RCM experts who don’t just submit claims but manage your overall revenue cycle process. By following specific payer rules, coding guidelines, and HIPAA compliance policies, they ensure fast payments, reduce denials, which ultimately improves your cash flow.

Don’t forget that outsourcing can also cut off your heavy in-house resources requirements – that’s the biggest opportunity for solo practitioners and small clinics.

Frequently Asked Questions

What CPT codes are used for behavioral health services?

The most common CPT codes behavioral health practices use include 90791,90792,90834,90836,90853, and 90849, based on patient condition and which service you deliver to them.

What is the CPT code for psychotherapy?

Psychotherapy CPT codes include 90832, 90834, 90837, for time-based sessions and, along with e/m services, must use 90833, 90836, and 90837.

Can behavioral health CPT codes be billed via telehealth?

Yes, you can bill behavioral health CPT codes for telehealth services, but ensure that it must be approved by commercial and federal health insurance companies. Moreover, must use POS and modifiers to avoid denials.

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