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Psychiatry Billing Services

Psychiatrists and psychiatric nurse practitioners bill as medical providers first: medication management is an E/M service, psychotherapy is added on top with its own time-based add-on codes, and treatments such as TMS and esketamine come with strict authorization and site requirements. That combination is what separates psychiatry billing from billing for a therapy practice.

  • E/M leveled separately from psychotherapy add-on time
  • TMS, ECT and esketamine authorizations prepared against payer criteria
  • Prescriber credentialing for physicians and psychiatric nurse practitioners
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The medical side of behavioral health billing

A typical follow-up visit combines medication management with brief psychotherapy. The medication work is billed as an E/M code and the therapy as an add-on, but the two cannot share minutes: when an add-on is billed, the E/M is leveled on medical decision making, and the psychotherapy time must be documented separately. Notes that blend the two make both codes hard to defend.

Psychiatry also includes procedures that therapy practices never bill. Transcranial magnetic stimulation is usually covered only after documented failure of medication treatment, ECT has to be coordinated with the anesthesia team, and esketamine must be given in a certified setting with the patient observed for a set period. Each has its own documentation that payers check before they approve or pay.

Finally, many psychiatric practices are mixed: physicians, nurse practitioners and sometimes therapists under one group. Each provider type bills a different set of codes and is credentialed differently, so a single billing setup for the whole practice usually fits none of them well.

Psychiatric E/M, add-on and procedure codes

Codes prescribers use that therapy-only practices do not. Confirm against current CPT, HCPCS and payer policy.

Psychiatry codes for evaluations, medication management, psychotherapy add-ons and procedures
CodesServiceBilling notes
90792Psychiatric diagnostic evaluation with medical services.Includes medical work such as medication review; for prescribers, in place of 90791.
99202 to 99215Office E/M for new and established patients, used for medication management.Medication management is billed with these E/M codes.
90833, 90836, 90838Psychotherapy add-ons with an E/M: about 30, 45 and 60 minutes.Billed only with an E/M on the same day; psychotherapy time is documented separately from E/M work.
90867, 90868, 90869TMS: initial treatment planning, subsequent treatment delivery, and motor threshold re-determination.Coverage policies require a documented history of failed treatment, and plans that require prior authorization check it before approval.
90870Electroconvulsive therapy.The psychiatrist bills the ECT itself; anesthesia for the treatment is arranged with the anesthesia provider.
G2082, G2083, J0013Esketamine: Medicare codes for a supervised visit with self-administration and two hours of observation, and the HCPCS code for the drug itself.How the drug itself is supplied and billed depends on the payer, which we confirm before treatment starts.
99492 to 99494Psychiatric collaborative care management, billed by the primary care practice.The psychiatric consultant works as an employee or contractor of the billing practitioner, who bills Medicare for the service.

CPT is a registered trademark of the American Medical Association.

Official sources: CMS NCCI Policy Manual, chapter 11 (psychiatric services) (external site), CMS: Physician fee schedule relative value file (code descriptors) (external site), CMS: HCPCS quarterly file (external site), CMS MLN: Behavioral health integration services (external site), CMS MLN: Medicare and mental health coverage (external site), CMS Claims Processing Manual, chapter 12 (external site)

Psychiatry-specific denial triggers

  • Add-on billed without an E/M

    A 90833 sent alone, or with an E/M from a different date, is denied because the add-on has no primary code.

  • Same minutes counted twice

    Total visit time used to level the E/M while also supporting the psychotherapy add-on.

  • TMS without criteria documented

    Authorization requests that do not show the medication trials, durations and outcomes the payer's policy requires.

  • Esketamine site or observation requirements missed

    Missing certification of the treatment setting or observation time documentation.

  • Evaluation code mismatched to provider type

    90791 billed by a prescriber who did medical work, or 90792 by a clinician who cannot prescribe.

Our psychiatry billing workflow

  1. Step 1: Separate E/M and therapy time

    Notes are checked for MDM supporting the E/M and separately documented psychotherapy time before both codes are billed.

  2. Step 2: Build procedure authorization packets

    TMS and ECT requests are assembled with medication histories and rating scales matched to each payer's criteria.

  3. Step 3: Configure codes by provider type

    Physicians, nurse practitioners and therapists in the group are set up with the codes and credentials that apply to each.

  4. Step 4: Track treatment courses

    Approved TMS sessions and esketamine treatments are counted against the authorization so renewals go in on time.

How psychiatry billing differs from therapy-practice billing

If your group includes both prescribers and therapists, these are the differences that need separate setups. Therapy-only practices are covered on our mental health billing page.

Differences between psychiatry billing and therapy practice billing
AreaPsychiatry (prescribers)Therapy practices
Main codesE/M codes plus psychotherapy add-ons; 90792 for evaluations.Stand-alone psychotherapy codes; 90791 for evaluations.
How the level is setMedical decision making for the E/M; time for the add-on.Session time alone.
ProceduresTMS, ECT and esketamine, each with authorization and site rules.Generally none.
Who rendersPsychiatrists and psychiatric nurse practitioners.Psychologists, LCSWs, LPCs and LMFTs.
Typical authorization focusProcedures and some medications.Number of therapy sessions.

Frequently asked questions

Can we bill medication management and psychotherapy on the same day?

Yes, as an E/M code plus a psychotherapy add-on (90833, 90836 or 90838), as long as each part is documented on its own.

How is time split between the E/M and the psychotherapy add-on?

The psychotherapy time is documented on its own and supports the add-on, while the E/M is leveled on medical decision making. The same minutes cannot support both.

What do payers usually require before approving TMS?

One Medicare contractor's policy, for example, requires confirmed severe major depression, resistance to or intolerance of antidepressant medication, and a psychotherapy trial without significant improvement. Other contractors and commercial payers set their own criteria.

Official source: CMS Medicare Coverage Database: LCD L34641 (TMS) (external site)

Is IV ketamine covered by insurance?

Coverage for IV ketamine depends on each plan's policy, so we check it before treatment and give patients a self-pay price where it is not covered. Esketamine nasal spray has FDA approval for certain depression indications, and plans set their own authorization rules for it.

Official source: FDA: Spravato prescribing information and medication guide (external site)

Do psychiatric nurse practitioners bill the same codes as psychiatrists?

Generally yes, within their state scope of practice and each payer's credentialing. Medicare and some other payers pay nurse practitioners a percentage of the physician rate; we track the current rate rather than quote it.

Official source: CMS: Physician Fee Schedule (external site)

Related services and specialties

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