Behavioral health billing is one of the most confusing topics for billers, and it’s no surprise, given that time-based therapy codes, add-ons, state-specific HCPCS codes, and payers’ policies can turn the simplest of claims into a multi-day auditing project. Most common codes, however, are fairly intuitive: the more procedures you do, the more you get paid, and the services are grouped according to their level of complexity and mode of delivery.
This cheat sheet covers the basics of CPT and HCPCS behavioral health coding that every biller should know to maximize practice revenue.
CPT vs. HCPCS: What’s the Difference?
Current Procedural Terminology (CPT) codes are developed and maintained by the American Medical Association and describe medical services rendered by providers. CPT is used as a universal standard by all payers, including Medicare, Medicaid, and private insurers.
Healthcare Common Procedure Coding System (HCPCS) was created to complement CPT and encompasses all other codes not found in CPT. In behavioral health, you’ll mostly see the H codes, which describe services like substance use counseling, case management, and intensive outpatient programs. These are used heavily by Medicaid programs and some state-funded plans, and their exact requirements can vary quite a bit from state to state.
In short, CPT codes are the universal language, and HCPCS codes are often where the local dialect comes in.
Diagnostic Evaluation Codes
Most behavioral health services begin with an evaluation, which can be billed using either CPT 90791 or 90792. The first code pertains to a psychiatric diagnostic evaluation without medical services, while the second one refers to a psychiatric diagnostic evaluation with medical service. Evaluation and management services are typically performed by physicians, but there are also CPT codes for non-physician providers: 90791 is used by psychologists, counselors, and social workers, while 90792 is billed by psychiatrists and psychiatric nurse practitioners.
Psychotherapy Codes
Psychotherapy procedures are also time-based, with three common CPT codes covering individual therapy services:
- 90832 – psychotherapy, approximately 30 minutes (16-37 minutes)
- 90834 – psychotherapy, approximately 45 minutes (38-52 minutes)
- 90837 – psychotherapy, approximately 60 minutes (53+ minutes)
Since CPT code 90837 involves a higher reimbursement, it is subject to more scrutiny by payers. Ideally, claims should include documentation of the time and date of the session to ensure accurate coding. Psychotherapy services provided during an Evaluation and Management (E/M) encounter, such as medication management, are billed using add-on codes:
- 90833 – psychotherapy, approximately 30 minutes
- 90836 – psychotherapy, approximately 45 minutes
- 90838 – psychotherapy, approximately 60 minutes
Crises, Family, and Group Therapy Codes
Psychiatric crisis services are covered by CPT code 90839, which includes psychotherapy for the first hour (60 minutes, 30 minutes). Additional 30-minute blocks are billed using code 90840. Crisis-related services usually require extensive documentation regarding the circumstances of the crisis and the intervention strategy.
Family therapy is divided into two CPT codes: 90846 (without the patient present) and 90847 (with the patient present), which both involve discussion of crisis-related issues. Ideally, claims should include adequate documentation on how the family’s involvement relates to the patient’s treatment plan. Group psychotherapy is covered by code 90853, which is billed per participant.
Interactive Complexity
Interactive complexity is an add-on code 90785 that can be used with evaluation, psychotherapy, and group service codes to indicate communication challenges during a session, such as working with disruptive families, dealing with a child’s limited verbal communication abilities, or incorporating a third party into the treatment setting. The code cannot be used with crisis management services or E/M services, unless they involve the abovementioned third-party encounters.
Psychological Testing Codes
Testing procedures are split into two categories: those related to providing testing results and those related to performing tests. Code 96130 is used to bill for the first hour of evaluation services (e.g., interpreting testing results and developing a report), with 96131 covering each additional hour.
Code 96136 covers the first 30 minutes of a psychological test performed by a professional, while 96137 is used for each additional 30-minute block. Separate CPT codes (96132-96135) apply to test performance by technicians and should be billed accordingly.
Collaborative Care Codes
The Collaborative Care Model codes describe care coordination services between a patient’s primary care physician and a behavioral health provider. Code 99492 is used for the first month of collaborative care management, while 99493 is used for every subsequent month. Any additional time spent by the physician can be billed using code 99494. These codes should only be billed by the physician’s office and have specific staffing and time-related requirements.
Commonly Used HCPCS in Behavioral Health
H-codes are primarily used in Medicaid and substance use treatment settings and cover a wide range of services:
- H0001 – alcohol and/or drug assessment
- H0004 – behavioral health counseling and therapy (per 15 minutes)
- H0005 – alcohol and/or drug group counseling
- H0015 – alcohol and/or drug intensive outpatient services
- H0031 – mental health assessment, non-physician
- H0035 – mental health partial hospitalization
- H2019 – therapeutic behavioral services (per 15 minutes)
Note that every state can have its own specific set of billing guidelines related to H-codes, including separate coverage determinations, eligibility criteria, and modifiers.
Modifiers Are Powerful
Modifiers add relevant information about a service to a CPT or HCPCS code. Some common modifiers in behavioral health billing include place of service (POS) codes that specify whether a particular service was rendered via telehealth, and HCPCS modifiers that indicate a service provider’s qualifications (e.g., HO for master’s level clinician).
An incorrect modifier is among the most common claim rejections and underpayment reasons in behavioral health, so it’s critical to ensure that all modifiers match the specific payer guidelines.
Let Integrity Billing Handle the Details
CPT and HCPCS codes are updated every year, and payer guidelines can change even more frequently. In particular, time-based rules, telehealth-related policies, and coverage guidelines for specific services can change drastically within a single year, so regular code updates are critical for proper revenue cycle management.
Even small coding errors can lead to denied or underpaid claims, resulting in reduced practice revenue. Let Integrity Billing help you with behavioral health coding to ensure your practice gets paid what it deserves! Contact us today for a consultation at 888-368-7461 or fill out our contact form online.