Behavioral health refers to the relationship between one’s actions and one’s physical, mental, and spiritual health.
This would cover how habits such as eating, drinking, and exercising have an impact on physical and mental health.
Outpatient Mental Health Therapist Diagnostics, Evaluation, Intake CPT Code:
- 90791 – Psychiatric Diagnostic Evaluation (usually just one/client is covered)
Outpatient Mental Health CPT Codes:
- 90832 – Psychotherapy, 30 minutes (16-37 minutes).
- 90834 – Psychotherapy, 45 minutes (38-52 minutes).
- 90837 – Psychotherapy, 60 minutes (53 minutes and over).
- 90846 – Family or couples psychotherapy, without patient present.
- 90847 – Family or couples psychotherapy, with patient present.
- 90853 – Group Psychotherapy (not family).
- 98968 – Telephone therapy (non-psychiatrist) – limit 3 units/hours per application
Outpatient Mental Health Crisis CPT Codes:
- 90839 – Psychotherapy for crisis, 60 minutes (30-74 minutes).
- +90840 – Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 90839.
Other Behavioral Health CPT Codes:
- +90785 – Interactive Complexity add-on code. Covered below.
- 90404 – Cigna / MHN EAP CPT Code. These two companies use a unique CPT code for EAP sessions.
- 96101 – Psychological testing, interpretation and reporting by a psychologist (per Hour)
- 90880 – Hypnotherapy – limit 10 units/hours per application
- 90876 – Biofeedback
- 90849 – Multiple family group psychotherapy
- 90845 – Psychoanalysis
Mental Health Add-On CPT Codes
Here is a short list of the most common Add-On codes for routine outpatient mental health billing.
- 90785 – Interactive complexity. Example: play therapy using dolls or other toys. This is an interactive complexity add-on code that is not a payable expense. This code only indicates that the treatment is complex in nature.
- 90863 – Pharmacologic Management after therapy.
- 99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
- 99051 – Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.
- 99354 – Additional time after the additional time of 74 minutes. Adding another 30 minutes. (Only use if the duration of your session is at least 90 minutes for 90837 or 80 minutes for 90847).
- 99355 – Additional time after first 60 minutes. First additional 30 to 74 minutes.
- 90840 – 30 additional minutes of psychotherapy for crisis. Used only in conjunction with CPT 90839.
- 90833 – 30 minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, then has 30 minute session.
- 90836 – 45 minute psychotherapy add-on. Example: Clinical Nurse Specialist evaluates medication response, then has 45 minute session.
We may cover these behavioral health and wellness services:
- Alcohol misuse screening and counseling for adults who use alcohol but aren’t dependent; if you detect misuse, we cover up to 4 brief face-to-face counseling sessions per year if patient is competent and alert during counseling
- Alcohol treatment, detoxification, outpatient hospital treatment, and rehabilitative services, including inpatient hospital stays
- Annual Wellness Visit (AWV) to develop or update personalized prevention plan, including health risk assessment and depression screening
- Advance Care Planning (ACP) to discuss patient’s health care wishes if they can’t make decisions about their care, as part of the AWV or a separate Part B service
- Behavioral Health Integration (BHI) by clinical staff to assess, monitor, and plan care
- Biofeedback therapy, where patients learn non-drug treatments to control bodily responses like heart rate and muscle tension
Bundled Opioid Use Disorder (OUD) payments for:
- OUD management and counseling
Billed in office setting, including:
- Overall management
- Care coordination
- Individual and group psychotherapy
- Substance use counselling
- Caregiver-focused behavioral health risk assessment of their own behavior and health risks, which benefits the patient
- Chemical and electrical aversion therapy to condition a person to avoid undesirable behavior by pairing it with unwanted stimuli
- Cognitive Assessment and Care Planning, a comprehensive evaluation of new or existing patient who exhibits cognitive impairment signs and symptoms, required to establish or confirm diagnosis, etiology, and condition severity
- Chronic Care Management (CCM) and complex CCM for patients with multiple chronic conditions placing them at high risk
- Annual depression screening, up to 15 minutes, when staff-assisted depression care supports can assure accurate diagnosis, effective treatment, and follow-up; screening by clinical staff in primary care setting who can advise physician of results and coordinate treatment referrals
- Diagnostic psychological and neuropsychological tests
- Drug therapy or pharmacological management using medication(s) to treat disease; all Medicare drug plans have drug management programs for at-risk patients enrolled in Part D
- Drug withdrawal treatment to monitor signs and symptoms after changes in regular drug dose
- Electroconvulsive therapy (ECT) treating depression and other mental illness using electric current to the head
- Family psychotherapy with or without patient present, as medically reasonable and necessary, with patient treatment as the primary purpose
- Health and behavioral assessment and intervention identifying or treating psychological, behavioral, emotional, cognitive, and social factors important to prevent, treat, or manage physical health issues
- Individual and group psychotherapy; individual therapy with 1 or more therapists or more than 1 individual in therapy session with 1 or more therapists
- Individual activity therapy that’s part of a Partial Hospitalization Program (PHP), which may be cognitive, physical, social, and spiritual but not recreational or diversionary
- PHP, a structured, intensive, outpatient psychiatric services program is an alternative to inpatient psychiatric care provided during the day (doesn’t require an overnight stay) through a hospital outpatient department or community mental health center
Medicare Advantage plans provide Part B covered mental health services and may offer certain (for example, telehealth) benefits beyond what Part B pays. They may also provide supplemental benefits Parts A or B don’t cover.
Medicare Non-Covered Services
These mental health services are not covered:
- Environmental intervention or modifications
- Adult day health programs
- Biofeedback training (any modality)
- Marriage counselling
- Pastoral counselling
- Report preparation
- Results or data interpretation or explanation
- Hemodialysis specifically for treating schizophrenia (experimental)
- Transportation or outpatient meals
- Phone service apps