Behavioral health work is cognitively demanding in a way the billing system historically undervalued, and the providers doing it, psychiatrists, psychiatric NPs and PAs, psychologists, and therapists, are among the most likely in all of medicine to undercode their own work. The structure below is the practical core, and the single biggest revenue insight comes first.
The Two-Service Visit: E/M Plus a Psychotherapy Add-On
If you are a prescriber (psychiatrist, PMHNP, PA) and your visit includes both medication management and genuine psychotherapy, those are two distinct, separately billable services. You bill the E/M code for the medical portion (99212–99215, selected by MDM exactly as in Chapter 4 ) plus a psychotherapy add-on code for the therapy portion:
| Add-on | Psychotherapy time | Billed with |
|---|---|---|
| +90833 | 16–37 minutes | Any office E/M (99202–99215) |
| +90836 | 38–52 minutes | Any office E/M |
| +90838 | 53+ minutes | Any office E/M |
A 99214 plus 90833 roughly adds 50% to the wRVU value of the visit (90833 carries 0.95 wRVUs against the 99214's 1.92), for therapy work many prescribers are already doing and documenting as an afterthought. The add-ons cannot be billed alone, and they cannot be billed by non-prescribing clinicians, who use the standalone codes below instead.
Standalone Psychotherapy: The Time Brackets
For psychotherapy without a medical E/M component (the structure used by psychologists, LCSWs, LPCs, and prescribers in therapy-only visits), the codes are strictly time-based:
| Code | Service | Actual time range |
|---|---|---|
| 90832 | Psychotherapy, "30 minutes" | 16–37 minutes |
| 90834 | Psychotherapy, "45 minutes" | 38–52 minutes |
| 90837 | Psychotherapy, "60 minutes" | 53+ minutes |
The trap is in the labels: the nominal session names are not the rule, the time ranges are. The brackets are 90832 for 16 to 37 minutes, 90834 for 38 to 52 minutes, and 90837 for 53 minutes or more (90837 carries 2.58 wRVUs). Two practical consequences follow. If your actual face-to-face therapy time is 53 minutes or more, bill 90837, do not reflexively downcode to 90834 out of caution; that is undercoding. But if a scheduled "hour" actually delivered only 50 minutes of therapy, it is a 90834, not a 90837; rounding up is upcoding. Document exact start and stop times, because those brackets are precisely what an auditor checks.
Evaluations, Crisis, and the Codes Around the Edges
Initial psychiatric diagnostic evaluations use one of two codes, and the difference is whether the evaluation included medical services. 90791 is the psychiatric diagnostic evaluation without medical services: the history, mental status examination, and formulation, used by non-prescribing clinicians such as psychologists and licensed therapists. 90792 is the same evaluation with medical services, meaning it also involved medical assessment and decision making such as ordering labs, a physical examination, or prescribing, so it is reported only by clinicians who can provide those services (psychiatrists, PMHNPs, PAs) and it pays more (about 2.80 wRVUs). In short, the split is not arbitrary: 90792 reflects added medical work, which is why it is limited to prescribers. Many payers cover one evaluation per patient per provider per year; verify before building intake-heavy templates. Crisis psychotherapy (90839 for the first 30 to 74 minutes, plus 90840 for each additional 30) covers urgent assessment of a patient in acute distress and pays better than routine therapy, with documentation of the crisis state and disposition required.
For Primary Care: The Integration Codes
Family physicians and internists deliver an enormous share of behavioral health care, and two structures pay for it. First, the same E/M-plus-add-on logic applies to any prescriber: a PCP managing an SSRI who also provides 16+ documented minutes of structured therapy can code the add-on. Second, the Collaborative Care Model codes (99492–99494) and general behavioral health integration code (99484) pay for monthly psychiatric care management delivered through your practice with a psychiatric consultant, a structure increasingly common in primary care networks. If your practice runs a CoCM program and you have never seen these codes on your reports, that is a conversation worth having with your administrator. If you are a primary care physician who came to this chapter looking specifically for the behavioral-health codes you can use, the primary care chapter (The 25 Codes That Pay Primary Care) also lists the collaborative-care and integration codes in the context of the rest of your day, which may be the easier place to see how they fit alongside your other billing.
Telehealth: Where Behavioral Health Lives Now
All core psychotherapy and psychiatric E/M codes are telehealth-eligible, and behavioral health retains the most durable telehealth coverage in Medicare. The mechanics: modifier 95 for synchronous video, modifier 93 (or FQ for some payers) for audio-only, and place-of-service 10 when the patient is at home. Audio-only psychotherapy remains covered for behavioral health under Medicare rules that outlasted the general telehealth flexibilities, a fact many billing offices have not caught up with.
A Psychiatric Visit, Worked Through
A psychiatrist sees an established patient for medication management of depression and also provides 30 minutes of psychotherapy in the same visit. This is two coded components: an office E/M for the medication management, selected by medical decision making, plus an add-on psychotherapy code for the time spent in therapy, documented separately. The therapy time must be distinct from the E/M work and recorded as its own block. Coding only the E/M, or only the therapy, undercaptures a visit that legitimately contained both, and this combination is among the most commonly under-coded in behavioral health.