CMS Physician Fee Schedule
The published Medicare rates and payment rules behind most of the codes on this page.
Read the sourcePsychiatry billing hinges on time-based psychotherapy add-ons (90832/90834/90837), E/M add-on psychotherapy (90833/90836/90838), ECT 90870/90871 facility versus professional splits, TMS 90867-90869 session coding, and telehealth modifier 95 parity. General billers miss the time documentation and add-on structure on every claim. MedFactor delivers psychiatry-specific RCM that protects every session.
From general adult psychiatry to child and adolescent, addiction, geriatric, neuromodulation, and telepsychiatry, we tailor billing to the coding rules of every psychiatric subspecialty.
Diagnostic eval 90791/90792, time-based psychotherapy 90832/90834/90837, E/M add-on psychotherapy 90833/90836/90838, and medication management with modifier 25 accuracy.
Age-based E/M, family psychotherapy 90846/90847, and developmental disorder coding (F90 ADHD, F84 autism) with time-based add-on documentation.
Substance use disorder ICD-10 F10-F19, medication-assisted treatment (MAT), and behavioral integration codes with parity-compliant telehealth billing.
Cognitive assessment, behavioral health integration (BHI), chronic care management (CCM), and polypharmacy-driven E/M leveling for older adults.
TMS 90867/90868/90869 session coding, ECT 90870/90871 facility versus professional splits, and anesthesia 00104 bundling rules.
Modifier 95 synchronous audio-video, originating-site parity, and telehealth psychotherapy with correct place-of-service codes per payer.
A psychiatry session is billed as a base diagnostic evaluation or E/M visit plus time-based psychotherapy add-ons, with separately reportable E/M add-on psychotherapy, group therapy, ECT, TMS, and telehealth modifier 95. Miss the time documentation or the add-on structure and revenue is lost on every session.
One psychiatric encounter is built on a diagnostic eval or office E/M, with time-based psychotherapy added by documented minutes, and the E/M add-on psychotherapy and telehealth modifier 95 billed as separately reportable.
Psychiatry billing is governed by time-based psychotherapy documentation, E/M add-on rules, ECT facility splits, and telehealth parity that general billing companies cannot navigate effectively.
Add-on psychotherapy 90833/90836/90838 denied when the E/M time and psychotherapy time are not documented separately and the add-on is billed without a qualifying E/M same day.
Telehealth psychotherapy underpaid or denied when modifier 95 is omitted, the originating-site rule is misapplied, or the place-of-service code does not match the payer’s parity policy.
ECT denied when facility and professional components are split incorrectly, or when anesthesia 00104 is billed by the same psychiatrist performing the ECT (bundled, modifier indicator 0).
Psychotherapy 90832/90834/90837 denied when total minutes are not documented in the note, or the wrong time-based code is selected for the documented duration.
TMS 90867/90868/90869 denied when the initial session is reported more than once, or 90868 and 90869 are billed together for the same session (CCI modifier indicator 0).
Psychotropic medications, pharmacogenomic testing, and TMS require payer prior authorization; claims deny when auth is not obtained or the diagnosis does not meet medical-necessity criteria.
Quick reference for the most frequently used codes in psychiatry billing and coding.
| Code | Description | Common Use |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation (no medical eval) | Initial intake, no medical service |
| 90792 | Psychiatric diagnostic evaluation with medical E/M | Intake including medical assessment |
| 90832 | Psychotherapy, 30 minutes | Time-based add-on, brief |
| 90834 | Psychotherapy, 45 minutes | Time-based add-on, standard |
| 90837 | Psychotherapy, 60 minutes | Time-based add-on, extended |
| 90833 | Add-on psychotherapy 30 min with E/M | Separately reportable with E/M |
| 90836 | Add-on psychotherapy 45 min with E/M | Separately reportable with E/M |
| 90838 | Add-on psychotherapy 60 min with E/M | Separately reportable with E/M |
| 90853 | Group psychotherapy | Multi-person session |
| 90870 | Electroconvulsive therapy, single seizure | ECT, includes monitoring |
| 90871 | Electroconvulsive therapy, multiple seizures per day | Multiple-monitored ECT (rare) |
| 90867 | TMS initial session (cortical mapping, motor threshold) | Initial TMS treatment session |
| 99202–99215 | Office / outpatient E/M, new & established | Office visits with medical decision-making |
| G2010 | Remote evaluation of recorded video / images | Store-and-forward, established patient |
| G2012 | Virtual check-in, 5–10 minutes | Brief communication tech service |
| Code | Description | Clinical Context |
|---|---|---|
| F20.x | Schizophrenia spectrum disorders | Psychotic disorder management |
| F31.x | Bipolar disorder | Mood stabilization, E/M heavy |
| F32.x | Major depressive disorder, single episode | TMS / ECT medical necessity |
| F33.x | Major depressive disorder, recurrent | TMS / ECT medical necessity |
| F41.x | Anxiety disorders | Psychotherapy + medication |
| F40.x | Phobic anxiety disorders | Exposure psychotherapy |
| F43.x | Stress / adjustment / PTSD | Trauma-focused psychotherapy |
| F60.x | Personality disorders | Long-term psychotherapy |
| F70–F79 | Intellectual disability / developmental | Child & adolescent psychiatry |
| F10–F19 | Substance use disorders | Addiction psychiatry / MAT |
| F90.x | ADHD | Stimulant / non-stimulant management |
| Modifier | Description | Psychiatry Application |
|---|---|---|
| 25 | Significant, separate E/M same day | E/M with same-day psychotherapy or procedure |
| 95 | Synchronous audio-video telehealth | Telehealth psychotherapy & E/M parity |
| GT | Telehealth (legacy / deprecated) | Historic telehealth, payer-specific legacy use |
| 59 | Distinct procedural service | Distinct psychotherapy / procedure same day |
| 51 | Multiple procedures | Multiple psychotherapy / procedure codes same session |
| 52 | Reduced services | Psychotherapy less than full time threshold |
| 22 | Increased procedural service | Extended psychotherapy beyond typical time |
| 32 | Preventive / mandated service | Court-ordered or preventive psychiatric eval |
Comprehensive revenue cycle management designed specifically for psychiatry practices.
Specialty coders handle time-based psychotherapy 90832/90834/90837, E/M add-ons 90833/90836/90838, ECT, TMS, and modifier 25/95 with accuracy.
Time-based documentation defense, E/M add-on bundling corrections, and telehealth parity appeals with session-level documentation.
Pre-service authorization for TMS, ECT, pharmacogenomic testing, psychotropic medications, and neuromodulation procedures.
Prioritized follow-up on aged psychotherapy, ECT, and TMS claims with strategic payer escalation to maximize recovery.
Regular audits focused on psychotherapy time capture, E/M add-on documentation, modifier 25/95, and TMS/ECT session rules.
Real-time dashboards tracking psychotherapy time distribution, E/M add-on capture, telehealth parity, and physician productivity.
Understanding the most common denial reasons is the first step to preventing them on psychotherapy, E/M, and procedure claims.
Psychotherapy 90832/90834/90837 denied when total minutes are not documented or the wrong time-based code is selected.
Per-session minute capture mapped to the correct time-based psychotherapy code with note-level documentation.
Add-on psychotherapy 90833/90836/90838 denied as bundled when E/M is not separately documented same day.
Separate E/M and psychotherapy time documentation with modifier 25 on the E/M where appropriate.
Telehealth psychotherapy underpaid or denied when modifier 95 is omitted or the place-of-service code does not match the payer’s parity policy.
Modifier 95 with correct place-of-service and payer-specific parity rule application on every telehealth claim.
ECT 90870/90871 denied when facility and professional components are split incorrectly, or anesthesia 00104 is billed by the same psychiatrist.
Correct facility versus professional billing with anesthesia 00104 bundled when the same physician performs both.
Identifying and plugging these common revenue leakage points can significantly improve your practice’s bottom line.
Minutes not recorded in the note, so 90832/90834/90837 downcode or deny.
90833/90836/90838 not billed when E/M and psychotherapy occur same day.
Telehealth psychotherapy reimbursed below parity when modifier 95 or POS is wrong.
90867 reported more than once, or 90868/90869 billed together against CCI edits.
See how psychiatry-specific revenue cycle management transforms your practice’s financial performance.
A structured onboarding process designed to deliver measurable improvements within the first 90 days.
Review of psychiatry billing operations, psychotherapy time capture, E/M add-on coding, and revenue cycle baseline.
EMR and telehealth-platform integration, dedicated psychiatry billing team, and payer enrollment verification.
Full billing with real-time claim submission, modifier 25/95 verification, and time-based documentation protocols.
Performance review against baseline, workflow optimization, and documented revenue improvement.
How our psychiatry-specific approach compares to in-house billing and general medical billing companies.
| Capability | In-House Team | General Billing Co. | MedFactor Psychiatry |
|---|---|---|---|
| Time-based psychotherapy minute capture | Inconsistent | ✕ | ✓ |
| E/M add-on psychotherapy 90833/90836/90838 | ✕ | ✕ | ✓ |
| Telehealth modifier 95 & originating-site parity | Inconsistent | ✕ | ✓ |
| ECT 90870/90871 facility vs professional splits | ✕ | ✕ | ✓ |
| TMS 90867-90869 session coding & CCI edits | Manual | Partial | ✓ |
| Prior auth on psychotropics & genetic testing | Inconsistent | Partial | ✓ |
| Group psychotherapy 90853 capture | Manual | Partial | ✓ |
| Psychotherapy time-distribution reporting | ✕ | ✕ | ✓ |
| Dedicated psychiatry billing team | ✕ | ✕ | ✓ |
Our team combines deep psychiatry billing expertise with the technology and processes to deliver consistent, measurable results for outpatient, neuromodulation, and telepsychiatry practices.
Discover exactly where your psychiatry practice is losing revenue. Our no-obligation audit analyzes your psychotherapy time capture, E/M add-on coding, and telehealth parity compliance.
Real results from psychiatry practices that partnered with MedFactor for specialty revenue cycle management.
An outpatient psychiatry practice was dropping add-on psychotherapy 90833/90836/90838 on same-day E/M visits and under-documenting psychotherapy minutes. MedFactor implemented per-session minute capture and add-on sequencing, recovering substantial revenue in seven months.
A TMS/ECT center was reporting 90867 more than once per course and splitting ECT facility versus professional components incorrectly. MedFactor implemented per-session TMS coding and correct ECT 90870/90871 billing, recovering procedure revenue.
A telepsychiatry group was underpaid on telehealth psychotherapy by omitting modifier 95 and using the wrong place-of-service. MedFactor applied modifier 95 with payer-specific parity rules, lifting telehealth reimbursement across all 50 states.
No matter where your psychiatry practice operates, our team understands the payer landscape and regulatory requirements in your region.
Deep coding knowledge across Medicare, Medicaid, and all major commercial payers for psychiatric services.
Modifier 95 and originating-site parity applied correctly across all 50 states and payers.
Facility and professional billing coordination across hospital-based ECT and outpatient TMS programs.
State Medicaid behavioral health coverage and parity rules for psychotherapy and medication management.
Common questions from psychiatry practices considering MedFactor’s specialty RCM services.
Add-on psychotherapy codes 90833 (30 min), 90836 (45 min), and 90838 (60 min) are separately reportable when a significant E/M service is performed on the same day. They are add-on codes — billed in addition to the base E/M (99202–99215) or psychiatric diagnostic eval — and the E/M and psychotherapy time must be documented separately. The E/M is reported with modifier 25 when a separate, significant E/M occurs on the same day as the psychotherapy. We capture the E/M and the add-on psychotherapy with separate time documentation so neither component is denied as bundled.
Psychotherapy codes 90832, 90834, and 90837 are time-based: 90832 is approximately 30 minutes, 90834 is approximately 45 minutes, and 90837 is approximately 60 minutes. The total minutes of the psychotherapy encounter must be documented in the note — not just the start and stop time. More than half the session time must be psychotherapy. We map the documented minutes to the correct time-based code on every claim so psychotherapy is paid at the correct level rather than downcoded for missing time documentation.
Modifier 95 indicates a synchronous audio-video telehealth service that meets the payer’s telehealth definition, and most payers reimburse it at parity with the in-person service. The claim must also carry the correct place-of-service code (such as 02 or 10) per the payer’s policy. Originating-site and geographic waivers vary by payer and state, so we verify each payer’s parity rule and apply modifier 95 with the matching place-of-service on every telehealth psychotherapy and E/M claim — preventing the underpayments and denials that occur when 95 is omitted or the POS is wrong.
ECT 90870 (single seizure) and 90871 (multiple seizures per day, rarely used) include necessary monitoring. The facility and professional components must be split correctly when a facility is involved. Anesthesia code 00104 is separately billable only when a separate anesthesia provider administers anesthesia — when the same psychiatrist performs both the ECT and the anesthesia, 00104 is bundled into 90870 by NCCI edits (modifier indicator 0) and cannot be separately reported. We verify who performed the anesthesia and bill the correct facility versus professional components so ECT claims are not denied for split or bundling errors.
Transcranial magnetic stimulation (TMS) is reported with 90867 for the initial session (including cortical mapping, motor threshold determination, delivery, and management) — only once per course of treatment — 90868 for each subsequent delivery and management session, and 90869 when the motor threshold is re-determined during a session. CCI edits bundle 90868 and 90869 together with a modifier indicator of 0, so they cannot be reported for the same session. We sequence 90867 once per course, bill 90868 for routine sessions, and use 90869 only when re-determination occurs, so TMS claims pass CCI edits and pay per session.
Many payers require prior authorization for high-cost psychotropic medications, pharmacogenomic (genetic) testing, and TMS — typically with medical-necessity criteria such as a documented major depressive disorder (F32.x/F33.x) and failure to respond to at least one antidepressant at a therapeutic dose for a minimum number of weeks. We obtain authorization before the service is rendered, confirm the diagnosis supports the payer’s criteria, and attach the authorization to the claim so psychotropic, genetic-testing, and TMS claims are not denied for missing or invalid authorization.
MedFactor applies the same code-level precision across the full practice spectrum. See how we bill these related specialties.
CPT®, ICD-10, HCPCS, and modifier codes referenced on this page reflect the current code sets and are subject to annual updates — always verify against the current-year fee schedule before submission. KPIs and case-study figures shown are representative benchmarks, not guarantees of individual practice results.
The rules on this page are published somewhere official. These are the ones worth reading yourself.
The published Medicare rates and payment rules behind most of the codes on this page.
Read the sourceThe rules governing referrals between a practice and its own ancillary services.
Read the sourceThe coding and billing standards body whose credentials most billers and coders hold.
Read the sourceEnforcement guidance on billing compliance, and the arrangements that attract scrutiny.
Read the sourceThe procedure-to-procedure and medically unlikely edits behind most bundling denials.
Read the sourceThe specialty society behind DSM criteria and the documentation payers expect for psychiatric care.
Read the sourceYour psychiatry practice deserves billing partners who know time-based psychotherapy coding, E/M add-ons 90833/90836/90838, ECT 90870/90871, TMS 90867, and telehealth modifier 95 — and code every claim correctly. Let MedFactor show you what specialty RCM can do.