CMS Physician Fee Schedule
The published Medicare rates and payment rules behind most of the codes on this page.
Behavioral health billing hinges on time-based 908xx psychotherapy code selection (90832, 90834, 90837), telehealth parity with modifier 95 and audio-only 93, and correct family-vs-individual and group code choice. Add non-physician provider credentialing and prior-authorization complexity — and general billers miss revenue on every session. MedFactor delivers behavioral-health-specific RCM that protects every claim.
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Therapy Session & Telehealth — RCM PanelSample · Audiogram
908xx Session Length & Modality Map
30m
45m
60m
Intake90791
Ind 3090832
Ind 4590834
Ind 6090837
Fam90847
Group90853
0%908xx Denial Reduction
$0MTelehealth Parity Recovered
0%Net Collection Lift, Avg.
Behavioral health claims fail at seven specific checkpoints. MedFactor catches them; in-house and general RCM teams don’t.
Without Specialty RCM
With MedFactor BH
Illustrative testimonials from practice owners who moved their behavioral health billing to MedFactor. Names and results are representative.
”
★★★★★
We were downcoding 60-minute sessions to 90834 because our last biller didn’t push for start/stop times. MedFactor rebuilt our note template and within two months we were billing 90837 correctly on every session. Our monthly deposits jumped meaningfully without seeing one extra patient.
↑ $11,400/mo recovered revenue
SR
Dr. Sarah ReynoldsOwner · Private Therapy Practice, TX
”
★★★★★
Our telehealth claims kept getting denied for modifier 95 missing. The MedFactor team built a payer-by-payer 95 / 93 / GT map and started applying it automatically. Denials on telebehavioral health dropped to nearly zero and we’re actually getting paid at parity now.
↓ 92% telehealth denials
MK
Michael K., LCSWClinical Director · Telebehavioral Group, FL
”
★★★★★
We run two IOP groups plus a small group private practice. MedFactor figured out per-member 90853 capture that nobody else could, and our group revenue line jumped overnight. The monthly reporting is the cleanest I’ve ever seen from a billing partner.
↑ 34% group revenue, 60 days
DA
Dana A., LMFTFounder · IOP + Group Practice, CA
From individual psychotherapy to family, group, and telebehavioral health, we tailor billing to the coding rules of every therapy subspecialty.
Individual
Time-based 90832 (30 min), 90834 (45 min), and 90837 (60 min) with documented start/stop times and add-on 90833/90836/90838 when E/M is also performed.
Family
90846 (family without patient) and 90847 (family with patient) with correct relational diagnosis and modifier 25 when paired with same-day E/M.
Group
90853 group psychotherapy with per-member capture, group-size documentation, and correct per-claim billing for each participant.
SUD
H0001, H0002, H0015 behavioral health assessment and intervention, plus SUD ICD-10 F10–F19 sequencing and per-diem or fee-for-service capture.
Pediatric
Time-based psychotherapy with age-appropriate ICD-10 (F90 ADHD, F93 child disorders) and family involvement codes for pediatric behavioral health.
Telehealth
908xx with modifier 95 (synchronous audio-video) and 93 (audio-only) per payer parity rules, plus GT where required for distant-site billing.
Behavioral health billing is built on time-based psychotherapy code selection — the session length and modality determine the code — and telehealth parity rules require the correct modifier (95 for audio-video, 93 for audio-only) or the claim is denied. This is the largest source of behavioral health denials.
One behavioral health episode starts with a diagnostic intake (90791/90792), then individual, family, or group therapy billed by documented session time — with add-on codes for therapy with E/M and separately reportable telehealth parity modifiers.
Intake / EvaluationPsychiatric diagnostic evaluation90791
Individual psychotherapy 30 minTime-based, 16–37 min90832
Individual psychotherapy 45 minTime-based, 38–52 min90834
Individual psychotherapy 60 minTime-based, 53+ min90837
Family psychotherapy (with patient)90847 with patient · 90846 without90847
Group psychotherapyPer-member capture for each participant90853
Behavioral health assessment / interventionH0001 / H0002 / H0015 — non-physicianH0001 · H0002 · H0015
Psychotherapy add-on with E/MWhen E/M also performed (typically physician)90833 · 90836 · 90838
Telehealth — synchronous audio-video (separately reportable)Parity modifier for distant-site billing95
Telehealth — audio-only (separately reportable)Parity modifier where payer permits93
Our focus: We select the 908xx code by documented session time (not the scheduled length), distinguish family-with-patient 90847 from family-without-patient 90846, capture each group member on 90853, and append the correct telehealth parity modifier — 95 for synchronous audio-video and 93 for audio-only — so behavioral health claims are paid at parity rather than denied for missing or incorrect telehealth modifiers.
Behavioral health billing is governed by time-based 908xx coding, telehealth parity modifiers, and non-physician credentialing rules that general billing companies cannot navigate effectively.
90832, 90834, and 90837 are selected by documented session time, but missing or rounded start/stop times cause downcoding to a lower-paying code or denial.
Severity~$18K/yr lost per clinician
Telebehavioral health claims denied when modifier 95 (audio-video) or 93 (audio-only) is missing, incorrect, or not accepted by the payer for that service.
Severity~21% of telehealth claims denied
Family therapy coded as individual psychotherapy, or 90846 (without patient) and 90847 (with patient) swapped, causing denials and incorrect reimbursement.
Severity~14% family claims denied
90853 group psychotherapy underbilled when only one claim is submitted for the group instead of capturing each member with proper documentation.
Severity~30% group revenue left uncaptured
LCSWs, MFTs, and counselors denied for non-parity payer enrollment, missing NPI taxonomy, or supervisor attestation gaps on claims.
SeverityTop cause of LCSW claim denial
Psychotherapy sessions denied for missing prior authorization, exhausted visit limits, or medical-necessity gaps in the treatment plan documentation.
Severity12% auth-exhaustion denials
Quick reference for the most frequently used codes in behavioral health and therapy billing and coding.
CPT / HCPCS
ICD-10 Codes
Modifiers
| Code | Description | Common Use |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | Intake without medical services |
| 90792 | Psychiatric diagnostic eval with medical services | Intake with medical assessment |
| 90832 | Individual psychotherapy, 30 min | 16–37 min session |
| 90834 | Individual psychotherapy, 45 min | 38–52 min session |
| 90837 | Individual psychotherapy, 60 min | 53+ min session |
| 90846 | Family psychotherapy without patient | Family counseling, no patient present |
| 90847 | Family psychotherapy with patient | Family counseling, patient present |
| 90853 | Group psychotherapy | Group therapy, per-member capture |
| 90839 | Psychotherapy for crisis, 60 min | Crisis intervention |
| 90840 | Crisis psychotherapy add-on, 30 min | Each additional 30 min of crisis |
| H0001 | Behavioral health assessment | Non-physician assessment |
| H0002 | Behavioral health screening | Screening / intervention |
| H0015 | Alcohol/drug services, intensive outpatient | SUD intensive outpatient |
| 90833 | Psychotherapy add-on 30 min with E/M | Add-on when E/M also performed |
| 90836 | Psychotherapy add-on 45 min with E/M | Add-on when E/M also performed |
| 90838 | Psychotherapy add-on 60 min with E/M | Add-on when E/M also performed |
| Code | Description | Clinical Context |
|---|---|---|
| F32.x | Major depressive disorder | Depression — single episode |
| F33.x | Major depressive disorder, recurrent | Recurrent depression |
| F41.x | Anxiety disorders | Generalized / panic anxiety |
| F43.x | Stress / adjustment disorders | Adjustment & trauma reactions |
| F90.x | Attention-deficit disorders (ADHD) | Child / adult ADHD |
| F10–F19 | Substance use disorders | SUD / addiction counseling |
| F40.x | Phobic / anxiety disorders | Specific phobia, agoraphobia |
| F45.x | Somatoform / somatic disorders | Somatic symptom disorders |
| F50.x | Eating disorders | Anorexia, bulimia, binge-eating |
| Z03.89 | Encounter for observation for suspected MH | Suspected mental condition |
| R45.x | Symptoms & signs of emotional state | Emotional / behavioral symptoms |
| Modifier | Description | Behavioral Health Application |
|---|---|---|
| 95 | Synchronous telemedicine via audio-video | Telebehavioral health, distant-site parity |
| 25 | Separate E/M same day | E/M with same-day psychotherapy or intake |
| 59 | Distinct procedural service | Distinct therapy services same day |
| 51 | Multiple procedures | Multiple therapy services same session |
| 52 | Reduced services | Session shorter than code minimum |
| 22 | Increased procedural service | Unusually long psychotherapy session |
| 32 | Preventive / mandated service | Court-ordered / mandated therapy |
| GT | Telehealth distant site (legacy) | Where payer still requires GT for telehealth |
Comprehensive revenue cycle management designed specifically for behavioral health and therapy practices.
Specialty coders handle time-based 908xx selection, telehealth 95/93 parity, family-vs-individual coding, and group per-member capture with accuracy.
Telehealth parity defense, time-based code corrections, and appeals with session-time documentation for behavioral health denials.
Pre-session authorization for psychotherapy, SUD treatment, intensive outpatient programs, and mandated / court-ordered therapy.
Prioritized follow-up on aged psychotherapy, group, and telehealth claims with strategic payer escalation to maximize recovery.
Regular audits focused on time-based code accuracy, telehealth modifier 95/93 parity, credentialing, and visit-limit tracking.
Real-time dashboards tracking session-mix, telehealth parity compliance, and per-provider productivity for non-physician staff.
Understanding the most common denial reasons is the first step to preventing them on psychotherapy, family, group, and telehealth claims.
Sessions billed with the wrong time-based code because start/stop times are missing, rounded, or not documented in the note.
Documented start/stop times mapped to the correct 90832 / 90834 / 90837 code on every claim.
Telebehavioral health claims denied when modifier 95 (audio-video) or 93 (audio-only) is missing or not accepted by the payer.
Payer-specific 95 / 93 / GT telehealth parity mapping on every distant-site claim.
Family therapy coded as individual psychotherapy, or 90846 / 90847 swapped, causing denials and incorrect payment.
Modality-based code selection with relational diagnosis and 90846 vs 90847 verification.
90853 group psychotherapy underbilled when only one claim is submitted instead of capturing each member with proper documentation.
Per-member claim capture with group-size and attendance documentation.
Identifying and plugging these common revenue leakage points can significantly improve your practice’s bottom line.
60-minute sessions billed as 90834 instead of 90837 due to missing start/stop times.
Telebehavioral health claims denied when 95 or 93 parity modifier is omitted.
90853 billed once for the group instead of per-member with attendance documentation.
Non-physician providers denied for missing parity enrollment or taxonomy gaps.
See how behavioral-health-specific revenue cycle management transforms your practice’s financial performance.
A structured onboarding process designed to deliver measurable improvements within the first 90 days.
1WEEK 1–2
Review of behavioral health billing operations, 908xx time-coding, telehealth parity, and revenue cycle baseline.
2WEEK 3–4
EMR integration, dedicated behavioral health billing team, and non-physician provider credentialing verification.
3WEEK 5–8
Full billing with real-time claim submission, telehealth parity verification, and denial prevention protocols.
4WEEK 9–12
Performance review against baseline, workflow optimization, and documented revenue improvement.
How our behavioral-health-specific approach compares to in-house billing and general medical billing companies.
| Capability | In-House Team | General Billing Co. | ★ RecommendedMedFactor BH |
|---|---|---|---|
| Time-based 90832 / 90834 / 90837 selection | Inconsistent | ✕ | ✓ |
| Telehealth 95 / 93 audio-only parity | ✕ | ✕ | ✓ |
| Family 90846 vs 90847 coding | Inconsistent | ✕ | ✓ |
| Group 90853 per-member capture | ✕ | ✕ | ✓ |
| Non-physician credentialing & parity | Manual | Partial | ✓ |
| Prior auth & visit-limit tracking | Inconsistent | Partial | ✓ |
| H0001 / H0002 / H0015 SUD capture | Manual | Partial | ✓ |
| Telehealth parity compliance reporting | ✕ | ✕ | ✓ |
| Dedicated behavioral health billing team | ✕ | ✕ | ✓ |
Our team combines deep behavioral health billing expertise with the technology and processes to deliver consistent, measurable results for individual, family, group, and telebehavioral health practices.
Discover exactly where your behavioral health practice is losing revenue. Our no-obligation audit analyzes your 908xx time-coding, telehealth parity modifiers, and non-physician credentialing.
Schedule Your Free Audit
1. 15-min call→2. We pull your claims data→3. 10-day audit report
22%Average Revenue ImprovementPractices see an average 22% improvement in net collections within the first year.
2 WeeksAudit Completion TimeComplete billing and coding audit delivered within 10 business days.
Real results from behavioral health and therapy practices that partnered with MedFactor for specialty revenue cycle management.
$310KRevenue Recovered
Group / Private Therapy
A group private therapy practice was downcoding 60-minute sessions to 90834 due to missing start/stop times and billing family therapy as individual. MedFactor implemented time-documentation protocols and modality-based code selection, recovering substantial revenue in seven months.
38%Denial Reduction18dA/R Reduced
$240KAnnual Capture
Telebehavioral Health
A telebehavioral health group was denying telehealth claims for missing modifier 95 and underbilling audio-only sessions. MedFactor implemented payer-specific 95 / 93 parity mapping, recovering parity reimbursement per session.
$240KAnnual Recovery31%Revenue Increase
+34%Revenue Increase
SUD / Addiction
An addiction counseling center was under-capturing H0001 behavioral health assessments and H0015 intensive outpatient services, plus SUD ICD-10 F10–F19 sequencing errors. MedFactor implemented per-member and per-encounter capture that protected SUD revenue.
$185KAnnual Savings34%Revenue Increase
No matter where your behavioral health 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 behavioral health services.
State-by-state telehealth parity and audio-only coverage rules applied correctly across all 50 states.
LCSW, MFT, and counselor credentialing and parity enrollment managed across state Medicaid and commercial payers.
Court-ordered therapy, intensive outpatient, and SUD program coverage rules applied per state requirements.
States with active behavioral health billing & parity programs
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutFloridaGeorgiaIllinoisIndianaMarylandMassachusettsMichiganMinnesotaMissouriNevadaNew JerseyNew YorkNorth CarolinaOhioOklahomaOregonPennsylvaniaTennesseeTexasVirginiaWashingtonWisconsin+ 22 more
Page last reviewed by MedFactor RCM team — Aug 2026 · CPT / ICD-10 / HCPCS codes verified against current-year fee schedule
Common questions from behavioral health and therapy practices considering MedFactor’s specialty RCM services.
What does MedFactor actually do for a behavioral health practice?
We run end-to-end revenue cycle management specialized for therapy and behavioral health practices. A dedicated BH billing team handles claim submission with correct 908xx time-coded selection (90832 / 90834 / 90837 from documented session time), telehealth parity modifiers (95 for audio-video, 93 for audio-only, GT where required), correct family-vs-individual coding (90846 vs 90847), per-member group capture on 90853, non-physician credentialing (LCSW / MFT / LPC), prior authorization and visit-limit tracking, denial management and appeals, and monthly performance reporting. Most practices see denial reductions in the 30–45% range within the first 90 days and net collection lifts of 15–25% within the first year.
How do telehealth modifiers 95 and 93 audio-only parity work?
Modifier 95 indicates a synchronous telemedicine service delivered via real-time audio and video, and modifier 93 indicates an audio-only telehealth service where the payer permits it. Behavioral health is one of the most telehealth-friendly specialties, but parity rules vary by payer and state — some payers pay audio-only 908xx at parity only for specific codes or during specific periods, and some still prefer the legacy GT modifier. We map each payer’s current 95 / 93 / GT telehealth parity rules and append the correct modifier on every distant-site behavioral health claim so the session is paid at parity rather than denied for a missing or incorrect telehealth modifier.
What is the difference between 90846 and 90847 family therapy?
90846 is family psychotherapy without the patient present — the clinician counsels family members about the patient’s condition when the patient is not in the room. 90847 is family psychotherapy with the patient present — the patient and family members are in the session together. The distinction is whether the identified patient is physically present. These codes are frequently swapped or both billed as individual psychotherapy, which causes denials and incorrect payment. We verify who is present in the session from the note and select 90846 or 90847 accordingly, with the correct relational diagnosis supporting the family therapy service.
How is 90853 group therapy billed for each member?
90853 is group psychotherapy (typically four or more patients with a therapist). Each group member is billed individually — one 90853 claim per participant per session, with the member’s own diagnosis and insurance. The note must document group size and the member’s attendance and participation. The most common leakage point is billing a single 90853 for the whole group rather than per member, which either denies or underpays the session. We capture each member on a separate 90853 claim with attendance documentation and the member’s own diagnosis, so every participant is reimbursed for the group session.
How do you handle credentialing and parity for non-physician providers?
Psychologists, LCSWs, MFTs, and licensed counselors must be individually credentialed and enrolled with each payer — and many payers apply parity rules that pay non-physician behavioral health providers at the same rate as physicians for the same 908xx service, while others do not. We verify each provider’s NPI, taxonomy code, state license, and payer enrollment before claims are submitted, and we track parity status per payer so non-physician providers are paid at the correct rate. Missing credentialing, wrong taxonomy, or unenrolled providers are the most common cause of behavioral health claim denial, and we catch these before the claim is ever submitted.
How do prior authorization and medical necessity affect therapy claims?
Many payers require prior authorization for psychotherapy after a set number of visits, and sessions beyond the limit are denied without supporting medical-necessity documentation in the treatment plan. We track each patient’s authorized visit count per payer, request additional authorization before the limit is reached, and ensure the treatment plan documents the diagnosis, goals, and progress that support medical necessity for ongoing therapy. This prevents the common denial pattern of sessions denied as not medically necessary or beyond the authorized visit limit.
MedFactor applies the same code-level precision across the full practice spectrum. See how we bill these related specialties.
Psychiatry
Internal Medicine
Pediatrics
All 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.
The rules governing referrals between a practice and its own ancillary services.
The coding and billing standards body whose credentials most billers and coders hold.
Enforcement guidance on billing compliance, and the arrangements that attract scrutiny.
The procedure-to-procedure and medically unlikely edits behind most bundling denials.
The federal agency publishing behavioural health guidance, parity resources and treatment rules.
Your behavioral health practice deserves billing partners who know time-based 908xx coding, telehealth 95/93 parity, and family-vs-individual and group per-member capture — and code every claim correctly. Let MedFactor show you what specialty RCM can do.
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