The Business of Medical Billing For Psychiatric Claims

The Business of Medical Billing For Psychiatric Claims

Psychiatric medical billing can be confusing for a lot of people, and many times improperly coded medical billing claims will result in the medial billing getting kicked back.

Some standard billing codes for the Psychiatric industry are as follows:

The “Initial Psych Eval” causes a lot of confusion. Normally the 45 – 60 minute initial evaluation is billed under CPT code 90801 (whether it is a psychiatrist, psychologist or therapist).

Psychiatric testing is another coding nightmare for a lot of people, normally it is billed under CPT code 96100 (regardless of the “type” of test – the CPT code is always the same). Each “unit” is per hour.

For follow-up, it is billed with several different codes, and the choice is made which medical billing code to use based on the degree level of the provider of services.

For psychologists or therapists, it is:
90804 = 20 to 30 minutes therapy
90806 = 45 to 60 minutes therapy
90847 = family therapy with patient present
90846 = family therapy without patient present

For psychiatrist, it is:
90862 = medication management (short visit, typically 5 to 10 mins.)
90805 = med mgmt with therapy (usually 15 to 30 mins)
90807 = med mgmt with therapy (over 30 mins).

There are a few other codes (such as used with biofeedback therapy), but the ones above are the most commonly used.

A word of warning, many insurance policies disperse their mental health coverage to “speciality” behavioral companies, and many times the coverage must be pre-authorized before it will be covered. So be sure that the insurance coverage is verified before billing!

View all Articles by: Melissa Clark, CCS-P