CPT (Current Procedural Terminology) coding is the crucial first step for behavioral health practices to accurately bill for services and drive proper reimbursement. However, due to complex cases and a lack of standardization within behavioral health revenue cycle management (RCM), coding teams inevitably make mistakes and overlook essential details — leading to poor revenue capture and limited reimbursement.
To best position your business for success, leverage expert insights into the maze of behavioral health CPT codes to streamline administrative processes and maximize practice revenue. Ensure your business captures all available claims and minimizes denials by exploring the information and strategies in this Behavioral Health CPT quick guide.
Top Behavioral Health CPT Codes in 2024
Recording clear and accurate CPT codes for behavioral health services is easier said than done. Coding teams must assess each component of care to extract every possible billing opportunity and assign the correct code. While the framework of behavioral health RCM continues to evolve as the industry adapts to the intricacies of mental health and psychiatric care, there is a set list of codes that your team must know to bill properly in 2024. The most commonly utilized codes include:1
- 90791: Psychiatric diagnostic evaluation
- 90792: Psychiatric diagnostic evaluation with medical services
- 90832, 90834, 90837: Psychotherapy for 30, 45, and 60 minutes
- 90845: Psychoanalysis
- 90846: Family or couples therapy without patient present
- 90847: Family or couples therapy with patient present
- 90849: Multiple family group psychotherapy
- 90853: Group psychotherapy (other than a multiple-family group)
- 90839: Psychotherapy for crisis, 60 minutes
- 90840: Psychotherapy for crisis, each additional 30 minutes
Digging Deeper: Assigning Code Modifiers
Determining the correct code is just the first piece of the behavioral health RCM puzzle. In many cases, coding modifiers must be used to accurately capture a unique or nontypical episode of care. In these situations, standard codes are not sufficient to describe the services rendered, and modifiers must be used to help insurance companies understand the correct reimbursement amount. Examples of frequently used modifiers include:2,3
- Modifier 25: Separately identifiable Evaluation and Management Services by one provider, or on the same day as another service
- Modifier 27: Multiple evaluation or management encounters on the same day
- Modifier 59: Distinct procedure from other services rendered on the same day
- Modifier 95: Audio-video counseling and therapy telehealth services
- Modifier AF: Services rendered by a specialty physician
- Modifier AH: Services rendered by a clinical psychologist
- Modifier HA: Child or adolescent program
- Modifier HB: Adult program, non-geriatric
- Modifier HE: Mental health program
- Modifier HF: Substance abuse program
- Modifier HG: Opioid addiction treatment program
- Modifier HK: Specialized mental health programs for high-risk populations
- Modifier HQ: Group setting
Leverage Best Practices for Behavioral Health Coding
Achieving complete coding accuracy requires an end-to-end overhaul of how your practice codes for your services — simply memorizing the list of codes and modifiers is not enough to improve revenue cycle performance. Follow these five best practices as the starting framework for a more profitable practice:
- Practice thorough documentation: Ensure comprehensive documentation of each patient encounter, including the services provided, duration, patient response, and any relevant diagnoses or symptoms.
- Eliminate coding errors: Select the most appropriate CPT code based on the services rendered and documentation guidelines. Avoid undercoding or overcoding, as these errors can lead to denials or audits.
- Stay current on new guidelines: Regularly review updates to CPT codes and guidelines to ensure compliance with the latest coding standards and regulations.
- Utilize technology: Implement electronic health record (EHR) systems and business intelligence tools to optimize billing workflows and automate coding processes where possible.
- Leverage coding expertise: Bring in a trained set of eyes to ensure your coding practices are accurate and efficient, and leverage these expert insights to identify gaps in your coding processes.
Unlike traditional medical billing, behavioral health RCM is not an easily navigable process — especially for an in-house billing team. Behavioral health coding and billing are incredibly complex and prone to errors, requiring specialized knowledge and experience to ensure maximum reimbursements. An expert partner like Accurio can work behind the scenes to ensure your practice is paid properly for your services. Accurio’s business intelligence-driven behavioral health RCM solutions integrate within each practice’s billing workflow, providing highly customized services that accelerate revenue growth and enhance financial visibility — without disrupting your day-to-day processes. By outsourcing your revenue cycle to a team of specialists who have mastered the intricacies of behavioral health coding and billing, your practice is free to focus your time, staff, and resources on what truly matters: caring for your patients.
Sources
- Billing and Coding: Psychiatry and Psychology Services. (2019, October 31). Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480
- Commonwealth of Massachusetts MassHealth Provider Manual Series. (2023). Service Codes and Descriptions. In Mental Health Center Manual (pp. 6-1–6-14). https://www.mass.gov/doc/mental-health-center-mhc-subchapter-6/download
- Authorized Modifiers. (2024, January 1). South Dakota Medicaid. https://dss.sd.gov/docs/medicaid/modifiers.pdf
