Psychiatry billing is different from therapy billing because most of it runs on evaluation and management (E/M) codes, with psychotherapy added on top. A psychiatry billing service has to code the intake by who delivered it, level each medication management visit by medical decision making or time, attach the right psychotherapy add-on when therapy is also provided, and keep prior authorizations and telehealth rules straight. Get those right and most psychiatry denials disappear.
What makes psychiatry billing different
| Visit | How it is usually billed | Where it goes wrong |
|---|---|---|
| Intake by a prescriber | 90792, psychiatric diagnostic evaluation with medical services | Billed for a non-prescriber, or billed again for follow-ups. |
| Intake by a non-prescriber | 90791, psychiatric diagnostic evaluation | Prescribers defaulting to 90791 and leaving the medical work unbilled. |
| Medication management follow-up | Office or outpatient E/M at the level supported by medical decision making or time | Levels chosen by habit rather than documentation. |
| Follow-up with psychotherapy | E/M plus a psychotherapy add-on: 90833 (16 to 37 minutes of therapy), 90836 (38 to 52) or 90838 (53 or more) | Therapy time not documented separately from the E/M work. |
| Therapy-only session | Standalone psychotherapy, such as 90837 for 53 minutes or more | Standalone codes billed alongside an E/M on the same visit. |
| Group session | 90853, group psychotherapy | Group size and time not documented. |
| Psychiatric consultation to primary care | Collaborative care codes such as 99492 | Monthly time and required elements not tracked. |
The rules behind most psychiatry denials
- One intake code, chosen by the clinician's scope. 90792 includes medical services, so it belongs to prescribers. Medicare's procedure-to-procedure edits pair 90792 with the office E/M codes 99202 to 99215 with a modifier indicator of 0, which means no modifier will allow both on the same day.
- Follow-ups are E/M, not another intake. Repeating 90792 for medication management visits creates a frequency denial pattern.
- Add-ons attach to the E/M. The psychotherapy add-on codes are reported with an E/M visit, never with a standalone psychotherapy code and never with 90792. The therapy minutes must be separate from the time used to support the E/M.
- Interactive complexity is narrow. 90785 is for genuine communication complications in the session, not for interpretation or translation alone.
- Who may bill matters. Nurse practitioners and physician assistants bill within their state scope and their payer enrollment, and payers differ on how they recognize them.
Prior authorization in psychiatry
Routine outpatient medication management rarely needs approval, but several psychiatric services often do, depending on the plan: transcranial magnetic stimulation, esketamine treatment, intensive outpatient and partial hospitalization programs, and some psychological testing. Approvals for these come with visit or session limits and end dates, so tracking them matters as much as obtaining them. Our prior authorization services cover the request, the follow-up and the renewal.
Telehealth in psychiatry
Many psychiatric follow-ups happen by video or phone. Telehealth visits use the same codes as in-person visits; what changes is the place of service code and, for some payers, a modifier. Errors here often underpay quietly rather than deny, which is why they can run for months unnoticed. Rules differ between Medicare, Medicaid and commercial plans, so they need to be set per payer.
What to look for in a psychiatry billing company
- Experience with E/M leveling and psychotherapy add-ons, not only therapy session codes.
- Routing of intake codes by rendering provider, not by appointment type.
- Prior authorization tracking for TMS, esketamine and program-level care.
- Telehealth place of service and modifier rules set per payer.
- Credentialing for psychiatrists, nurse practitioners and therapists in the same group.
- Reports that show denials by code and provider.
How Sterling Global Solution LLC bills for psychiatry practices
We check eligibility, benefits and authorization needs before each visit; code intakes by the rendering provider's scope; check that E/M levels and add-on therapy minutes are supported by the note; scrub every claim against payer edits; and work every denial inside its deadline. See how we approach behavioral health and therapist billing more broadly, and the credentialing side for the therapists in your group.
Try it on your own claims with our 30-Day Free Trial.
Frequently asked questions
How is psychiatry billing different from therapy billing?
Can 90792 be billed with an E/M visit on the same day?
Which add-on codes are used for psychotherapy with an E/M visit?
Do psychiatry practices need prior authorization?
Can we try your psychiatry billing service first?
Sources
American Medical Association, CPT 2026 Professional Edition: psychiatric diagnostic evaluation, psychotherapy add-on and interactive complexity codes and time ranges.
Centers for Medicare & Medicaid Services, Medicare NCCI procedure-to-procedure edits, practitioner file, 2026 Q4: 90792 with 99202 to 99215, modifier indicator 0.
CPT® is a registered trademark of the American Medical Association. Payer rules vary; check each plan's policy. How we verify this guidance.
Related reading
- Behavioral health billing. Our full approach for mental health practices.
- CPT 90792 billing guide. The prescriber intake code in detail.
- CPT 99492 billing guide. Collaborative care with primary care.
- Prior authorization services. TMS, esketamine and program approvals tracked.
- Credentialing services for therapists. Getting every clinician in your group in network.
See your psychiatry claims worked properly
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