CPT codes are the five-digit billing identifiers maintained by the American Medical Association that you use to tell payers what service you delivered, for how long, and to whom. For mental health clinicians, getting them right is the difference between a clean claim and a denial, because while most of the codes you'll use are not procedure-based. This guide walks through the codes that matter most in 2026, the documentation each one demands, and the changes that took effect this year.

Key Takeaways

• Most of the common outpatient mental health CPT codes you'll use are time-based, so your documented start and stop times are the single most important element protecting your reimbursement.

• The 2026 Medicare Physician Fee Schedule brought real changes, including new G-codes for Collaborative Care, expanded crisis and digital mental health pathways, and tighter enforcement on time thresholds and modifiers.

• LMFTs, LPCs, and LMHCs are now established Medicare providers, but documentation standards and time-tracking discipline apply to every clinician regardless of license type. LMFTs and independently licensed mental health counselors (including many LPCs and LMHCs, depending on state title) are now recognized as Medicare providers.

What Are CPT Codes in Mental Health Billing?

CPT stands for Current Procedural Terminology, and the codes function as a shared language between your clinical work and the payer's reimbursement system.

When you bill 90834 for a 45-minute session, you're telling the insurer exactly what happened in a way their system can process. The closer your documentation matches the code's definition, the smoother your claim moves through.

What makes behavioral health billing distinct is that your codes are tied to minutes of face-to-face clinical work, not a fixed procedure. A surgeon bills the same code for the same operation every time. You're billing for time and complexity, which means your note has to carry the weight of proving what you did. That reliance on narrative documentation is also why mental health claims draw extra scrutiny during payer audits, and why clean clinical documentation is your best defense.

Before getting into specific codes, it helps to know the categories you'll work within: diagnostic evaluations, individual psychotherapy, psychotherapy add-ons used with medication management, family and group therapy, crisis services, and psychological testing. Each category carries its own documentation expectations, which we'll cover below.

Diagnostic Evaluation Codes (90791 and 90792)

Diagnostic evaluations are what you bill at intake, when you're gathering a comprehensive history and formulating a working diagnosis. These two codes anchor the start of treatment.

• 90791 is the psychiatric diagnostic evaluation without medical services. It's the code most therapists, counselors, psychologists, and social workers use for an intake.

• 90792 is the same evaluation with medical services, used by prescribers who include medication review or medical decision-making as part of the assessment.

You typically bill one of these once per episode of care, and you generally can't bill an evaluation code and a full psychotherapy session on the same day. In most plans, you bill one of these once per episode of care, with additional evaluations reserved for new episodes, new providers, or significant changes in clinical presentation. Your note should document the history you gathered, a mental status exam, risk assessment, the diagnosis you reached, and the treatment plan you're proposing. If you want a reference point for what a thorough intake looks like in practice, a worked psychiatric intake note shows how those elements come together, and the same structure carries over when you write a full psychiatric evaluation.

In 2026, approximate Medicare rates for these evaluations run from roughly $174 for 90791 to around $202 for 90792, though the exact figure depends on your locality and payer. With evaluation codes established, the next category covers the bulk of your weekly billing.

Individual Psychotherapy Codes and the Time Thresholds That Matter

The three core individual psychotherapy codes are defined entirely by the face-to-face time you document. This is where the midpoint rule trips up even experienced clinicians.

• 90832 covers roughly 16 to 37 minutes (the "30-minute" session).

• 90834 covers roughly 38 to 52 minutes (the "45-minute" session).

• 90837 covers 53 minutes or more (the "60-minute" session).

The threshold between 90834 and 90837 is the one to watch. Billing 90837 requires at least 53 documented minutes, not 52 and not "about an hour." A 52-minute session billed as 90837 is considered upcoding under CMS guidelines, and while a single instance usually slips through, a consistent pattern is exactly what a payer audit looks for during a multi-year lookback. The fix is simple and non-negotiable: record actual start and stop times in every note.

When you provide both medication management and psychotherapy in the same visit, you don't use the standalone codes above. Instead, you pair an evaluation and management (E/M) code with a psychotherapy add-on: 90833 for 16 to 37 minutes, 90836 for 38 to 52 minutes, and 90838 for 53 or more minutes of psychotherapy time. Many payers want modifier 25 on the E/M code to show it was a separately identifiable service, so check your payer's policy before submitting.

One more add-on worth knowing is 90785, interactive complexity, which captures the added difficulty when communication barriers, third parties, or high-conflict dynamics complicate a session. It's an add-on, never a standalone code. Once your individual session codes are solid, the relationship and group codes follow the same time-and-documentation logic.

Family, Couples, and Group Therapy Codes

Therapy that involves more than one person in the room has its own set of codes, and the distinctions are easy to mix up.

• 90846 is family therapy without the patient present.

• 90847 is family or couples therapy with the patient present, which is the code most couples sessions fall under.

• 90853 is group psychotherapy, billed per group member you treat.

Couples work raises a billing question that clinicians ask constantly: whether insurance will pay at all.

The answer depends heavily on medical necessity and how the plan treats relational versus individual diagnoses, and the practical realities of insurance coverage for couples therapy are worth understanding before you set expectations with clients. For group sessions, your documentation has to reflect each member's individual participation and progress, not just a single shared summary, which is what makes group progress notes their own documentation challenge.

With routine treatment codes covered, the next category handles the moments when a client is in acute distress.

Crisis and Higher-Acuity Codes

Crisis psychotherapy codes exist for sessions where a client is in acute distress or at imminent risk of harm, and they reimburse at a higher rate to reflect that intensity.

• 90839 covers crisis psychotherapy for the first 60 minutes, with a 30-minute minimum.

• 90840 is the add-on for each additional 30 minutes, used alongside 90839.

Crisis codes draw audit attention because they pay more, so your note needs to clearly establish the acute nature of the presentation, the risk you assessed, and the interventions you provided.

Documenting the clinical reasoning behind a crisis designation, rather than just checking a box, is what holds up under review. That same clarity matters when documentation touches on safety and disclosure, where understanding the limits of confidentiality directly shapes what you record and how.

What Changed for Mental Health Billing in 2026

The 2026 Medicare Physician Fee Schedule, effective January 1, brought the most significant coding changes behavioral health has seen in years. A few stand out as worth your attention.

Medicare now allows certain behavioral health integration and psychiatric collaborative care services to be reported through new optional APCM add-on codes G0568–G0570 when APCM is billed in the same month. If your practice participates in collaborative or integrated care, your billing team needs to update those references before submitting January claims. CMS also added new crisis support codes and established a billing pathway for Digital Mental Health Treatment.

There's also a major privacy development that intersects with billing. Updated 42 CFR Part 2 regulations governing substance use disorder records reached full enforcement on February 16, 2026, aligning SUD record handling more closely with HIPAA while adding stricter consent and breach-notification requirements.

If you treat substance use, your consent forms and Notice of Privacy Practices need to reflect the new rules. Staying current on these shifts is part of the ongoing continuing education and compliance work that keeps a practice audit-ready.

Telehealth coding also continues to matter. The CPT code itself doesn't change when you deliver a session virtually; a 45-minute video session is still 90834. What changes is the modifier and place of service, typically modifier 95 for synchronous audio-video and POS 10 when the client is in their home. We'll touch on the documentation side of that below.

Telehealth Modifiers and Place of Service Codes

Because so much mental health care now occurs via video, the modifier and place-of-service rules warrant their own mention. Modifier 95 indicates a synchronous telemedicine service delivered through real-time audio-video. Some Medicaid plans still use the older GT modifier, so verify your payer's preference.

Place of service is where reimbursement actually shifts. POS 10 indicates the client was in their private home, which is reimbursed at the higher non-facility rate, while POS 02 covers other telehealth locations and pays at the lower facility rate. Your note should document the modality and the client's location, and the broader telehealth documentation requirements cover what else belongs in a virtual session record.

Who Can Bill Which Codes in 2026

License type determines which codes you can use, and 2026 reflects an expansion that's still settling in. Licensed Clinical Social Workers have been Medicare providers for years. As of January 1, 2024, Licensed Marriage and Family Therapists, Licensed Professional Counselors, and Licensed Mental Health Counselors became eligible Medicare Part B providers as well, reimbursed at roughly 75 percent of the Physician Fee Schedule rate.

These clinicians can bill 90791 for diagnostic evaluations but cannot bill 90792, which requires prescriptive authority. Enrollment runs through PECOS or a CMS-855I application before the first claim, and that process can take 60 to 120 days, so plan ahead. Commercial payer credentialing is handled separately from Medicare enrollment. If you're building toward independent billing, the foundational steps of starting a private practice include getting these credentialing pieces in order early.

How Berries AI Supports Accurate Coding and Documentation

Because every mental health CPT code rests on documentation that proves time, medical necessity, and the interventions you delivered, the quality of your notes directly affects whether your claims get paid. That's where an AI scribe built for behavioral health earns its place in your workflow.

Berries is a HIPAA-compliant AI scribe designed specifically for mental health professionals. It captures your session and generates a structured clinical note in seconds, complete with the elements payers look for, so the documentation supporting your chosen code is thorough without costing you an hour of charting. The platform learns your formatting style, works for both in-person and telehealth sessions, and integrates with any EMR, which means you can move from session to clean note to billing without the administrative drag. Your first 20 sessions are free, with no credit card required, so you can see how it fits your practice before committing.

Frequently Asked Questions

How do I know whether to bill 90834 or 90837?

It comes down to documented face-to-face time. Use 90834 for 38 to 52 minutes and 90837 for 53 minutes or more. Always record actual start and stop times rather than rounding, because the gap between these two codes is one of the most audited thresholds in behavioral health billing.

Can I bill for medication management and psychotherapy in the same session?

Yes. You bill an E/M code for the medication management plus a psychotherapy add-on (90833, 90836, or 90838) based on the psychotherapy time. Many payers require modifier 25 on the E/M code to show the two services were separately identifiable, so confirm your payer's rule first.

Do CPT codes change when I provide telehealth?

The code itself doesn't change. A 45-minute video session is still 90834. What changes is the modifier (typically 95) and the place of service (POS 10 for the client's home, POS 02 for other sites). Your documentation should note the modality and the client's location.

What are the biggest billing changes for 2026?

The Collaborative Care codes were replaced with new G-codes (G0568 through G0570), CMS added crisis and digital mental health pathways, and updated 42 CFR Part 2 rules for substance use records reached full enforcement on February 16, 2026. Payers are also enforcing time thresholds and modifier requirements more strictly.

Can LPCs and LMFTs bill Medicare now?

Yes. As of January 1, 2024, LPCs, LMFTs, and LMHCs became eligible Medicare providers, reimbursed at about 75 percent of the Physician Fee Schedule. They can bill 90791 but not 90792, and they must enroll through PECOS before submitting claims.

This article is for educational purposes and professional development only. It does not constitute clinical supervision or replace professional judgment in therapeutic practice. CPT codes and reimbursement rates are maintained by the AMA and CMS and change periodically; always verify current codes, rates, and modifier requirements with your specific payers.