Your Comprehensive Guide To Mental Health (CPT) Codes For Billing | UPDATED!

Updated: Jul 6, 2021

The mental health field is constantly evolving new ways to help and provide treatment for clients who suffer from the many forms of mental illnesses. But, would that mean that the billing codes change as well?



The short answer, yes. But here's why:


The coding for mental and psychotherapy administrations changed in 2013 and albeit that was years back! Even in today's day in age, there are numerous therapists, mental medical caretaker professionals (NPs), and mental doctor partners (PAs) are as yet acclimating to the change. Don't forget. There were also analysts, social specialists, and other authorized emotional well-being experts who saw their coding change in 2013, albeit not as radically.



So how would you be able to understand the old vs the new? Just continue reading, because this guide will address your inquiries concerning how to code for conduct wellbeing administrations including:

  • Introductory assessments

  • Re-assessments

  • Prescription administration

  • Psychotherapy





In certain areas, that are isolated by kind of clinician, since doctors, NPs, and PAs have an alternate extent of training than therapists, social laborers, and other authorized psychological well-being experts.




Please Note: Changes Beginning January 1, 2021, for Office-Based E/M Services Only








Here's a list of new CPT codes for 2021


Modifications apply to the New and Established Evaluation also, Management (E/M) CPT Codes 99201-99215.

  • Psychiatric Providers generally started utilizing the Office-Based E/M Services on January 1, 2013.

  • We utilized the current detailing and documentation rules as all doctors have done. Previous codes

  • CMS had "Proposed" to pay a solitary rate (Mixed Rate) for E/M Visits Levels 2-4 beginning in 2021.

  • This new charge structure was taken out and wiped out.

  • Medicare and different payers will keep on having particular installment rates for every office/outpatient E/M code in 2021 with more significant levels accepting higher installment values contrasted with lower levels if FFS utilized.

The 2021 CPT code set will not include new patient level 1 code 99201.


All other E/M Office-Based services and codes remain available in 2021 and include 99202-99205; 99211-99215.


Using Medical Decision Making to Select the Appropriate Code.




The Medical Decision Making for each distinct code level is the same, regardless of whether the code is for a “New” or “Established” patient.

  • Level 2 codes 99202 and 99212 both require Straightforward MDM.

  • Level 3 codes 99203 and 99213 both require Low MDM

  • Level 4 codes 99204 and 99214 both require a Moderate MDM

  • Level 5 codes 99205 and 99215 both require a High MDM



Number and Complexity of Problems Addressed at the Experience

  • Amount or potentially Complexity of Data to be Reviewed and Dissected

  • Risk of Complications* as well as Morbidity or Mortality of Patient The board Mental supplier audits lab results requested in past experience on the day of the E/M help – 4 minutes.

  • Psychiatric supplier audits history of reaction to treatment from a case chief gathering of 8 notes since last mental visit 90 days earlier and makes a two-sentence outline - 8 min.

  • Psychiatric supplier plays out a medicinally fundamental history and mental test (utilize just "medicinally proper" components for example HPI for two issues and 7 test slugs no score from these)– 14 minutes.

  • Psychiatric supplier submits clinical discoveries through a call or composed data. To staff part mentioning MCO UM administration approval - 5 min.

  • 31 minutes complete = Level 4 E/M – 99214 Ordering tests, medications, or procedures-(part of the MDM)

  • Referring and communicating with other health care professionals to collaborate on the care (can be internal or external), just not reported separately by another professional-(part of the MDM)

  • Documenting clinical information in the electronic or other health records (The purpose of the New E/M guidelines are to reduce the documentation)

  • Care Coordination (not required)

  • Communicating results of care to client/family/caregivers





There are no changes for the extra psychotherapy codes for 2021. The accompanying three codes are accessible to add to an E/M Service right now and after 2021:

  • +90833 – 30 minutes (16-37 minutes)

  • +90836 – 45 minutes (38-52 minutes)

  • +90838 – an hour (53-89 minutes)

  • Psychiatric Providers should archive the exact time for the extra Psychotherapy codes following the CPT ® time-sensitive standards.

  • Rates for add-on Psychotherapy Services is dictated by the payer.

  • Psychiatric Providers should finish a short/brief psychotherapy note to archive the psychotherapy added into E/M assistance.




Well, there you go. Some updates and a bit of explanation regarding the new CPT codes for 2021. Although I do not give legal advice, please follow up with medical professionals in your area to understand how these changes may affect you. Don't network with other therapists in your field? Why not? Learn about the benefits of doing so here!



36 views0 comments