Mental Health CPT Code Cheat Sheet 2026: The Definitive Guide for Therapists, Psychiatrists, and Group Practices

If you've ever stared at a superbill wondering whether you billed 90837 or 90834 — and whether it even matters — this guide is for you.

Spoiler: it absolutely matters. One wrong CPT code can trigger a claim denial, a payer audit, or a compliance headache that takes months to unwind. This 2026 edition covers every major mental health CPT code you need to know, updated reimbursement benchmarks, time-based billing rules, add-on codes, telehealth modifiers, and the documentation traps that get practices audited.

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Why CPT Codes Change (And Why 2026 Is Different)

The AMA updates CPT codes annually, and CMS follows with updated RVU values and Medicare Physician Fee Schedule (MPFS) rates. For 2026, behavioral health practices need to pay attention to:

Continued telehealth flexibility — Congress has extended several pandemic-era telehealth provisions through 2026, meaning audio-only and cross-state billing rules are still evolving
E/M code refinements — Psychiatrists using office E/M codes need to stay current on medical decision making (MDM) documentation standards
Group practice compliance pressure — CMS and commercial payers have increased audit activity on group practices billing incident-to and supervision-based services
Behavioral health integration codes — BHI codes (99484, 99492, 99493, 99494) are getting more attention as collaborative care expands

This isn't a year to coast on last year's cheat sheet.

The Core Mental Health CPT Codes: 2026 Reference Table

Here's your master reference. Medicare rates shown are approximate 2026 national averages (non-facility). Commercial rates vary by payer and contract — typically 10–40% higher than Medicare.

Psychotherapy Codes (Non-Prescribers)

| CPT Code | Service Description | Typical Time | 2026 Medicare Rate (Est.) | Who Bills It | |---|---|---|---|---| | 90832 | Psychotherapy, 16–37 min | ~30 min | ~$80–$90 | LCSW, LPC, LMFT, PhD | | 90834 | Psychotherapy, 38–52 min | ~45 min | ~$108–$120 | LCSW, LPC, LMFT, PhD | | 90837 | Psychotherapy, 53+ min | ~60 min | ~$150–$165 | LCSW, LPC, LMFT, PhD | | 90839 | Psychotherapy for crisis, first 60 min | 60 min | ~$185–$200 | All licensed clinicians | | 90840 | Psychotherapy for crisis, each add'l 30 min | +30 min | ~$75–$85 | Add-on to 90839 | | 90847 | Family psychotherapy with patient present | 50 min | ~$120–$135 | All licensed clinicians | | 90846 | Family psychotherapy without patient present | 50 min | ~$110–$125 | All licensed clinicians | | 90853 | Group psychotherapy | 60–90 min | ~$35–$45/patient | All licensed clinicians |

Psychiatric Evaluation Codes

| CPT Code | Service Description | Typical Time | 2026 Medicare Rate (Est.) | Who Bills It | |---|---|---|---|---| | 90791 | Psychiatric diagnostic evaluation | 45–60 min | ~$165–$185 | All licensed clinicians | | 90792 | Psychiatric diagnostic eval with medical services | 45–60 min | ~$225–$250 | MD, DO, NP, PA only |

Psychiatry Add-On Codes (Psychotherapy + E/M)

These are add-ons billed alongside E/M codes when a prescriber provides both medication management AND psychotherapy in the same session.

| CPT Code | Add-On Description | Time | 2026 Medicare Rate (Est.) | |---|---|---|---| | 90833 | Psychotherapy, 16–37 min (add-on to E/M) | ~30 min | ~$68–$78 | | 90836 | Psychotherapy, 38–52 min (add-on to E/M) | ~45 min | ~$92–$105 | | 90838 | Psychotherapy, 53+ min (add-on to E/M) | ~60 min | ~$130–$145 |

Office E/M Codes (Psychiatrists, NPs, PAs)

| CPT Code | Service Description | Complexity | 2026 Medicare Rate (Est.) | |---|---|---|---| | 99202 | New patient, straightforward | Low | ~$80–$95 | | 99203 | New patient, low complexity | Low-Mod | ~$115–$130 | | 99204 | New patient, moderate complexity | Moderate | ~$165–$185 | | 99205 | New patient, high complexity | High | ~$210–$235 | | 99211 | Established patient, minimal | Minimal | ~$25–$35 | | 99212 | Established patient, straightforward | Low | ~$75–$85 | | 99213 | Established patient, low complexity | Low-Mod | ~$110–$125 | | 99214 | Established patient, moderate complexity | Moderate | ~$150–$170 | | 99215 | Established patient, high complexity | High | ~$195–$220 |

Telehealth Modifiers (2026)

| Modifier | Meaning | When to Use | |---|---|---| | 95 | Synchronous telehealth via audio/video | Real-time video sessions | | GT | Via interactive audio and video (Medicare Advantage) | Some MA plans still require GT | | 93 | Audio-only (telephone) | When video isn't available — check payer rules | | FQ | Audio-only modifier (Medicare) | Required by Medicare for audio-only psychotherapy | | GQ | Via asynchronous telehealth | Asynchronous/store-and-forward |

Important: Not all payers accept audio-only codes in 2026. Always verify with Aetna, BCBS, Cigna, UnitedHealthcare, and Medicaid plans individually before billing audio-only sessions.

Time-Based Billing Rules: The Most Common Audit Trigger

Time-based billing is where most therapists get into trouble — not from fraud, but from documentation that doesn't match the code billed.

Here's what the AMA actually says:

90832: Start time to end time must fall between 16–37 minutes of face-to-face psychotherapy time
90834: 38–52 minutes
90837: 53 minutes or more

The time documented must reflect psychotherapy time only — not check-in, scheduling, or note writing. If your session runs 55 minutes but 10 of those were admin tasks, you may only have 45 minutes of billable psychotherapy. That's 90834, not 90837.

Pro tip: Always document start and stop times in your progress note. Payers like UnitedHealthcare and Aetna have increasingly flagged claims without documented session times during audits.

Diagnostic Evaluations: 90791 vs. 90792

This is a common point of confusion, so let's be direct:

90791 = Psychiatric diagnostic evaluation. No prescribing involved. Used by therapists, LCSWs, psychologists, and psychiatrists when conducting an intake that does NOT include prescribing or medical decision making.
90792 = Psychiatric diagnostic evaluation WITH medical services. Requires a prescriber (MD, DO, NP, PA). Includes review of medications, prescribing decisions, or medical history as part of the evaluation.

A therapist should never bill 90792. Period. It will either be denied outright or flagged as an upcoding violation.

Medicare reimbursement difference: roughly $60–$80 more for 90792 over 90791 nationally. That differential is what makes it tempting — and what makes it an audit target.

Behavioral Health Integration (BHI) Codes

If your practice operates in a collaborative care model with primary care, or if you're a psychiatrist providing consultation services, these codes are worth understanding:

| CPT Code | Description | Billed By | |---|---|---| | 99484 | General BHI care management, 20+ min/month | PCP or billing provider | | 99492 | Initial psychiatric CoCM, 70+ min first month | Psychiatrist or BH provider | | 99493 | Subsequent psychiatric CoCM, 60+ min/month | Psychiatrist or BH provider | | 99494 | Add-on for additional 30 min of CoCM | Add-on to 99492/99493 |

These codes are increasingly reimbursed by commercial payers including Anthem, Cigna, and most state Medicaid programs. If your practice isn't billing BHI codes yet, you may be leaving significant revenue on the table.

What Major Payers Are Watching in 2026

Let's talk about the real-world payer landscape:

UnitedHealthcare: Has increased behavioral health audit activity, particularly around 90837 frequency (flagging practices billing 90837 for 90%+ of sessions as a statistical outlier) and group therapy documentation (90853).

Aetna: Requires detailed session notes for telehealth claims, including explicit documentation of patient location, provider location, and the technology platform used.

Cigna/Evernorth: Has been aggressive about requesting medical necessity documentation for long-term therapy cases, particularly beyond 26 sessions per year.

BCBS (varies by state): Many BCBS plans require pre-authorization for intensive outpatient, psychological testing, and crisis codes beyond a threshold.

Medicare: Watch for FQ modifier requirements for audio-only, and ensure your NPIs and taxonomy codes are correctly linked if billing as a group practice.

Medicaid (state-specific): Rates vary enormously — from ~$60 for a 90837 in some states to over $130 in others. Always check your state fee schedule.

The 5 Most Common Mental Health Billing Mistakes

Upcoding time: Billing 90837 for a 48-minute session. The code requires 53+ minutes. This is the #1 audit trigger.
Wrong evaluation code by discipline: Therapists billing 90792 when only 90791 is appropriate for their license type.
Missing telehealth modifiers: Forgetting to append modifier 95 or FQ results in claim denials or payment recoveries.
Underdocumented group therapy: 90853 requires documentation of each patient's participation, therapeutic interventions, and clinical response — not just a group attendance list.
Incident-to billing errors in group practices: Non-physician providers billing under the psychiatrist's NPI without meeting Medicare's direct supervision requirements for incident-to billing.

Documentation Requirements by Code: Quick Reference

Every CPT code has a documentation minimum. Here's what your progress notes must include:

For 90832/90834/90837:

Start and stop times
Chief complaint/reason for visit
Mental status or clinical observations
Therapeutic interventions used (not just "CBT" — describe the actual intervention)
Patient response
Plan and next appointment

For 90791/90792:

Chief complaint and history of present illness
Psychiatric, social, and family history
Mental status examination
Diagnostic impressions (DSM-5-TR diagnosis)
Treatment plan
Risk assessment

For E/M codes (99202–99215):

History (relevant to visit)
Medical decision making OR total time (your choice post-2021 E/M updates)
If using MDM: number/complexity of problems, data reviewed, risk of complications

Telehealth Billing in 2026: What's Still Allowed

Following Congressional action, here's where telehealth stands for behavioral health in 2026:

Video therapy: Covered by Medicare and most commercial payers with modifier 95
Audio-only: Medicare continues coverage through 2026 with FQ modifier; commercial payer policies vary significantly
Home as originating site: Patients can still receive telehealth from home under Medicare through current extensions
Mental health in-person requirement: CMS had proposed requiring one in-person visit every 12 months for mental health telehealth — watch for updates to this rule in late 2025/early 2026
State licensure: You must be licensed in the state where your patient is physically located during the session — not where they live or where your office is

Frequently Asked Questions (FAQ)

1. Can I bill 90837 for every session if my sessions are always 60 minutes?

Yes — if your documented time consistently shows 53+ minutes of face-to-face psychotherapy. However, payers like UnitedHealthcare use statistical outlier logic. If your practice bills 90837 for 95% of sessions while the regional average is 60%, you may receive an audit request. The solution isn't to downcode — it's to have airtight documentation that supports every 90837 you bill.

2. What's the difference between 90791 and 90792, and can a therapist bill 90792?

90791 is a diagnostic evaluation without medical services. 90792 adds medical services (prescribing, medication review, medical decision making) and is restricted to prescribers — MDs, DOs, NPs, and PAs. Therapists, LCSWs, LPCs, and LMFTs should only bill 90791. Billing 90792 as a non-prescriber is a compliance violation.

3. How do I bill for a session where I do both therapy and medication management?

If you're a prescriber (psychiatrist, NP, PA), you bill the E/M code (e.g., 99214) PLUS the appropriate psychotherapy add-on code (90833, 90836, or 90838) based on how many minutes of psychotherapy were provided. The total time for the add-on must be documented separately from the E/M time.

4. Are group therapy notes really audited that closely?

Yes, and this is increasing. 90853 group therapy claims are audited because the documentation requirements are often underestimated. Each patient in the group needs their own progress note documenting their specific participation, response, and clinical status — not a generic group note applied to everyone. Some payers also cap the group size at 8–12 patients per clinician for this code.

5. What modifiers do I need for telehealth in 2026?

For Medicare: Use modifier 95 for synchronous audio-video sessions. Add modifier FQ for audio-only telephone sessions. For most commercial payers: 95 is standard for video. Always check your payer contract for audio-only rules, as Cigna, Aetna, and BCBS have different policies. Never assume — incorrect modifiers result in denials or payment recoupment.

6. What happens if I'm audited and my notes don't support the codes billed?

The payer can demand repayment of all claims under review — sometimes going back 2–3 years. Depending on the payer and the size of the discrepancy, this can result in extrapolated repayment demands (where they calculate overpayment across your entire claim history, not just the audited sample). In egregious cases, it can result in exclusion from the payer network or referral to OIG. This is why documentation isn't optional — it's your audit defense.

How Mozu Health Keeps Your Documentation Audit-Ready

Manually tracking all of these rules — time thresholds, modifier requirements, per-code documentation standards, payer-specific policies — is a full-time job on top of your actual clinical work.

That's the problem Mozu Health solves.

Mozu Health is an AI-powered clinical documentation platform built specifically for behavioral health. Here's what that means in practice:

AI-generated progress notes that are automatically structured to meet CPT code documentation requirements — no more blank-page anxiety at 9 PM
Built-in billing accuracy checks that flag when your documented time doesn't match the code you're billing before the claim goes out
Telehealth documentation support with automatic modifier guidance based on session type and payer
HIPAA-compliant infrastructure with audit trail logging that holds up under payer review
Group practice tools including supervision documentation, incident-to compliance tracking, and multi-provider billing support
Audit defense documentation — every note generated creates a compliant, timestamped clinical record that supports your codes if you're ever reviewed

Whether you're a solo therapist tired of spending evenings on notes, or a group practice administrator managing compliance across 20 clinicians, Mozu Health was built for your workflow.

Ready to Stop Worrying About Documentation and Start Getting Paid Accurately?

Your clinical expertise deserves billing that matches it. Stop leaving money on the table with undercoded sessions, and stop losing sleep over audit risk from underdocumented notes.

Try Mozu Health free at mozuhealth.com — see how AI-powered clinical documentation can protect your practice, improve your reimbursement accuracy, and give you back hours every week.

CPT codes and reimbursement rates referenced in this guide are estimates based on 2025 CMS data and projected 2026 MPFS values. Always verify current rates with CMS.gov and your individual payer contracts. This content is for educational purposes and does not constitute legal or compliance advice.

Mental Health CPT Code Cheat Sheet 2026 Edition