Psychiatry Billing in 2026: E/M, Psychotherapy Add-On Codes, Medication Management, and Denial Prevention

Psychiatric practices operate in a billing environment that combines medical evaluation, medication management, psychotherapy, telehealth, and increasingly complex interventional treatments.

A psychiatrist may spend one appointment evaluating medication response, reviewing adverse effects, assessing risk, adjusting treatment, and providing psychotherapy.

Another patient may receive only medication management.

A third may undergo transcranial magnetic stimulation.

Another may receive esketamine treatment requiring authorization, medication administration, and observation.

These encounters cannot all be billed through the same workflow.

That is what makes Psychiatry Billing different from general psychotherapy or counseling billing.

A successful psychiatric revenue cycle may need to manage:

• Psychiatric diagnostic evaluations
• E/M services
• Medication management
• Psychotherapy
• E/M with psychotherapy add-on codes
• Telepsychiatry
• Crisis psychotherapy
• TMS
• Esketamine/Spravato
• Electroconvulsive therapy
• Psychiatrist billing
• PMHNP billing
• Prior authorization
• Behavioral-health benefit carve-outs
• Denial management
• Accounts receivable

One of the biggest challenges is determining what actually occurred during the encounter.

A 45-minute appointment does not automatically mean 45 minutes of psychotherapy.

A medication-management visit does not automatically mean a psychotherapy code should be added.

An initial psychiatric evaluation does not always use the same diagnostic code.

A telepsychiatry encounter must satisfy both clinical and payer requirements.

And advanced treatments such as TMS or Spravato can create entirely different authorization and billing workflows from a routine follow-up visit.

For psychiatric practices, accurate reimbursement therefore depends on connecting:

clinical work → documentation → CPT selection → payer requirements → claim submission → payment review.

This guide explains how Psychiatry Billing works in 2026, how it differs from therapy billing, which psychiatric services create the greatest coding complexity, and how practices can reduce preventable denials before they turn into aging accounts receivable.

What Is Psychiatry Billing?

Psychiatry Billing is the process of documenting, coding, submitting, and managing claims for psychiatric evaluation, treatment, medication management, psychotherapy, and other medically necessary psychiatric services.

Psychiatric practices may provide care for conditions such as:

• Major depressive disorder
• Anxiety disorders
• Bipolar disorder
• Schizophrenia and other psychotic disorders
• Attention-deficit/hyperactivity disorder
• Post-traumatic stress disorder
• Obsessive-compulsive disorder
• Substance-related conditions
• Other psychiatric and behavioral disorders

Depending on the practice, services may be provided by:

• Psychiatrists
• Psychiatric mental health nurse practitioners
• Physician assistants where applicable
• Clinical psychologists
• Licensed therapists
• Other eligible behavioral-health professionals

The billing model changes according to both the service and the clinician providing it.

Why Psychiatry Billing Is Different From Therapy Billing

Psychiatry and psychotherapy overlap, but their billing models are not identical.

A psychotherapy-only practice may primarily use codes for:

• Individual psychotherapy
• Family psychotherapy
• Group psychotherapy
• Crisis psychotherapy

Psychiatric prescribers may also perform medical services involving:

• Medication initiation
• Medication adjustment
• Adverse-effect assessment
• Review of medical conditions
• Laboratory monitoring
• Medical decision-making
• Risk assessment
• Treatment planning

This means a psychiatrist or eligible psychiatric prescriber may need to report an E/M service, sometimes along with a separately supported psychotherapy add-on service.

CMS recognizes psychotherapy codes 90833, 90836, and 90838 as add-on services used with appropriate E/M services when the psychotherapy and E/M components are separately supported.

That creates a fundamentally different billing workflow from a psychotherapy-only encounter.

Psychiatry vs Therapy Billing at a Glance

Area	Psychiatry Billing	Therapy Billing
Medical Evaluation	Frequently relevant because psychiatrists and other eligible prescribers provide medical assessment and treatment.	Usually not the central service in psychotherapy-only practices.
Medication Management	A major revenue and clinical component, commonly reflected through appropriate E/M services.	Generally outside the scope of therapists who do not prescribe medications.
Psychotherapy	May be performed alone or alongside a separately supported E/M service.	Often represents the primary billable service.
Diagnostic Evaluation	May involve psychiatric diagnostic evaluation with medical services.	May involve diagnostic evaluation without a medical component.
Advanced Treatments	May include TMS, esketamine/Spravato, ECT, and other psychiatric interventions.	Typically not part of a standard psychotherapy billing workflow.
Prior Authorization	Especially important for advanced treatment, certain medications, and payer-specific services.	May still apply, but the authorization profile is usually different.

Major Revenue Streams in Psychiatry Billing

Psychiatric practices may generate revenue from several very different service categories.

Understanding those categories is important because each can have its own:

• CPT codes
• Documentation requirements
• Time rules
• Authorization requirements
• Payer edits
• Reimbursement methodology

Psychiatric Diagnostic Evaluations

A psychiatric diagnostic evaluation is often the beginning of treatment.

The clinician may assess:

• Presenting symptoms
• Psychiatric history
• Medical history
• Medication history
• Substance use
• Family history
• Mental status
• Risk factors
• Functional impairment
• Diagnosis
• Treatment recommendations

Two particularly important codes are:

• 90791
• 90792

CMS distinguishes psychiatric diagnostic evaluation from psychiatric diagnostic evaluation with medical services, which is why the correct code depends on the work actually performed.

90791 vs 90792

At a high level:

90791 generally represents psychiatric diagnostic evaluation without the medical-services component.

90792 represents psychiatric diagnostic evaluation with medical services.

This distinction is especially relevant in psychiatry because a psychiatrist or another qualified prescriber may perform medical assessment as part of the psychiatric evaluation.

The practice should not select 90792 simply because the rendering provider is a psychiatrist.

The documentation should support the service actually provided.

Part 2 will examine 90791 and 90792 in greater detail.

Medication Management Billing

Medication management is central to many psychiatric practices.

A follow-up appointment may involve:

• Symptom assessment
• Medication effectiveness
• Adverse effects
• Adherence
• Drug interactions
• Treatment response
• Dose adjustment
• Medication initiation or discontinuation
• Laboratory or diagnostic information
• Risk assessment

For psychiatrists and other eligible prescribers, medication-management work is commonly reported through the appropriate E/M framework rather than automatically assigning a standalone “medication management” psychiatry code.

That distinction matters because some billing resources still create confusion around CPT 90863.

Psychiatric medication management should be coded according to the service actually performed, provider eligibility, and current payer requirements.

Psychiatry E/M Services

Psychiatric prescribers may use standard E/M services when their encounter includes medically necessary evaluation and management.

The appropriate level should be selected according to applicable E/M coding rules.

Clinical factors may include:

• Problems addressed
• Data reviewed or analyzed
• Risk of patient management
• Prescription medication management
• Other medical decision-making

The practice should not select an E/M level simply according to the patient’s psychiatric diagnosis.

A stable patient with one treatment plan may require different E/M work than a patient experiencing:

• Medication toxicity
• Severe symptom worsening
• Suicidal risk
• Complex polypharmacy
• Significant comorbid disease

The documentation should support the level reported.

Psychotherapy in Psychiatric Practice

Psychiatrists and other qualified clinicians may also provide psychotherapy.

Standalone psychotherapy commonly uses codes such as:

• 90832
• 90834
• 90837

when the applicable requirements are met.

CMS identifies these as psychotherapy services without a medical E/M component.

The correct code depends heavily on the actual psychotherapy time.

Appointment Length Is Not Automatically Psychotherapy Time

This is one of the most important billing principles in psychiatry.

Suppose a patient is scheduled for 45 minutes.

During that visit, the clinician may spend time on:

• Medication review
• Medical decision-making
• Prescription changes
• Psychotherapy

The entire 45 minutes should not automatically be reported as psychotherapy.

The clinical record should distinguish the services performed.

E/M With Psychotherapy

This is one of the most important areas of Psychiatry Billing.

A psychiatric prescriber may provide both:

1. A medically necessary E/M service, and
2. A separately identifiable psychotherapy service.

When both requirements are met, psychotherapy add-on codes may include:

• 90833
• 90836
• 90838

CMS specifically recognizes these codes as psychotherapy performed with an E/M service.

Why Separate Documentation Matters

The record should make it possible to understand:

what work supported the E/M service

and

what work represented psychotherapy.

Simply documenting:

“Medication management and psychotherapy provided”

is usually much weaker than documenting the medical management and psychotherapy components clearly.

Do Not Count the Same Work Twice

The E/M and psychotherapy portions should be separately supported.

The psychotherapy service should represent actual psychotherapy, not merely:

• Medication counseling
• Reviewing side effects
• Explaining prescriptions
• General treatment discussion

Part 2 will cover the specific timing thresholds and E/M selection requirements.

Psychotherapy Time in Psychiatry Billing

Psychotherapy is highly time-sensitive.

CMS currently recognizes the following general time ranges:

• 90832 / 90833: 16–37 minutes
• 90834 / 90836: 38–52 minutes
• 90837 / 90838: 53 minutes or more

This creates a major documentation requirement.

The note should make clear how much qualifying psychotherapy time occurred.

Why Psychiatry Practices Lose Psychotherapy Revenue

Revenue can be missed when:

• Psychotherapy occurred but was not documented
• Time was not recorded
• The wrong add-on code was selected
• Staff assumed medication management already included psychotherapy
• The E/M and psychotherapy portions could not be distinguished

Revenue can also be placed at risk when psychotherapy is billed without sufficient evidence that psychotherapy actually occurred.

Telepsychiatry Billing

Psychiatry remains one of the specialties most closely associated with telehealth.

Telepsychiatry may be used for:

• Diagnostic evaluation
• Medication-management follow-up
• Psychotherapy
• Ongoing psychiatric treatment

However, telehealth billing depends on more than the CPT code.

The practice may need to verify:

• Payer coverage
• Patient location
• Provider location
• Place of service
• Modifier requirements
• Audio-video or audio-only rules
• State licensure
• Medicare requirements

Medicare Mental Health Telehealth in 2026

There is an important Medicare change in 2026.

CMS states that after January 30, 2026, an in-person, non-telehealth visit is generally required within six months before a patient’s first qualifying Medicare mental-health telehealth service furnished in the home.

After that, an in-person service is generally required at least every 12 months, subject to applicable exceptions.

CMS also explains that patients who began receiving qualifying home-based mental-health telehealth on or before January 30, 2026 are treated differently for the initial six-month requirement.

This makes telepsychiatry scheduling part of the revenue cycle.

If a practice ignores required in-person follow-up rules, otherwise valid telehealth claims may face payment problems.

Why Telepsychiatry Needs Its Own Workflow

A telepsychiatry claim should be reviewed for more than:

“Was the visit virtual?”

The billing workflow should also determine:

• Which payer covers the service
• Whether the clinician is eligible
• Whether the patient location is allowed
• Whether the applicable in-person requirement is satisfied
• Whether the correct place-of-service information is used
• Whether the documentation supports the service provided

Commercial insurers may apply rules different from Medicare.

Practices should maintain payer-specific telehealth policies rather than one universal workflow.

TMS Billing

Transcranial magnetic stimulation has become an important revenue stream for some psychiatric practices treating patients with qualifying conditions.

The core TMS procedure family includes:

• 90867
• 90868
• 90869

At a high level, these codes distinguish stages of TMS treatment such as:

• Initial treatment planning
• Subsequent treatment sessions
• Re-determination or motor-threshold-related services when applicable

TMS billing frequently depends on more than code selection.

The practice may also need to manage:

• Diagnosis
• Medical necessity
• Treatment history
• Failed medication trials
• Prior authorization
• Number of approved sessions
• Treatment-series tracking

Authorization Should Match the Treatment Course

A TMS authorization may specify:

• Number of sessions
• Treatment period
• Diagnosis
• Rendering provider
• Place of service

The practice should monitor remaining authorized sessions throughout treatment rather than discovering an exhausted authorization after claims are denied.

Spravato and Esketamine Billing

Esketamine treatment creates another specialized psychiatric billing workflow.

Medicare uses HCPCS codes including:

• G2082
• G2083

for applicable esketamine treatment services.

Unlike a routine office visit, these services can involve multiple components of care, including:

• Clinical evaluation
• Drug administration
• Patient monitoring
• Required observation

That means practices should avoid automatically adding separate services that are already included within the applicable bundled payment structure.

Part 2 will examine G2082 and G2083 in detail.

Why Spravato Billing Is Operationally Complex

The financial workflow may include:

• Insurance verification
• Prior authorization
• Diagnosis validation
• Drug acquisition
• Treatment scheduling
• Administration
• Observation
• Documentation
• Claim submission
• Reauthorization

A problem at any one stage can interrupt an entire treatment series.

Treatment-Series Tracking

A strong system should monitor:

• Authorized visits
• Visits completed
• Authorization expiration
• Drug access
• Claim status
• Patient responsibility

This is more reliable than treating each Spravato encounter as an isolated office claim.

Electroconvulsive Therapy Billing

Electroconvulsive therapy remains an important treatment for selected psychiatric patients.

The central ECT procedure code is:

• 90870

ECT billing may involve coordination between:

• Psychiatrist
• Anesthesia professional
• Facility
• Payer

This makes accurate role separation important.

The psychiatric procedure, anesthesia service, and facility service may each follow different billing pathways depending on the circumstances.

ECT Documentation

The psychiatric record may need to support:

• Diagnosis
• Medical necessity
• Treatment plan
• Treatment number
• Clinical response
• Continued need for therapy

Authorization requirements should be verified before beginning or extending a treatment series.

Crisis Psychotherapy Billing

Psychiatric practices may also treat patients experiencing an urgent psychiatric crisis.

Core crisis psychotherapy codes include:

• 90839
• 90840

CMS describes 90839 as the initial crisis psychotherapy service and 90840 as the additional-time code. CMS also says crisis psychotherapy is reported separately rather than combined with ordinary diagnostic or psychotherapy codes for the same crisis service.

Crisis Care Is More Than a High-Acuity Diagnosis

A patient having a severe psychiatric disorder does not automatically mean the encounter qualifies for crisis psychotherapy.

The documentation should support:

• Immediate crisis
• Urgent assessment
• Mental status
• Risk
• Intervention
• Treatment planning
• Qualifying time

Medicare Crisis Psychotherapy in Non-Facility Settings

Medicare also uses additional HCPCS codes in certain qualifying circumstances for crisis psychotherapy delivered outside traditional facility settings.

This creates another area where place of service and payer-specific rules matter.

Part 2 will cover:

• G0017
• G0018
• Current Medicare crisis reimbursement rules

in greater detail.

Interactive Complexity

Some psychiatric encounters involve communication challenges that materially complicate treatment.

CPT 90785 may apply in specific circumstances.

However, interactive complexity should not simply mean:

“The patient was difficult.”

CMS identifies qualifying circumstances such as certain:

• Maladaptive communication among participants
• Caregiver behavior interfering with the treatment plan
• Mandated-report situations
• Communication barriers requiring specific techniques

The documentation needs to establish what made the communication clinically more complex.

Psychiatrist and PMHNP Billing

Modern psychiatric practices often use mixed provider teams.

A practice may include:

• Psychiatrists
• PMHNPs
• Therapists
• Psychologists
• Other clinicians

This creates credentialing and claim-routing challenges.

The billing system needs to know:

• Who performed the service
• Whether that clinician is enrolled with the payer
• Which NPI should appear on the claim
• Whether the provider is linked to the group
• Whether authorization is provider-specific
• Whether the payer recognizes the clinician for the service billed

Rendering Provider Errors Can Delay Otherwise Valid Claims

Even when:

• CPT is correct
• Diagnosis is correct
• Documentation is complete

the claim can still fail if the rendering provider information is wrong.

This makes provider enrollment an important part of psychiatric revenue-cycle management.

Behavioral Health Benefit Carve-Outs

Psychiatric billing may also involve behavioral-health benefits administered separately from the patient’s general medical plan.

A patient may present an insurance card showing active coverage, but psychiatric services may be managed through:

• Another payer
• Another behavioral-health network
• A delegated administrator
• A separate authorization system

That means ordinary medical eligibility verification may not be enough.

Verify the Behavioral Health Benefit

The front office should determine:

• Who manages psychiatric benefits
• Whether the psychiatrist is in-network
• Whether the PMHNP is separately credentialed
• Whether prior authorization is required
• Whether telehealth is covered
• Whether advanced services have separate requirements

This should occur before the patient begins a high-cost or multi-session treatment plan.

The Psychiatry Billing Workflow

A strong Psychiatry Billing workflow begins before the appointment and continues through final payment.

A typical process may include:

1. Patient registration
2. Eligibility verification
3. Behavioral-health benefit verification
4. Provider enrollment check
5. Prior authorization when required
6. Psychiatric service
7. Documentation completion
8. CPT and diagnosis coding
9. Psychotherapy-time validation
10. Telehealth review when applicable
11. Claim submission
12. Payment posting
13. Denial management
14. Underpayment review
15. AR follow-up

Psychiatry Billing Workflow Explained

Step	Purpose
Patient Registration	Collects demographics, insurance information, referral details, and reason for psychiatric treatment.
Eligibility Verification	Confirms active coverage, deductible, copay, coinsurance, network status, and general behavioral-health benefits.
Behavioral Health Benefit Review	Determines whether psychiatric benefits are administered through the primary medical payer or a separate behavioral-health organization.
Provider Verification	Confirms that the psychiatrist, PMHNP, or other clinician is properly enrolled and linked to the payer and group.
Authorization	Obtains approval when required for services such as TMS, esketamine treatment, ECT, or other payer-restricted care.
Psychiatric Service	The clinician performs diagnostic evaluation, E/M, psychotherapy, medication management, telepsychiatry, or another psychiatric service.
Documentation	Records diagnosis, medical decision-making, psychotherapy, time, treatment plan, medication management, and other service-specific information.
Coding	Assigns the appropriate E/M, psychotherapy, psychiatric, HCPCS, diagnosis, and modifier information.
Psychotherapy Time Review	Confirms that psychotherapy time supports 90832/90834/90837 or the applicable E/M psychotherapy add-on code.
Telehealth Review	Checks payer coverage, place-of-service requirements, technology rules, and applicable in-person requirements.
Claim Submission	Submits the claim with the correct provider, service, diagnosis, modifiers, and payer-required information.
Payment Posting	Records payer reimbursement, contractual adjustments, patient responsibility, and other payment information.
Denial Management	Investigates coding, authorization, provider, time, medical necessity, telehealth, and benefit denials.
Underpayment Review	Compares payment with expected reimbursement and identifies downcoding, missing add-on payments, or contractual variances.
AR Follow-Up	Tracks unresolved psychiatric claims until payment, appeal, adjustment, or other appropriate resolution occurs.

Documentation Requirements in Psychiatry Billing

Psychiatric documentation needs to support both clinical care and the service reported.

A note should not be written simply to “justify a code.”

However, the coding team needs enough information to understand what occurred.

Diagnosis and Clinical Status

The record should identify:

• Psychiatric condition
• Current symptoms
• Functional impact
• Changes since the last encounter
• Relevant risk factors

Diagnosis selection should reflect the documented clinical condition.

Medication Management

When medication is managed, the record may document:

• Current medication
• Effectiveness
• Adverse effects
• Adherence
• Dose changes
• New prescriptions
• Discontinued medication
• Monitoring
• Clinical rationale

This information can help support the medical E/M component.

Psychotherapy

When psychotherapy is reported, documentation should establish:

• Psychotherapy was actually performed
• Therapeutic focus
• Intervention
• Patient response
• Qualifying psychotherapy time

The record should distinguish psychotherapy from ordinary medication counseling.

E/M Plus Psychotherapy

When both services are reported, documentation should demonstrate separate work for:

• Medical E/M
• Psychotherapy

CMS requires the E/M and psychotherapy services to be significant and separately identifiable.

Risk Assessment

Psychiatric encounters may require assessment of:

• Suicidal thoughts
• Homicidal thoughts
• Self-harm
• Psychosis
• Substance use
• Safety concerns

The record should reflect the actual clinical circumstances rather than using identical template language at every visit.

Telepsychiatry

For telehealth encounters, documentation may also need to support:

• Modality
• Patient location
• Provider location when required
• Consent according to applicable rules
• Clinical service provided
• Payer-specific requirements

Advanced Treatment Documentation

TMS, Spravato, and ECT usually require more specialized documentation.

This may include:

• Diagnosis
• Previous treatment
• Medical necessity
• Authorization
• Treatment session
• Response
• Continued treatment plan

Incomplete documentation can disrupt an entire treatment series.

Common Psychiatry Billing Challenges

Challenge	Potential Impact on the Practice
90791 vs 90792 Error	The diagnostic code may not match whether medical services were actually provided and documented.
Medication Management Coding Error	A service may be assigned an inappropriate psychiatric code instead of the E/M service supported by the actual medical work.
E/M Downcoding	The claim may be reimbursed at a lower level when documentation or payer processing does not support the submitted E/M service.
Missing Psychotherapy Add-On	Separately performed psychotherapy may go unbilled when staff captures only the medication-management E/M service.
Unsupported Psychotherapy Add-On	90833, 90836, or 90838 may be denied when psychotherapy work or qualifying time is not clearly documented.
Psychotherapy Time Error	The selected psychotherapy code may not match the actual documented psychotherapy minutes.
Behavioral Health Carve-Out Error	The claim may be sent to the patient’s medical plan even though psychiatric benefits are administered elsewhere.
Provider Enrollment Error	A psychiatrist or PMHNP claim may deny because enrollment, group linkage, or rendering-provider information is incomplete.
Telepsychiatry Denial	The claim may fail because place of service, payer coverage, technology, or applicable in-person requirements were not satisfied.
TMS Authorization Denial	Treatment may exceed approved sessions or fail payer-specific medical-necessity requirements.
Spravato Billing Error	Services may be unbundled incorrectly or authorization, drug, observation, and treatment requirements may not align.
ECT Coordination Error	Psychiatric, anesthesia, facility, and authorization workflows may not align for the treatment session.
Crisis Psychotherapy Error	An ordinary high-acuity visit may be reported as crisis psychotherapy without documentation supporting the crisis service and time.
Interactive Complexity Error	90785 may be added simply because an encounter was difficult rather than because specific communication complexity requirements were met.

90791 vs 90792 for Psychiatric Diagnostic Evaluation

Two of the most important diagnostic codes in psychiatry are:

• 90791
• 90792

Although they sound similar, they represent different services.

90791: Psychiatric Diagnostic Evaluation

CPT 90791 generally represents a psychiatric diagnostic evaluation without medical services.

The encounter may include assessment of:

• Presenting psychiatric symptoms
• Psychiatric history
• Psychosocial history
• Mental status
• Substance use
• Functional impairment
• Risk
• Diagnosis
• Initial treatment recommendations

This code may commonly be relevant when the clinician performs a psychiatric diagnostic evaluation but does not furnish the medical-services component represented by 90792.

90792: Psychiatric Diagnostic Evaluation With Medical Services

CPT 90792 represents psychiatric diagnostic evaluation with medical services.

The medical component may include work relevant to areas such as:

• Medical assessment
• Medication evaluation
• Physical health considerations
• Prescription treatment
• Other medically necessary psychiatric management

CMS recognizes 90791 as psychiatric diagnostic evaluation and 90792 as psychiatric diagnostic evaluation with medical services.

90791 vs 90792 at a Glance

Code	General Service	Primary Documentation Focus
90791	Psychiatric diagnostic evaluation	Psychiatric assessment, history, mental status, risk, diagnosis, and treatment planning without the medical-services component represented by 90792.
90792	Psychiatric diagnostic evaluation with medical services	Psychiatric diagnostic assessment plus medically necessary medical evaluation or management performed by an eligible clinician.

Do Not Choose 90792 Just Because the Provider Is a Psychiatrist

Provider specialty alone does not determine the code.

The record should show that the medical-services component was actually performed.

A psychiatrist could perform an encounter that is correctly represented by another code depending on the clinical circumstances.

Similarly, a psychiatric diagnostic evaluation should not automatically be repeated at every follow-up visit.

CMS contractor guidance generally treats psychiatric diagnostic procedures as services used at the outset of an illness or when circumstances justify a new diagnostic evaluation, such as a significant change, new episode, or other documented need.

Psychiatry E/M Coding

After the initial diagnostic phase, many psychiatric prescriber encounters are billed using standard E/M codes.

Common office/outpatient E/M families include:

New patients

• 99202
• 99203
• 99204
• 99205

Established patients

• 99211
• 99212
• 99213
• 99214
• 99215

For psychiatry, these services may include medical management involving:

• Symptoms
• Medication effectiveness
• Prescription changes
• Adverse effects
• Comorbid medical conditions
• Laboratory information
• Safety concerns
• Clinical risk
• Treatment decisions

The E/M level should be supported by the actual work performed.

Medical Decision-Making in Psychiatry

Medical decision-making can become significant when the clinician manages situations such as:

• Multiple psychiatric conditions
• Worsening depression
• Mania
• Psychosis
• Suicidal risk
• Complex medication regimens
• Medication toxicity
• Drug interactions
• Significant side effects
• Treatment-resistant illness

The diagnosis itself does not automatically determine the E/M level.

The documentation needs to support the level of decision-making reported.

CMS states that medical necessity remains an important criterion for E/M payment and that documentation should support the CPT and diagnosis codes submitted.

Medication Management Billing in Psychiatry

Medication management is one of the most misunderstood areas of Psychiatry Billing.

For psychiatrists, prescription management is commonly reported through an appropriate E/M service.

Examples of medically relevant work may include:

• Reviewing current medication
• Evaluating treatment response
• Assessing adverse effects
• Reviewing adherence
• Adjusting dose
• Starting medication
• Discontinuing medication
• Assessing interactions
• Reviewing monitoring results
• Managing psychiatric and medical risk

Medication Management Is Not Automatically Psychotherapy

A clinician may spend substantial time discussing medication with a patient.

That does not automatically mean psychotherapy occurred.

Discussions involving:

• Side effects
• Dose instructions
• Medication adherence
• Prescription risks
• Laboratory monitoring

generally relate to medical management rather than psychotherapy.

Psychotherapy should be separately identifiable when it is billed.

Why CPT 90863 Is Not the Routine Psychiatrist Medication-Management Code

CPT 90863 can create confusion.

When the former pharmacologic-management code 90862 was deleted, CMS specifically stated that psychiatrists should use the appropriate E/M code when furnishing pharmacologic management services.

CMS explained that 90863 was created for pharmacologic management by a nonphysician when performed with psychotherapy in applicable circumstances.

Therefore, a psychiatry practice should not build a workflow that automatically assigns:

Medication management = 90863

for psychiatrist visits.

For psychiatric prescribers providing an E/M service, pharmacologic management is generally part of the E/M work.

CMS guidance also notes that where pharmacologic management is already included in the E/M service, 90863 should not be separately added simply to report the same medication-management work.

Coverage and provider eligibility should still be verified for the specific payer and clinician.

Standalone Psychotherapy Codes

Psychotherapy without a separately reported medical E/M service commonly uses:

• 90832
• 90834
• 90837

These codes are time-based.

CMS currently recognizes the following general psychotherapy time ranges.

Code	General Psychotherapy Time	Typical Use
90832	16–37 minutes	Standalone individual psychotherapy within the applicable 30-minute code range.
90834	38–52 minutes	Standalone individual psychotherapy within the applicable 45-minute code range.
90837	53 minutes or more	Standalone individual psychotherapy within the applicable 60-minute code range.

Psychotherapy Time Must Represent Psychotherapy

The total appointment duration is not necessarily psychotherapy time.

Suppose an established patient is in the office for 50 minutes.

During the encounter, the psychiatrist spends time:

• Reviewing medication response
• Assessing side effects
• Changing medication
• Evaluating suicide risk
• Providing psychotherapy

The practice should not automatically report 50 minutes of psychotherapy.

Only time spent furnishing the qualifying psychotherapy service should be used to determine the psychotherapy code.

CMS expects psychotherapy time to be documented, including start/stop or total psychotherapy time where applicable.

E/M With Psychotherapy Add-On Codes

When a psychiatric prescriber furnishes a medically necessary E/M service and separately identifiable psychotherapy during the same encounter, the psychotherapy component may be reported through an add-on code.

The major add-on codes are:

• 90833
• 90836
• 90838

These codes are reported with the appropriate qualifying E/M service rather than by themselves.

CMS states that the E/M and psychotherapy services must be significant and separately identifiable.

Psychiatry Psychotherapy Add-On Codes

Psychotherapy Add-On Code	Psychotherapy Time	Reported With
90833	16–37 minutes	Appropriate qualifying E/M service
90836	38–52 minutes	Appropriate qualifying E/M service
90838	53 minutes or more	Appropriate qualifying E/M service

CMS recognizes these same psychotherapy time ranges for the add-on codes.

E/M Plus Psychotherapy: The Most Important Coding Rule

When psychotherapy add-on codes 90833, 90836, or 90838 are reported with an E/M service, CMS guidance states that:

• The E/M and psychotherapy portions must be separately identifiable.
• The E/M level is selected based on medical decision-making.
• Time spent on E/M activities cannot be counted as psychotherapy time.
• E/M time should not be used as the basis for selecting the E/M level in this combined billing scenario.
• Prolonged services should not be added based on the overlapping combined time.

This is a major denial-prevention point.

Do Not Count the Same Minutes Twice

Consider a visit where the clinician performs:

• E/M medication-management work
• 40 minutes of actual psychotherapy

If the E/M service is separately supported and psychotherapy time is 40 minutes, the psychotherapy component may fall within the 90836 range.

The E/M level should then be selected based on the documented medical decision-making under the applicable CMS combined-service rule.

The clinician should not count the same 40 psychotherapy minutes toward both:

• E/M time
• Psychotherapy time

Document the Two Services Separately

A strong note should allow the reviewer to understand:

Medical E/M Work

For example:

• Symptoms reviewed
• Medication response
• Adverse effects
• Risk
• Prescription decision
• Medical decision-making

Psychotherapy Work

For example:

• Therapeutic focus
• Intervention
• Clinical goal
• Patient response
• Psychotherapy time

The documentation does not necessarily need to become two completely separate notes.

But the two services should be distinguishable.

A Separate Diagnosis Is Not Required Just to Bill Both Services

CMS guidance states that a separate diagnosis is not required merely because E/M and psychotherapy are both reported on the same date.

The important issue is whether the two services themselves are significant, medically necessary, and separately identifiable.

Common E/M Plus Psychotherapy Errors

Potential mistakes include:

• Billing psychotherapy when only medication counseling occurred
• Counting total appointment time as psychotherapy
• Selecting E/M by time while also billing psychotherapy under Medicare’s combined-service rule
• Using 90836 when documented psychotherapy time supports only 90833
• Billing an add-on psychotherapy code without a qualifying E/M code
• Missing psychotherapy revenue because staff submitted only the E/M

A pre-bill review can help identify both overcoding and missed legitimate charges.

Interactive Complexity: CPT 90785

CPT 90785 is an add-on code for qualifying interactive complexity.

It does not simply mean:

• Difficult patient
• Angry patient
• Complicated diagnosis
• Long conversation
• Parent attended appointment

CMS identifies specific communication-related circumstances that can support interactive complexity. These may involve issues such as maladaptive communication among participants, caregiver behavior interfering with implementation of the treatment plan, certain mandated-report situations, or communication barriers requiring special techniques.

Services That May Support 90785

CMS guidance recognizes 90785 with applicable services including:

• 90791
• 90792
• 90832
• 90834
• 90837
• 90833
• 90836
• 90838
• 90853

when the interactive-complexity requirements are met.

Do Not Bill 90785 With Crisis Psychotherapy

CMS states that interactive complexity should not be reported with crisis psychotherapy codes 90839 and 90840.

Family Psychotherapy

Psychiatric practices may also provide family psychotherapy.

Common codes include:

• 90846 — family psychotherapy without the patient present
• 90847 — family psychotherapy with the patient present

CMS distinguishes these services from simple:

• Family history taking
• E/M counseling
• Discussions with paid institutional staff

and contractor guidance generally requires that the service represent actual family psychotherapy directed toward treatment of the patient’s condition.

Group Psychotherapy

CPT 90853 represents group psychotherapy.

When medically necessary and properly supported, interactive complexity 90785 may also be relevant for a specific patient participating in group therapy.

Group therapy documentation should support:

• Patient participation
• Therapeutic focus
• Medical necessity
• Relationship to the treatment plan

A generic group attendance record is weaker than documentation connecting the service to the patient’s psychiatric treatment.

Crisis Psychotherapy: 90839 and 90840

Psychotherapy for crisis uses a separate coding structure.

The core codes are:

• 90839 — first 60 minutes
• 90840 — each additional 30 minutes

CMS states that crisis psychotherapy time can be accumulated on the date of service even when it is not continuous, but during each counted period the clinician must devote full attention to the patient. The patient must be present for at least some of the crisis service.

Crisis Psychotherapy Should Represent an Actual Crisis

A severe psychiatric diagnosis by itself does not establish a crisis psychotherapy service.

The record should support circumstances such as:

• Acute crisis
• Urgent assessment
• Immediate safety concerns
• Significant psychiatric distress
• Risk assessment
• Crisis intervention
• Stabilization planning

Time should also be documented.

Do Not Combine Crisis Codes With Ordinary Psychotherapy for the Same Crisis Service

CMS states that 90839/90840 should not be billed together with codes such as:

• 90791
• 90792
• 90832–90838

for the same crisis service.

Medicare G0017 and G0018 for Crisis Psychotherapy

This is an important current Medicare billing opportunity.

CMS’s 2026 crisis psychotherapy guidance instructs providers to use G0017 and G0018 for qualifying crisis psychotherapy furnished in applicable non-facility sites where the non-facility rate applies, excluding the office setting.

CMS states that qualifying crisis psychotherapy in these locations is paid at 150% of the applicable fee schedule amount.

This can apply to settings such as qualifying care furnished outside the traditional office, including patient homes when other Medicare requirements are met.

The billing team should verify:

• Place of service
• Crisis code
• Time
• Documentation
• Medicare eligibility
• Telehealth requirements when applicable

rather than treating G0017/G0018 as general crisis add-ons for every encounter.

Telepsychiatry Billing in 2026

Telepsychiatry remains highly relevant, but Medicare mental-health telehealth rules changed in 2026.

After January 30, 2026, Medicare generally requires an in-person, non-telehealth visit within the six months before the patient’s first qualifying mental-health telehealth service furnished in the home.

After the initial telehealth service, an in-person service is generally required at least every 12 months, subject to limited exceptions. Patients who had already begun qualifying home-based mental-health telehealth on or before January 30, 2026 are not subject to the same initial six-month requirement.

Telepsychiatry Coding Still Depends on the Actual Service

A telehealth visit does not create a new psychotherapy or E/M code simply because it occurred virtually.

The practice should first determine what was performed:

• Diagnostic evaluation
• E/M
• Psychotherapy
• E/M plus psychotherapy
• Crisis psychotherapy

Then it should apply the payer’s telehealth requirements.

Telepsychiatry Claim Review

The billing team should verify:

• CPT/HCPCS service
• Patient location
• Provider location where relevant
• Appropriate place of service
• Required telehealth modifier
• Audio-video or audio-only requirements
• In-person visit requirement
• Provider licensure
• Payer-specific coverage

Commercial payers may use telehealth rules different from Original Medicare.

TMS Billing

Transcranial magnetic stimulation creates a very different revenue cycle from standard psychiatric office visits.

The major TMS CPT family includes:

• 90867
• 90868
• 90869

CPT 90867

90867 generally represents the initial TMS treatment-planning service.

CMS contractor guidance expects 90867 to be reported only once per treatment episode for initial planning and not together with 90868 or 90869 in the circumstances described by the applicable policy.

CPT 90868

90868 generally represents subsequent TMS treatment delivery and management.

A course of TMS may involve many 90868 sessions.

The billing team therefore needs to track:

• Treatment date
• Authorization
• Approved sessions
• Sessions completed
• Remaining visits
• Expiration date

A single authorization error can affect an entire treatment series.

CPT 90869

90869 is used for qualifying re-determination of the motor threshold with treatment delivery and management.

CMS guidance states that 90869 should not be reported in conjunction with 90867 or 90868 under the applicable TMS policy.

TMS Coding Review

Code	General Role in TMS Treatment	Billing Risk
90867	Initial treatment planning	Reporting repeatedly within the same treatment episode or together with another excluded TMS code.
90868	Subsequent treatment delivery and management	Exceeding authorized sessions, missing medical necessity, or incorrect treatment-series tracking.
90869	Re-determination of motor threshold with treatment delivery/management	Reporting with incompatible TMS codes or without documentation supporting the re-determination.

Coverage criteria for TMS can differ by MAC and commercial payer, so practices should verify:

• Diagnosis
• Failed treatment requirements
• Contraindications
• Treatment history
• Authorization
• Session limits

before beginning treatment.

Spravato and Esketamine Billing

Esketamine treatment is one of the most specialized areas in modern Psychiatry Billing.

For qualifying Medicare services, two important HCPCS codes are:

• G2082
• G2083

CMS continues to identify G2082 and G2083 for qualifying esketamine treatment.

G2082

G2082 represents a qualifying outpatient service involving:

• E/M for an established patient
• Supervision
• Provision of up to 56 mg of self-administered esketamine
• Required post-administration observation

CMS’s payment rule describes the code as including approximately two hours of post-administration observation.

G2083

G2083 represents a similar bundled service involving a dose above 56 mg.

It likewise includes the related E/M, esketamine provision, and required observation components under the Medicare bundled methodology.

Do Not Automatically Add a Separate E/M to G2082 or G2083

CMS explicitly states that G2082 and G2083 already include an E/M component.

Therefore, billing a separate E/M for the same bundled medical work would be duplicative.

This is an important denial-prevention rule.

Separately Performed Services Require Separate Analysis

CMS has also explained that other genuinely separate and otherwise billable services, such as qualifying psychotherapy, may require their own analysis rather than being assumed to be part of the esketamine bundle.

Commercial payer workflows can differ considerably.

Some insurers may use:

• Different drug billing arrangements
• Specialty pharmacy models
• Prior authorization
• Different HCPCS requirements
• Different observation reimbursement

The practice should not assume Medicare’s G2082/G2083 structure applies to every payer.

Spravato Authorization Tracking

Spravato treatment often occurs as a series.

Practices should track:

• Diagnosis
• Authorization number
• Authorized visits
• Dose
• Treatment date
• Observation
• Drug acquisition pathway
• Claims paid
• Reauthorization date

Losing track of authorization can cause several consecutive treatment claims to deny before the practice recognizes the problem.

Electroconvulsive Therapy Billing

CPT 90870 represents electroconvulsive therapy.

ECT may require coordination among:

• Psychiatrist
• Anesthesia professional
• Facility
• Payer

The psychiatric procedure should be separated operationally from the services furnished by other clinicians.

ECT and Anesthesia

CMS guidance states that when the psychiatrist performs both the ECT and the associated anesthesia, Medicare does not separately pay the anesthesia service to that same psychiatrist.

CMS also identifies 90870 as a physician service in the relevant psychiatry guidance.

If another anesthesia professional provides the anesthesia, that professional’s billing follows the applicable anesthesia rules.

ECT Authorization and Treatment-Series Management

Depending on the payer, the practice may need to track:

• Diagnosis
• Medical necessity
• Treatment frequency
• Number of authorized treatments
• Continued response
• Facility
• Psychiatrist
• Anesthesia coordination

Like TMS and Spravato, ECT should be treated as a treatment series rather than a set of unrelated claims.

Common Psychiatry Billing Denials

Denial / Billing Problem	Why It Happens	Prevention Strategy
90791 / 90792 Error	The diagnostic code does not match whether medical services were actually performed.	Code from the documented diagnostic service rather than provider specialty alone.
Duplicate Diagnostic Evaluation	A diagnostic evaluation is repeated without documentation supporting a new or significantly changed clinical circumstance.	Review the clinical reason before repeating 90791 or 90792.
Medication Management Coding Error	90863 is treated as the standard medication-management code for psychiatrist encounters.	Use the appropriate E/M pathway for psychiatrist medical management when supported.
E/M Downcoding	The documentation does not support the submitted medical decision-making level or the payer reduces the service.	Document conditions addressed, data, medication decisions, and clinical risk clearly.
Missing Psychotherapy Add-On	The clinician performs separately identifiable psychotherapy but only the E/M charge reaches billing.	Reconcile psychotherapy documentation and time with the charge before submission.
Unsupported 90833 / 90836 / 90838	The note does not demonstrate separate psychotherapy work or qualifying time.	Document psychotherapy intervention, focus, response, and actual psychotherapy time.
Double-Counting Time	The same minutes are counted for both E/M selection and psychotherapy.	Use MDM for the Medicare E/M component when psychotherapy add-on codes are reported and keep psychotherapy time separate.
Incorrect Psychotherapy Code	The code does not match the documented psychotherapy time range.	Validate the actual psychotherapy minutes before claim submission.
90785 Denial	Interactive complexity is added because the patient was simply difficult or emotional.	Document the specific qualifying communication complexity.
Crisis Psychotherapy Denial	The encounter does not support an actual crisis service or the required time.	Document crisis status, intervention, risk, time, and immediate treatment needs.
Telepsychiatry Denial	Payer, POS, modality, or Medicare in-person requirements are not satisfied.	Use a payer-specific telepsychiatry verification workflow before the encounter.
TMS Authorization Denial	The practice exceeds authorized sessions or fails medical-necessity requirements.	Track each treatment against the authorization and applicable payer policy.
TMS Code Combination Error	90867, 90868, or 90869 are reported together when the applicable policy prohibits the combination.	Validate the treatment stage and current payer rules before coding.
Spravato Bundling Error	A separate E/M is added even though the Medicare G-code already includes the E/M component.	Review G2082/G2083 bundling before adding other services.
Spravato Authorization Denial	Drug, diagnosis, authorization, dose, or treatment-series requirements are incomplete.	Maintain a dedicated esketamine authorization and treatment tracker.
ECT Billing Error	Psychiatric, anesthesia, and facility services are not coordinated correctly.	Identify which provider furnished each component and apply the appropriate billing pathway.

How Psychiatry Practices Can Prevent Billing Denials

1. Determine the Service Before Selecting the Code

Start by identifying whether the encounter was:

• Diagnostic evaluation
• E/M
• Psychotherapy
• E/M plus psychotherapy
• Crisis psychotherapy
• TMS
• Esketamine
• ECT

Do not choose codes based solely on appointment length or provider type.

2. Separate Medication Management From Psychotherapy

Medication-management discussion should support the medical E/M component when appropriate.

Psychotherapy should involve separately identifiable therapeutic work.

3. Validate Psychotherapy Time

Before submitting:

• 90832
• 90834
• 90837
• 90833
• 90836
• 90838

confirm that the documented psychotherapy minutes fall within the applicable range.

4. Use MDM for Medicare E/M When Reporting Psychotherapy Add-On Codes

For Medicare combined E/M + psychotherapy billing, select the E/M level based on medical decision-making.

Do not count psychotherapy minutes as E/M time.

5. Do Not Use 90863 as an Automatic Medication Code

For psychiatrist pharmacologic management, use the appropriate E/M service when supported rather than automatically applying 90863.

6. Document Interactive Complexity Specifically

If 90785 is reported, the note should explain the communication circumstance that created interactive complexity.

7. Use a Dedicated Crisis Workflow

Crisis billing should capture:

• Crisis condition
• Time
• Risk
• Intervention
• Location

and determine whether Medicare G0017/G0018 rules are relevant.

8. Maintain a 2026 Telepsychiatry Checklist

Medicare practices should track the applicable in-person mental-health telehealth requirement rather than relying only on the fact that telehealth technology is available.

9. Track TMS by Treatment Episode

Create a treatment-series record showing:

• 90867 initial planning
• 90868 sessions
• 90869 when applicable
• Authorization
• Remaining sessions

10. Build Separate Spravato and ECT Workflows

Advanced psychiatric treatment should not be processed like a routine 99214.

These services need dedicated:

• Authorization
• Documentation
• Coding
• Treatment-series
• Claim follow-up

processes.

Psychiatry Billing Denial Prevention Checklist

Area	Review Question
90791 / 90792	Does the documentation support whether medical services were included in the diagnostic evaluation?
Repeat Diagnostic Evaluation	Is there a documented clinical reason for repeating the diagnostic service?
E/M	Does medical decision-making support the submitted office or outpatient E/M level?
Medication Management	Is pharmacologic management reflected through the appropriate E/M pathway rather than an automatic 90863 workflow?
Standalone Psychotherapy	Does psychotherapy time support 90832, 90834, or 90837?
E/M + Psychotherapy	Are the medical E/M and psychotherapy services significant and separately identifiable?
90833 / 90836 / 90838	Does documented psychotherapy time support the selected add-on code?
Time Separation	Has the practice avoided counting the same time toward both E/M and psychotherapy?
90785	Does the note describe a qualifying interactive-complexity circumstance rather than merely a difficult encounter?
Family Therapy	Does 90846 or 90847 represent actual family psychotherapy rather than history-taking or routine counseling?
Group Therapy	Does 90853 documentation connect the group service to the patient’s treatment plan?
Crisis	Does the record support crisis status, required time, full attention, and intervention?
G0017 / G0018	Does the Medicare crisis service meet the applicable non-facility place-of-service requirements?
Telepsychiatry	Are payer, POS, modality, licensure, and applicable 2026 Medicare in-person requirements satisfied?
TMS 90867	Is this the appropriate initial planning service for the treatment episode?
TMS 90868	Is the treatment session authorized and correctly tracked within the approved course?
TMS 90869	Does documentation support motor-threshold re-determination and appropriate code combination?
Spravato	Have authorization, diagnosis, dose, observation, and payer-specific billing requirements been verified?
G2082 / G2083	Has the practice avoided separately billing medical work already included in the Medicare bundled service?
ECT 90870	Are psychiatrist, anesthesia, facility, medical necessity, and authorization responsibilities clearly separated?

How Psychiatry Practices Can Improve Revenue Cycle Performance

Revenue-cycle improvement should begin before the psychiatric encounter.

The practice should know:

• Which payer manages psychiatric benefits
• Whether the clinician is enrolled
• Whether authorization is required
• Which services are covered
• Whether telehealth requirements are satisfied
• How patient responsibility should be handled

After the visit, the clinical documentation should support the service actually performed.

That may be:

• Diagnostic evaluation
• E/M
• Psychotherapy
• E/M plus psychotherapy
• TMS
• Spravato
• ECT
• Crisis psychotherapy

The claim should then be monitored through final reimbursement rather than considered complete simply because it was submitted.

1. Verify Behavioral Health Benefits Before the Visit

Active medical insurance does not automatically confirm psychiatric coverage.

Some health plans use a behavioral-health carve-out or separate administrator.

The front office should determine:

• Whether behavioral-health coverage is active
• Who administers psychiatric benefits
• Whether the provider is in-network
• Copay or coinsurance
• Deductible
• Authorization requirements
• Telehealth coverage
• Visit limits when applicable

This is especially important for new patients and advanced treatment programs.

2. Confirm the Rendering Provider Is Enrolled

Psychiatric groups may include:

• Psychiatrists
• PMHNPs
• Physician assistants
• Psychologists
• Therapists

Each clinician should be properly enrolled and linked to the group according to payer requirements.

A valid clinical service can still deny because:

• Rendering NPI is incorrect
• Group linkage is missing
• Credentialing is incomplete
• Provider taxonomy is wrong
• Authorization is associated with another clinician

Provider enrollment therefore needs to be connected to billing operations.

3. Separate E/M and Psychotherapy Charge Capture

One of the biggest revenue risks in psychiatrist billing is failing to capture legitimate psychotherapy provided during a medication-management visit.

For example, a psychiatrist may document:

• Medication management
• Medical decision-making
• 25 minutes of separately identifiable psychotherapy

If billing receives only the E/M charge, the psychotherapy component may never be submitted.

The opposite problem is also possible.

A psychotherapy add-on code may be entered even though the note does not support psychotherapy or the required time.

A structured reconciliation process can help identify both situations.

4. Validate Psychotherapy Time Before Claim Submission

The practice should confirm that documented psychotherapy time supports the reported service.

For example:

• 90833: 16–37 minutes
• 90836: 38–52 minutes
• 90838: 53 minutes or more

for qualifying psychotherapy performed with E/M.

The billing system should not infer psychotherapy time from total appointment length.

5. Track Authorization by Treatment Series

TMS, Spravato, and ECT should not be managed like isolated office visits.

The practice should track:

• Authorization number
• Effective dates
• Approved sessions
• Sessions completed
• Sessions remaining
• Reauthorization date
• Rendering provider
• Diagnosis
• Claim status

This helps prevent multiple denials caused by one expired authorization.

6. Maintain a Dedicated Telepsychiatry Workflow

Telepsychiatry should have its own payer rules.

The workflow may need to verify:

• Patient location
• Provider location
• Place of service
• Required modifier
• Audio-video requirements
• Audio-only coverage
• State licensure
• Payer-specific restrictions

For qualifying Medicare home-based mental-health telehealth services in 2026, the practice should also monitor applicable in-person visit requirements rather than assuming continuous virtual treatment remains billable indefinitely.

7. Review Payments for Downcoding and Underpayments

A psychiatric claim can be paid and still be incorrect.

Examples include:

• 99214 reduced to 99213
• Psychotherapy add-on not paid
• Contracted rate not applied
• TMS payment lower than expected
• Incorrect patient responsibility
• Telehealth service processed under the wrong benefit

Payment posting should therefore compare actual reimbursement with expected reimbursement.

Behavioral Health Benefit Verification

Psychiatry practices should verify more than general medical eligibility.

Area	What the Practice Should Verify
Eligibility	Confirm that coverage is active for the date of service.
Behavioral Health Administrator	Determine whether psychiatric benefits are managed by the medical payer or a separate behavioral-health organization.
Provider Network	Confirm whether the psychiatrist, PMHNP, therapist, or other rendering clinician is participating.
Patient Responsibility	Verify applicable copay, deductible, and coinsurance.
Diagnostic Services	Confirm coverage requirements for psychiatric evaluation when applicable.
Psychotherapy	Review benefit limitations, visit requirements, and payer policies.
Telepsychiatry	Verify telehealth eligibility, modality, place-of-service requirements, and other payer rules.
TMS	Confirm diagnosis criteria, prior authorization, treatment limits, and approved sessions.
Spravato	Review drug benefit, medical benefit, authorization, treatment requirements, and acquisition pathway.
ECT	Confirm authorization, treatment frequency, facility requirements, and provider coverage.

Psychiatrist and PMHNP Credentialing

Provider enrollment is particularly important in psychiatry because one group may have several clinician types.

Before scheduling insured patients, the practice should know whether each provider is:

• Credentialed
• Contracted
• Linked to the group
• Effective with the payer
• Authorized for the relevant service

Track Effective Dates

Credentialing approval does not always mean claims are payable for every previous date.

The practice should maintain:

• Application date
• Approval date
• Effective date
• Group linkage
• Recredentialing date
• Payer identifiers

This can prevent avoidable out-of-network or noncredentialed-provider denials.

PMHNP Claims Need Correct Rendering Information

PMHNP billing should accurately identify the clinician who furnished the service.

The billing team should avoid automatically submitting a psychiatrist as the rendering provider simply because the psychiatrist owns or supervises the practice.

Claim structure should reflect:

• Actual rendering clinician
• Payer rules
• Enrollment
• Applicable supervision or incident-to requirements where relevant

E/M and Psychotherapy Charge Reconciliation

A psychiatry practice can create a daily charge-reconciliation process.

For encounters where the clinician provides both medication management and psychotherapy, billing can compare:

• E/M charge
• Psychotherapy add-on charge
• Documented psychotherapy time
• Provider
• Date of service

Psychiatry Charge Reconciliation

Clinical Documentation	Billing Review
Medication management only	Confirm appropriate E/M service without automatically adding psychotherapy.
E/M plus 16–37 minutes of psychotherapy	Review whether the documentation supports the E/M service plus 90833.
E/M plus 38–52 minutes of psychotherapy	Review whether the documentation supports the E/M service plus 90836.
E/M plus 53 or more minutes of psychotherapy	Review whether the documentation supports the E/M service plus 90838.
Standalone psychotherapy	Review the appropriate 90832, 90834, or 90837 pathway based on documented psychotherapy time.
No documented psychotherapy time	Do not infer an add-on code from the scheduled appointment length.

Preventing Missed Psychotherapy Revenue

Missed psychotherapy revenue can occur when the psychiatrist performs psychotherapy but:

• Does not record time
• Does not distinguish psychotherapy from medical counseling
• Does not select a psychotherapy charge
• Uses a template that captures only medication management

Improve Documentation Templates

The psychiatric note can include distinct fields for:

• Medical-management work
• Psychotherapy performed
• Psychotherapy focus
• Intervention
• Response
• Psychotherapy time

This helps the clinician document what actually occurred without forcing the entire encounter into one generic narrative.

Audit E/M-Only Visits

A practice may periodically review selected long-duration E/M encounters to determine whether legitimate psychotherapy was consistently being performed but not reaching billing.

The goal is not to add codes after the fact without support.

The goal is to identify workflow patterns that cause future legitimate services to be missed.

Telepsychiatry Revenue Cycle Controls

Telepsychiatry is convenient for patients, but it adds another layer of payer compliance.

A useful telehealth workflow can review:

• Coverage
• Service type
• Place of service
• Modifier
• Technology
• Patient location
• Provider location
• Required in-person care

Monitor Medicare In-Person Requirements

For qualifying Medicare mental-health telehealth delivered to patients in their homes after January 30, 2026, practices should track applicable in-person requirements.

A useful scheduling field can show:

• Date of last qualifying in-person visit
• Next required in-person visit
• Exception when applicable

This allows scheduling staff to identify a potential compliance problem before another telepsychiatry visit occurs.

Keep Medicare and Commercial Rules Separate

A commercial payer may have substantially different requirements.

The practice should not apply the Medicare six-month/12-month workflow automatically to all commercial patients.

TMS Revenue Cycle Management

TMS creates predictable billing volume but also predictable denial risk if the treatment series is poorly managed.

Before TMS Begins

The practice should verify:

• Covered diagnosis
• Prior treatment requirements
• Medical necessity
• Prior authorization
• Approved number of sessions
• Authorization dates
• Provider
• Place of service

Track Each Session

A TMS treatment tracker can show:

• Initial 90867
• Each 90868 session
• 90869 when applicable
• Session number
• Authorization remaining
• Claim submission
• Payment

This can help the practice recognize authorization exhaustion before an additional session is performed.

TMS Treatment-Series Tracking

Field	Why It Matters
Authorization Number	Connects the treatment series to payer approval.
Authorization Period	Prevents services from being performed outside approved dates.
Approved Sessions	Establishes the total number of covered treatments.
Sessions Completed	Shows how many authorized services have already been used.
Sessions Remaining	Helps staff determine when reauthorization may be needed.
90867	Tracks initial treatment planning within the treatment episode.
90868	Tracks ongoing treatment delivery and management.
90869	Tracks qualifying motor-threshold re-determination when applicable.
Claim Status	Identifies unpaid or denied sessions before the balance becomes old AR.

Spravato and Esketamine Revenue Cycle Management

Spravato programs require coordination between clinical treatment, medication access, payer authorization, and billing.

A breakdown in one area can delay multiple treatments.

Verify the Drug Acquisition Model

Depending on payer arrangements, esketamine may involve:

• Medical benefit
• Pharmacy benefit
• Specialty pharmacy
• Other payer-specific acquisition models

The billing team should know which pathway applies before treatment.

Track Authorization by Dose and Treatment Period

The practice should monitor:

• Approved indication
• Authorization dates
• Dose
• Number of treatments
• Reauthorization
• Observation requirements

Review Medicare Bundling

For applicable Medicare services using G2082 or G2083, the practice should recognize that the service includes components such as E/M, the esketamine drug, and required observation.

The billing team should not automatically add another E/M for the same bundled medical work.

Monitor Drug and Service Revenue Together

A Spravato program may experience financial problems when:

• Drug is obtained but treatment claim denies
• Treatment is provided after authorization expires
• Incorrect dose is billed
• Observation documentation is incomplete
• Payer assigns the claim to the wrong benefit

Tracking both medication and professional-service workflow can make these problems more visible.

ECT Claim Coordination

ECT billing may involve three separate financial components:

• Psychiatric professional service
• Anesthesia
• Facility

Each should be handled by the appropriate billing entity.

Coordinate Treatment Dates

The psychiatrist’s ECT claim should align with:

• Facility record
• Anesthesia record
• Treatment date
• Authorization

Mismatched dates or procedure information can delay payment.

Track Treatment-Series Authorization

Like TMS, ECT may involve repeated treatments.

The practice should monitor:

• Authorized treatments
• Treatments completed
• Continued medical necessity
• Reauthorization requirements

Crisis Psychiatry Revenue Cycle

Crisis psychotherapy should be tracked separately from ordinary office psychotherapy.

The practice should monitor:

• 90839
• 90840
• G0017/G0018 when applicable
• Place of service
• Time
• Payer
• Documentation

This helps ensure that crisis services are not accidentally processed as routine psychotherapy or vice versa.

Managing Psychiatry Denials by Service Category

A combined denial rate can hide important problems.

Psychiatry practices should consider reporting denials separately for:

• Diagnostic evaluations
• E/M
• E/M plus psychotherapy
• Standalone psychotherapy
• Telepsychiatry
• TMS
• Spravato
• ECT
• Crisis services

Why Service-Level Reporting Matters

Suppose the overall denial rate is 6%.

That number may look acceptable.

But deeper reporting could show:

• E/M denial rate: 2%
• Psychotherapy add-on denial rate: 12%
• TMS denial rate: 18%

The practice now knows where to investigate.

Psychiatry Denial Root-Cause Analysis

Denial Category	Potential Root Cause
Eligibility	Coverage inactive or behavioral-health carve-out not identified.
Provider Enrollment	Psychiatrist or PMHNP not enrolled, linked, or effective with payer.
E/M	Documentation, medical necessity, coding, or payer downcoding issue.
Psychotherapy Add-On	Missing psychotherapy time or failure to show a separately identifiable psychotherapy service.
Telepsychiatry	POS, modifier, modality, location, licensure, or payer telehealth policy issue.
TMS	Authorization, diagnosis criteria, treatment limit, or code-combination problem.
Spravato	Authorization, dose, drug acquisition, bundled-service, or observation documentation issue.
ECT	Authorization, provider role, facility coordination, or medical necessity issue.
Crisis Psychotherapy	Time, crisis status, place of service, or documentation does not support the code.

Downcoded Psychiatry E/M Claims

A claim does not have to be denied to create revenue loss.

Payers may process a submitted E/M service at a lower level.

For example:

• Submitted 99214
• Paid as 99213

The practice should not assume every reduction is correct.

Review Downcoding Trends

Track downcoding by:

• Payer
• Provider
• E/M code
• Location
• Reason

Then compare the payer’s action with the documentation and contract.

If the documentation supports the submitted service, the practice can determine whether an appeal or reconsideration is appropriate.

Avoid Automatic Upcoding in Response

The solution to payer downcoding is not to raise code levels.

E/M selection should continue to reflect the documented medical decision-making.

The practice should challenge inappropriate payer reductions without changing clinically accurate coding habits.

Psychiatry Underpayment Analysis

Other underpayments can occur when:

• Psychotherapy add-on is omitted from payment
• Contract rate is incorrect
• TMS is reduced improperly
• Telehealth rate is incorrect
• Provider-type adjustment is wrong
• Multiple services are bundled incorrectly

Compare Expected and Actual Reimbursement

Payment posting can capture:

• Charge
• Expected allowed
• Actual allowed
• Payment
• Adjustment
• Patient responsibility
• Variance

Large variances should be moved to an underpayment work queue.

Manage Psychiatry AR by Service Category

Psychiatric AR should not be viewed only as one total balance.

Useful categories include:

• Psychiatric evaluations
• Medication-management E/M
• E/M plus psychotherapy
• Standalone psychotherapy
• Telepsychiatry
• TMS
• Spravato
• ECT
• Crisis care

This allows the practice to see whether a particular treatment program is generating disproportionate unpaid revenue.

Monitor Advanced Treatment AR More Closely

TMS and Spravato can produce multiple claims within a treatment series.

If one payer problem affects every session, the outstanding balance can grow quickly.

These claims should receive earlier follow-up than a standard low-dollar office balance.

Psychiatry Revenue Cycle Metrics to Monitor

Useful performance indicators may include:

• Clean claim rate
• First-pass payment rate
• Overall denial rate
• E/M denial rate
• Psychotherapy add-on denial rate
• TMS denial rate
• Spravato denial rate
• Telehealth denial rate
• Provider enrollment denial rate
• Authorization denial rate
• E/M downcoding rate
• Days in AR
• AR over 90 days
• Treatment-series AR
• Unbilled encounters
• Missing psychotherapy charges
• Underpayment volume
• Appeal success rate
• Time from date of service to claim submission

These metrics can help administrators identify whether problems originate in:

• Front office
• Clinical documentation
• Coding
• Authorization
• Claim submission
• Payment processing
• AR follow-up

Psychiatry Revenue Cycle Review

Revenue Cycle Area	What the Practice Should Monitor
Behavioral Health Eligibility	Whether psychiatric benefits are active and correctly routed to the responsible payer or administrator.
Provider Enrollment	Whether psychiatrists, PMHNPs, and other clinicians are properly credentialed and linked.
E/M	Whether medical decision-making supports the submitted service and whether payers are downcoding claims.
Psychotherapy Add-Ons	Whether 90833, 90836, or 90838 is supported and whether legitimate psychotherapy charges are being missed.
Telepsychiatry	Whether payer, POS, modality, licensure, and applicable in-person requirements are satisfied.
TMS	Whether authorization, treatment sessions, code usage, and claim payment are tracked across the episode.
Spravato	Whether authorization, dose, drug acquisition, observation, bundled billing, and payment are aligned.
ECT	Whether psychiatric, anesthesia, facility, authorization, and treatment-series information are coordinated.
Denials	Whether denials are categorized by service and root cause.
Underpayments	Whether actual reimbursement is compared with expected contractual payment.
AR	Whether unpaid balances are segmented by service, payer, age, and financial value.

In-House vs Outsourced Psychiatry Billing

Psychiatric practices can maintain an internal billing department or work with an external revenue-cycle company.

The right approach depends on:

• Practice size
• Provider mix
• Payer mix
• Telepsychiatry volume
• Advanced treatment programs
• Internal coding knowledge
• Authorization workload
• Denial rates
• AR performance

Area	In-House Psychiatry Billing	Outsourced Psychiatry Billing
Behavioral Health Benefits	Internal staff verifies carve-outs, network status, and patient responsibility.	Dedicated billing resources can support benefit verification and payer routing workflows.
Provider Enrollment	The practice monitors psychiatrist and PMHNP payer participation internally.	Credentialing and enrollment support can help manage applications, group linking, and payer follow-up.
E/M + Psychotherapy	Internal coders validate MDM, psychotherapy time, and add-on charges.	Specialty billing review can help identify missing or unsupported psychotherapy add-ons.
Telepsychiatry	The practice maintains current payer and Medicare telehealth rules.	Billing support can apply payer-specific telehealth claim workflows.
TMS	Internal staff handles authorization, session tracking, coding, and AR.	Dedicated workflows can help track authorizations and claims through the complete treatment series.
Spravato	The practice manages drug access, authorization, observation, billing, and reauthorization internally.	Revenue-cycle support can help coordinate authorization and claim follow-up around the treatment program.
Denial Management	Internal staff researches payer, coding, time, authorization, and provider denials.	Denials can be categorized by root cause and analyzed for recurring workflow problems.
Underpayments	The practice compares payer reimbursement with expected amounts.	Payment review can help identify E/M downcoding, missing add-on payment, and contractual variances.
AR Follow-Up	Internal billing staff works aging psychiatric claims.	Dedicated AR resources can prioritize treatment-series claims, high balances, and recurring payer issues.

Benefits of Outsourcing Psychiatry Billing

Outsourcing may help psychiatric practices that need additional billing expertise or operational capacity.

Better E/M and Psychotherapy Claim Review

Psychiatric billing teams need to understand the difference between:

• Medication management
• E/M
• Standalone psychotherapy
• E/M plus psychotherapy

That distinction can reduce both missed charges and unsupported billing.

Stronger Benefit Verification

A dedicated verification process can help identify:

• Behavioral-health carve-outs
• Provider network issues
• Patient responsibility
• Telehealth coverage
• Authorization requirements

before treatment.

More Consistent Authorization Tracking

Advanced psychiatry programs can create substantial authorization workload.

A structured workflow can help track:

• TMS sessions
• Spravato treatments
• ECT treatments
• Approval dates
• Reauthorization

Better Denial Analysis

Specialty reporting can determine whether denials are coming primarily from:

• E/M
• Psychotherapy
• Telepsychiatry
• TMS
• Spravato
• Provider enrollment
• Authorization

This allows the practice to improve the actual process causing the problem.

More Focused AR Follow-Up

Dedicated follow-up can prioritize:

• Treatment-series claims
• High-value balances
• Old claims
• Underpayments
• Appeals

instead of treating every balance identically.

When Should a Psychiatry Practice Consider Outsourcing Billing?

Outsourcing may be worth evaluating when the practice experiences:

• Growing AR
• Repeated psychotherapy add-on denials
• Missing psychotherapy revenue
• Behavioral-health carve-out errors
• Credentialing delays
• Telepsychiatry denials
• TMS authorization problems
• Spravato billing issues
• E/M downcoding
• Underpayments
• Staff turnover
• Billing backlogs
• Limited financial reporting

The decision should depend on the practice’s actual operational needs.

How to Choose a Psychiatry Billing Partner

A billing partner should understand psychiatry beyond generic behavioral-health claims.

1. Do They Understand E/M Plus Psychotherapy?

Ask how the team handles:

• 90833
• 90836
• 90838
• Psychotherapy time
• E/M medical decision-making

They should understand that total appointment time cannot simply be counted twice.

2. Do They Understand Medication Management?

A strong psychiatry billing team should know that psychiatrist pharmacologic management is commonly incorporated into appropriate E/M billing rather than automatically using 90863.

3. Can They Handle Behavioral Health Carve-Outs?

Ask how they identify when psychiatric claims belong to a different behavioral-health administrator than the patient’s general medical plan.

4. Can They Manage PMHNP Claims?

The team should understand:

• Credentialing
• Rendering provider
• Group linkage
• Payer-specific provider requirements

5. Do They Understand Telepsychiatry?

The billing company should have processes for:

• POS
• Modifiers
• Payer telehealth rules
• Medicare requirements
• Patient location

6. Can They Manage TMS Treatment Series?

Ask whether the team can track:

• Authorization
• 90867
• 90868
• 90869
• Remaining sessions
• Reauthorization
• Claim payment

7. Can They Manage Spravato?

A psychiatry billing partner should understand the interaction between:

• Authorization
• Dose
• Drug pathway
• Observation
• Medicare G2082/G2083
• Payer-specific billing

8. Can They Handle ECT?

The team should understand the separation between:

• Psychiatric professional billing
• Anesthesia billing
• Facility billing

and the need for treatment-series authorization.

9. Do They Review Underpayments?

Ask whether the billing team monitors:

• E/M downcoding
• Missing psychotherapy payments
• Contract variances
• TMS payment
• Advanced-treatment reimbursement

10. What Reporting Will the Practice Receive?

Useful reporting should provide visibility into:

• Collections
• Denials
• AR
• E/M
• Psychotherapy
• Telehealth
• TMS
• Spravato
• ECT
• Underpayments
• Authorization trends

How Pro Medical Billing Solutions Supports Psychiatry Practices

Psychiatric practices need revenue-cycle workflows that can support both routine psychiatric care and increasingly complex treatment programs.

Billing challenges may begin with:

• Benefit verification
• Credentialing
• Authorization
• Documentation
• Coding
• Claim submission
• Payment posting
• Denial management
• AR follow-up

Pro Medical Billing Solutions supports healthcare organizations across revenue-cycle functions such as:

• Medical billing
• Medical coding
• Insurance verification
• Prior authorization support
• Credentialing
• Claim submission
• Payment posting
• Denial management
• Accounts receivable follow-up
• Revenue cycle management

For psychiatric practices, these workflows can place particular attention on:

• Behavioral-health payer routing
• Psychiatrist and PMHNP claims
• E/M billing
• Psychotherapy add-ons
• Telepsychiatry
• Authorization
• TMS
• Advanced treatment claims
• Denials
• Underpayments
• Aging AR

The goal is to give practices stronger financial visibility from patient eligibility through final claim resolution.

Frequently Asked Questions

What is Psychiatry Billing?

Psychiatry Billing is the process of documenting, coding, submitting, and managing claims for psychiatric services such as:

• Diagnostic evaluations
• Medication management
• E/M
• Psychotherapy
• Telepsychiatry
• TMS
• Spravato
• ECT
• Crisis care

What is the difference between psychiatry billing and therapy billing?

Psychiatry billing commonly includes medical services such as medication management and E/M in addition to psychotherapy.

Therapy billing generally focuses more heavily on psychotherapy and behavioral-health treatment without medical prescriber services.

What is the difference between 90791 and 90792?

90791 generally represents psychiatric diagnostic evaluation without the medical-services component.

90792 represents psychiatric diagnostic evaluation with medical services.

The code should reflect what was actually performed rather than simply the provider’s specialty.

How is medication management billed in psychiatry?

Psychiatrists and other eligible prescribers commonly report medication-management work through an appropriate E/M service.

Medication management does not automatically mean CPT 90863.

Can a psychiatrist bill E/M and psychotherapy together?

Yes, when both services are medically necessary, significant, separately identifiable, and properly documented.

Common psychotherapy add-on codes include:

• 90833
• 90836
• 90838

What is the difference between 90833, 90836, and 90838?

These psychotherapy add-on codes correspond to different psychotherapy time ranges when performed with a qualifying E/M service:

• 90833: 16–37 minutes
• 90836: 38–52 minutes
• 90838: 53 minutes or more

Can E/M time and psychotherapy time overlap?

For Medicare E/M plus psychotherapy billing, the psychotherapy time should remain separate from E/M work.

The E/M level is selected based on medical decision-making in this combined-service scenario.

The same time should not be counted twice.

Does a difficult patient justify CPT 90785?

No.

Interactive complexity requires qualifying communication circumstances.

A patient being emotional, angry, or clinically complicated does not by itself establish 90785.

What CPT codes are used for TMS?

The main TMS code family includes:

• 90867
• 90868
• 90869

Each serves a different role within the treatment episode.

How can a psychiatry practice reduce TMS denials?

Practices can improve TMS billing by tracking:

• Medical necessity
• Prior authorization
• Approved sessions
• Sessions completed
• Remaining sessions
• Code usage
• Treatment dates

across the entire treatment episode.

What codes does Medicare use for Spravato treatment?

For applicable Medicare esketamine treatment, G2082 and G2083 may be used depending on the dose and service requirements.

These codes include components such as E/M, esketamine, and required observation.

Can an E/M code be billed separately with G2082 or G2083?

A separate E/M should not automatically be billed for medical work already included in the Medicare G2082/G2083 bundled service.

Any additional service would need to be independently evaluated for separate reportability.

What code is used for ECT?

CPT 90870 is the primary professional code associated with electroconvulsive therapy.

ECT may also involve separate facility and anesthesia services depending on who provides each component.

What are common psychiatry billing denials?

Common causes include:

• Incorrect 90791/90792 selection
• Provider enrollment problems
• Behavioral-health carve-out errors
• Unsupported psychotherapy add-ons
• Incorrect psychotherapy time
• E/M downcoding
• Telepsychiatry errors
• TMS authorization
• Spravato billing
• ECT coordination

Why do psychiatry E/M claims get downcoded?

Potential causes include:

• Documentation that does not support the submitted MDM level
• Payer processing rules
• Automated payer edits
• Payer interpretation of medical necessity

Practices should review whether the documentation supports the original code before deciding whether an appeal is appropriate.

How does telepsychiatry billing work in 2026?

Telepsychiatry billing depends on:

• Service performed
• Payer
• Patient location
• Provider location
• Place of service
• Modifier
• Technology requirements
• Licensure
• Applicable in-person requirements

Medicare has specific 2026 rules for qualifying home-based mental-health telehealth that practices should monitor separately from commercial payer policies.

Should a psychiatry practice outsource billing?

Outsourcing may be useful when a psychiatric practice experiences:

• Growing AR
• Coding complexity
• Psychotherapy add-on errors
• Credentialing problems
• Authorization workload
• Telehealth denials
• TMS or Spravato billing issues
• Underpayments
• Staffing limitations

The decision should depend on the practice’s provider mix, payer mix, treatment services, and internal billing capacity.

Final Thoughts: Building a Stronger Psychiatry Revenue Cycle

Psychiatry Billing has become much more complex than submitting psychotherapy claims.

Modern psychiatric practices may provide:

• Psychiatric diagnostic evaluation
• Medication management
• Medical E/M
• Psychotherapy
• E/M plus psychotherapy
• Telepsychiatry
• TMS
• Esketamine treatment
• ECT
• Crisis care

Each service introduces its own billing questions.

For routine psychiatric visits, practices need to determine whether the encounter supports:

• E/M only
• Psychotherapy only
• E/M plus psychotherapy

When psychotherapy accompanies E/M, the documentation should clearly establish the psychotherapy service and its qualifying time.

For advanced treatment, the revenue cycle becomes even more operationally complex.

TMS requires authorization and session tracking.

Spravato can require coordination of drug access, treatment, observation, authorization, and billing.

ECT may involve separate psychiatric, anesthesia, and facility workflows.

Telepsychiatry introduces payer, location, technology, and in-person requirements.

Provider enrollment adds another risk because psychiatrists, PMHNPs, therapists, and other clinicians may have different payer relationships.

Once claims are submitted, psychiatry practices should continue monitoring:

• Denials
• E/M downcoding
• Missing psychotherapy payment
• Contract underpayments
• Advanced-treatment AR
• Telehealth denials
• Authorization problems

A structured Psychiatry Billing process can help practices:

• Improve behavioral-health benefit verification
• Reduce payer-routing errors
• Strengthen provider enrollment
• Improve E/M coding accuracy
• Capture legitimate psychotherapy revenue
• Reduce psychotherapy time errors
• Improve telepsychiatry billing
• Strengthen TMS authorization management
• Improve Spravato claim workflows
• Coordinate ECT billing
• Identify downcoding and underpayments
• Reduce aging AR

For psychiatric practices, the goal is not simply to submit more codes.

The goal is to make sure the clinical service, provider, documentation, time, authorization, payer rules, and reimbursement all accurately reflect the psychiatric care that was actually delivered.