The core mental health CPT codes for 2026 are 90791 for psychiatric diagnostic evaluation, 90832, 90834, and 90837 for individual psychotherapy at 16 to 37, 38 to 52, and 53 or more minutes respectively, 90846 and 90847 for family therapy, and 90853 for group therapy. The 53-minute minimum on 90837 is the single most audited threshold in behavioral health billing.
Behavioral health billing punishes imprecision more than almost any other specialty, because the codes are time-defined, the documentation standard is explicit, and the largest payers audit the time bands specifically. Most of the revenue lost here is lost to detail, not to policy.
The time bands, exactly
Psychotherapy CPT time bands, exactly
Face-to-face time requirements for CPT 90832, 90834 and 90837, plus the two diagnostic evaluation codes that are not selected by time.
Time is the code selection factor for 90832, 90834 and 90837. Codes 90791 and 90792 are selected by the content of the service, not its duration. Always match the code to the documented service and check payer-specific billing rules.
Billing 90837 for a 50-minute session is upcoding. Not arguably, not in a gray area: 50 minutes falls inside the 90834 band and the payer’s audit logic knows it. Blue Cross plans and others audit this pattern specifically, and the exposure is not the single claim but every similarly coded claim in the period. Document exact start and stop times on every session note and the question never arises.
The modality is irrelevant to the code. 90834 covers a CBT session and an EMDR session identically, because these are time-based codes describing duration, not technique.
The codes around the core
- 90833, 90836, 90838: psychotherapy add-ons for prescribers combining medication management with therapy in one visit. These attach to a primary E/M code. A psychiatrist should not be billing standalone therapy codes for a combined visit.
- 90785: interactive complexity add-on, for communication difficulties during the session. Attaches to 90791, 90792, 90832, 90834, 90837, or the psychotherapy add-ons.
- 90839 and 90840: crisis psychotherapy, requiring a genuinely high-severity presenting problem and documentation of the crisis and the interventions.
- 96130 to 96139: psychological and neuropsychological testing.
- 99484: general behavioral health integration.
- G0568 to G0570: introduced for 2026 to cover collaborative care and behavioral health integration services without the time-based rules that constrained the previous code family. Worth reviewing if you run a CoCM program.
Who can bill, and at what rate
Licensed marriage and family therapists and mental health counsellors are now Medicare-covered providers, reimbursed at 75% of the Physician Fee Schedule amount. That percentage is not a penalty to negotiate away; it is statutory. What it does mean is that PECOS enrollment for these license types is directly revenue-generating work, and enrollment backlogs are lost revenue rather than administrative inconvenience. The mechanics are in provider credentialing and payer enrollment.
On rates: 2026 saw increases across most psychotherapy codes as the conversion factor recovered from the 2025 cut. Published national estimates for 2026 vary between sources, with 90837 quoted anywhere from roughly $155 to $167 and 90834 from roughly $114 to $131, so treat any figure you see as indicative and pull your locality from the CMS Physician Fee Schedule lookup. Commercial rates for 90837 commonly run $110 to $220 depending on plan, credential level, and market. Medicaid typically pays 70% to 80% of Medicare, varying sharply by state.
One practical benchmark: if your commercial allowed amount sits below about 85% of the 2026 Medicare national rate for your code and credential level, that is grounds for a written rate review request rather than acceptance.
Telehealth rules that affect payment
Telehealth coverage for behavioral health is permanent, which removes a long-running source of uncertainty. What remains is getting the claim right.
- Modifier 95 for synchronous audio-video, modifier 93 for audio-only.
- POS 10 when the patient is at home, which pays the non-facility rate. POS 02 when the patient is elsewhere, which pays the lower facility rate. Defaulting everything to POS 02 underpays most sessions.
- 98000 to 98016 is the telehealth E/M family that replaced the deleted telephone E/M codes, relevant to prescribers rather than to therapy codes.
Where the denials come from
The leading denial cause in behavioral health is documentation rather than coverage: missing start and stop times, vague descriptions of intervention, and no visible link between the session and the treatment plan goals. Diagnosis coding is the second: the ICD-10 code has to establish medical necessity for the CPT billed, and a mismatch fails the whole claim.
Then there are the bundling edits. NCCI blocks 90837 with 90832 or 90834 on the same day, since the time ranges overlap. Pairing 90837 with 90791 requires clearly distinct, separately documented services. Group therapy 90853 generally cannot be billed the same day as individual therapy for the same patient under most payer policies. And 99417 remains an E/M-only prolonged services code that cannot be paired with 90837 or 90847, which catches practices looking for a way to bill genuinely long sessions.
Behavioral health carve-outs add a further layer, where a commercial member’s mental health benefit is administered by a separate organization with its own fee schedule, authorization rules, and claim address. Sending a carve-out claim to the medical plan produces a denial that looks like a coverage problem and is actually a routing problem, which is why eligibility verification matters more here than in most specialties.
These edits are all preventable pre-submission through claim scrubbing, and the denials that do land are worked through denial management. For clinics and groups wanting the whole cycle run by people who know carve-outs and parity rules, that is mental health billing services. To see what your current denial mix is costing, request a denial recovery report.
Frequently asked questions
What is the difference between 90834 and 90837?
Session length only. 90834 covers 38 to 52 minutes of face-to-face psychotherapy and 90837 covers 53 minutes or more. The clinical technique is irrelevant to the choice.
Can I bill 90837 for a 50-minute session?
No. Fifty minutes falls within the 90834 band. Billing 90837 at 50 minutes is upcoding and payers audit for this pattern across a provider’s claim history, not claim by claim.
What is CPT 90791 used for?
The psychiatric diagnostic evaluation, typically billed once per episode of care, covering comprehensive history, mental status examination, and treatment planning. 90792 is the equivalent when medical services such as prescribing are included.
Can LMFTs and LMHCs bill Medicare in 2026?
Yes. Licensed marriage and family therapists and mental health counsellors are Medicare-covered providers, reimbursed at 75% of the Physician Fee Schedule amount, subject to completing PECOS enrollment.
Which modifier is used for teletherapy?
Modifier 95 for synchronous audio-video and modifier 93 for audio-only, with POS 10 when the patient is at home and POS 02 when the patient is elsewhere. POS 10 pays the higher non-facility rate.
Why do mental health claims get denied most often?
Insufficient documentation: missing start and stop times, vague intervention descriptions, and no documented link to treatment plan goals. Diagnosis-to-procedure mismatch and behavioral health carve-out routing errors follow closely behind.