Psychotherapy Medical Billing & Coding Guide for 2025: The Revenue You're Leaving Behind
- Sirius solutions global
- Jan 29
- 5 min read
Last month, a therapist from Portland called me frustrated. She'd been in practice for seven years, seeing 25-30 clients weekly, but her collections kept declining despite her schedule being fully booked. "I don't understand," she said. "I'm working harder than ever but bringing home less money."
I asked one question: "Are you documenting your session times?"
Long pause. "I write my notes, if that's what you mean."
That was the problem. She'd been billing every session as 90834 (45-minute code) regardless of actual session length. Sometimes sessions ran 35 minutes. Sometimes 55 minutes. Her documentation said "patient seen for therapy" with no time recorded.
Here's what that cost her: When sessions actually lasted 50-55 minutes, she should have billed 90837 (paying about $138) instead of 90834 (paying about $108). That's $30 left on the table per session. With 15-20 qualifying sessions weekly, she was losing $450-600 weekly, or about $24,000-31,000 annually.
On the flip side, when sessions only lasted 30 minutes but she billed 90834 anyway, she was technically overcoding creating audit risk that could cost far more than the extra $20-30 per session.
This isn't about fraud or aggressive coding. This is about billing accurately for the work you actually do. And across the country, therapists are quietly losing thousands of dollars because nobody ever taught them how psychotherapy billing really works.
Why Psychotherapy Billing Feels Harder Than It Should
Here's the frustrating truth: the clinical work helping someone process trauma, manage anxiety, navigate depression requires years of training and expertise. The billing part? Theoretically straightforward. A handful of CPT codes, time-based rules, standard documentation requirements.
So why do so many therapists struggle with it?
The time rules are confusing. You'd think a 45-minute code means exactly 45 minutes. It doesn't. It means 38-52 minutes. And if you go one minute over, suddenly you're in different code territory with different reimbursement.
Documentation requirements keep changing. What satisfied payers three years ago might trigger denials today. Audit standards tighten. Medical necessity criteria evolve. Telehealth policies shift constantly.
Nobody teaches this in grad school. You spent years learning therapeutic techniques, diagnostic criteria, and ethical practice. Billing compliance? Maybe one afternoon if you were lucky.
The stakes feel high. Bill too conservatively and you lose legitimate income. Bill too aggressively and you risk audits, payer termination, even fraud accusations.
Let's cut through the confusion.
The Psychotherapy CPT Codes You Actually Use
Forget the 50+ behavioral health codes theoretically available. In daily practice, you'll use maybe 8-12 codes regularly. Let's focus on those.
The Core Psychotherapy Codes
CPT 90832 – 30-Minute Therapy
Time range: 16-37 minutes
Medicare pays: ~$76
When to use: Brief check-ins, focused interventions, patients who can't tolerate longer sessions
CPT 90834 – 45-Minute Therapy
Time range: 38-52 minutes
Medicare pays: ~$108
When to use: Your standard therapy hour (which is really 45-50 minutes)
CPT 90837 – 60-Minute Therapy
Time range: 53+ minutes
Medicare pays: ~$138
When to use: Complex cases, crisis intervention, intensive trauma processing
The Critical Time Documentation Rule
Your documentation must include session start and end times. Not "approximately 45 minutes." Not "standard session." Actual times: "Session 2:00 PM - 2:47 PM, total 47 minutes."
Why? Because when auditors review your charts, they're looking for time documentation supporting your code selection. Missing time documentation = automatic denial + potential overpayment recovery.
Initial Evaluation Codes
CPT 90791 – Diagnostic Evaluation
Complete psychiatric intake without medical services
Medicare pays: ~$183
Includes: comprehensive history, mental status exam, diagnosis, treatment planning
CPT 90792 – Diagnostic Evaluation With Medical Services
Includes everything in 90791 PLUS medication evaluation/management
Medicare pays: ~$212
Only use if you're prescribing or evaluating medication needs
The Trap: Most therapists can only bill 90791 because they don't prescribe. Using 90792 when you're not a prescriber invites trouble.
Add-On Codes That Boost Revenue
CPT 90785 – Interactive Complexity
Add-on code used WITH another psychotherapy code
Medicare pays: ~$27 additional
When to use: Communication barriers (non-verbal child, severe cognitive impairment), high emotional intensity requiring specialized techniques, third-party involvement complicating care
Documentation requirement: Your note must explicitly describe the interactive complexity factor and how it complicated the session beyond typical therapeutic work.
Family Therapy Codes
CPT 90846 – Family Therapy Without Patient
Medicare pays: ~$104
When to use: Meeting with parents to discuss child's treatment, family sessions where patient isn't present
CPT 90847 – Family Therapy With Patient
Medicare pays: ~$113
When to use: Patient actively participates in family therapy session
Common Billing Mistakes Costing Therapists Real Money
Let's examine the errors I see most often and what they cost.
Mistake #1: Using 90837 for Every Session
Some therapists default to 90837 thinking "I provide quality care, my sessions deserve the higher code." Problem: unless your sessions consistently run 53+ minutes, you're overcoding.
Payers track your billing patterns. If 95% of your claims are 90837 when the national average is 20-30%, you'll get flagged for audit. And when auditors review your charts and find documented times of 45-50 minutes, you'll have to repay the difference potentially thousands of dollars.
Mistake #2: No Time Documentation
"Patient seen for individual therapy. Discussed coping strategies for anxiety. Patient receptive to interventions. Will continue weekly sessions."
What's missing? Session time. Without documented start/end times, payers default to the lowest code (90832) regardless of what you billed. That costs $30-60 per session in lost reimbursement.
Mistake #3: Not Billing Interactive Complexity When Appropriate
Working with a non-verbal autistic child requiring specialized communication techniques? That's interactive complexity (+90785). Doing EMDR with a severely dissociative trauma patient requiring constant grounding? Interactive complexity. High-conflict divorce case where hostile ex-spouse keeps interrupting treatment? Interactive complexity.
These aren't "normal" therapy complications they are scenarios justifying additional reimbursement. But therapists often don't bill for it because they don't realize it's legitimate.
Lost revenue: $25-30 per applicable session. For therapists with 5-10 complex cases weekly, that's $6,500-15,000 annually.
Mistake #4: Missing the Separate E/M Code
This applies mainly to prescribing clinicians (psychiatrists, psychiatric NPs). When you provide significant evaluation and management services (medication review, side effect assessment, dose adjustments) in addition to psychotherapy, you can bill both services.
Example: You spend 15 minutes doing medication management, then 45 minutes providing psychotherapy. You bill an E/M code (99213-99215 depending on complexity) PLUS psychotherapy add-on code 90836.
Many prescribers only bill psychotherapy codes, leaving E/M revenue uncaptured.
Top Psychotherapy and Mental Health Billing Services in 2025
For practices overwhelmed by details, specialized billing partners make a difference. Based on denial reduction, specialty expertise, compliance support, and outcomes:
Sirius Solutions Global — Stands out with deep psychotherapy knowledge, precise time-based coding, and proven denial management that often cuts rejections by 60-80%.
TheraThink
Certified Healthcare Billing (CHBMD)
Valant
TherapyNotes
Kareo/Tebra
Sirius Solutions Global offers scalable, cost-effective solutions with a consultative approach tailored to psychotherapy practices.
Telehealth Billing in 2025: What You Must Know
Telehealth permanently changed therapy. But billing rules remain confusing.
Modifier 95: Append this to your psychotherapy codes (90832, 90834, 90837) when services are delivered via real-time audio-video telehealth.
Place of Service 02: Use this when patient is at home receiving telehealth services.
Audio-Only Sessions: Medicare and many commercial payers now permanently cover audio-only therapy (telephone) for established patients. Same CPT codes (90832, 90834, 90837) with modifier FQ or 93 depending on payer.
Documentation Requirement: Your note must explicitly state "telehealth session conducted via secure video platform" and document patient consent for telehealth services.
How Sirius Solutions Global Helps Therapists Maximize Revenue
After seeing these patterns across hundreds of behavioral health practices, we built our approach around what actually works:
Automated Time Validation: Our system flags claims missing documented session times before submission, preventing denials.
Pattern Analysis: We track your billing distribution. If you're using 90837 for 80% of sessions, we alert you before payers do.
Documentation Training: We provide therapist-specific education on documentation requirements not generic billing advice, but practical guidance for your specific practice type.
Results Our Therapy Clients Experience:
15-25% revenue increase within 90 days (from proper coding, not upcoding)
98%+ clean claim rates
Denial rates under 3%
Collections within 25-30 days
Schedule a complimentary therapy billing analysis: (469) 694-5375 | Info@siriussolutionsglobal.com
