Psychiatry and PMHNP practices billing
Psychiatric billing where E/M and psychotherapy are coded correctly together
Psychiatric billing covers diagnostic evaluations, medication management and combined medication-and-psychotherapy visits provided by psychiatrists and psychiatric mental health nurse practitioners (PMHNPs). The core difficulty is that a single visit can combine an evaluation and management (E/M) service with a psychotherapy add-on — and the documentation must support both, separately.
Built for
- Independent psychiatrists and psychiatric group practices
- PMHNP-owned practices and mixed physician/NP groups
- Telepsychiatry practices serving patients in multiple states
Where psychiatry revenue usually gets stuck
- E/M with psychotherapy add-ons
- Combined visits are frequently under-coded (add-on left off) or denied (time not documented separately).
- Medication management volume
- Short, frequent follow-ups make E/M level selection and documentation consistency important across providers.
- Nurse practitioner billing
- Whether a PMHNP bills under their own NPI or incident-to a physician changes requirements and, for Medicare, reimbursement.
- Telehealth across states
- Licensure, enrollment and telehealth rules must line up for each state where patients are located.
What we handle for you
The services that apply to psychiatry practices, and what each one means in practice.
| Service | For psychiatry practices |
|---|---|
| Medical coding and coding quality | E/M level selection, psychotherapy add-on time, diagnostic evaluation with medical services. |
| End-to-end medical billing | High-frequency follow-up visits, telehealth claims, secondary filing. |
| Credentialing, payer enrollment and contracting | Physician and NP enrollment per payer and per state, including behavioral health carve-outs. |
| Eligibility, benefits and prior authorization | Medical vs behavioral health benefit determination before visits. |
| Denial prevention and appeals | Add-on and modifier denials, provider-type denials, telehealth policy denials. |
| Accounts receivable management | Follow-up prioritized by payer, provider and filing deadline. |
Claims, coding and authorization details that matter
- E/M plus psychotherapy add-on
- Psychotherapy performed with an E/M visit is reported with add-on codes (90833, 90836, 90838) based on psychotherapy time. Time spent on psychotherapy cannot also be counted toward E/M time, so documentation should make both components distinct.
- Psychiatric diagnostic evaluation
- 90792 (with medical services) and 90791 (without) are distinct from E/M new-patient visits; payer preference and frequency limits vary.
- Medication management
- Follow-up visits are generally reported with E/M codes selected by medical decision making or total time, following current CPT E/M guidelines.
- PMHNP reimbursement
- Under Medicare, services billed under a nurse practitioner's own NPI are generally paid at 85% of the physician fee schedule; incident-to billing has strict supervision and plan-of-care requirements. Commercial payers set their own policies.
Our psychiatry billing workflow
- 1
Provider enrolled per state
Enrollment and licensure confirmed for every state where patients are seen.
- 2
Visit documented
E/M elements and psychotherapy time documented as separate components when both occur.
- 3
Coding review
E/M level and add-on time checked against the note before the claim is built.
- 4
Telehealth applied
Place of service and modifiers set per payer policy for video or audio-only visits.
- 5
Adjudication watched
Add-on denials and provider-type denials worked promptly.
- 6
Provider-level report
Monthly results by provider, including coding review findings.
Payer coordination
- Some plans route psychiatric services through a behavioral health carve-out and others through the medical plan — sometimes depending on the code billed.
- NP credentialing is handled differently by different payers; some require a collaborating physician on file depending on state scope-of-practice law.
- Telehealth for patients located in another state requires the provider to be licensed, and usually enrolled, for that state.
Compliance notes
- Coding statements are general guidance based on CPT and CMS policy; final code selection depends on documentation and current payer rules.
- Prescribing rules for controlled substances via telemedicine are a clinical and regulatory matter outside billing scope; we do not advise on them.
- Incident-to billing is applied only when the practice confirms that all requirements are met.
Psychiatry and PMHNP practices billing: questions we hear
Our providers often forget the psychotherapy add-on. Can you catch that?
Yes. Coding review compares the note to the codes selected. When psychotherapy time is documented but not coded — or coded without documentation — we flag it to the provider before the claim goes out.
Do you bill for PMHNPs under their own NPI?
Yes, and we can help you understand when incident-to billing applies and what it requires. The decision is yours; we make sure it is applied consistently.
We see patients in several states by telehealth. Can you handle that?
We manage enrollment and billing for each state where you are licensed. Before billing, we confirm the provider is licensed and enrolled for the patient's location.
Can you review our E/M coding before we switch?
A coding review on a sample of recent visits is a good starting point. It shows where documentation and code selection line up — and where they do not.
Related specialties
Primary sources
Content last reviewed . Payer rules change; this page is general information, not legal or coding advice for a specific claim.
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