2026 Clinical Practice Reference

Behavioral Health CPT & Billing Reference Guide

Searchable CPT coding benchmarks, session duration thresholds, parity audit rules, and documentation requirements for mental health clinics and solo practitioners.

90837 Individual Psychotherapy

Psychotherapy, 60 minutes

Required Time Threshold: 53 to 67 minutes (minimum 53 minutes required)

Insight-oriented, behavior-modifying, or supportive psychotherapy with the patient for 60 minutes.

Required Clinical Documentation:

  • Exact session start and stop times must be explicitly documented in the clinical record.
  • Clinical rationale for an extended 60-minute duration must be evident (e.g. trauma processing, crisis de-escalation, severe symptom severity).
  • Must document mental status exam, progress toward treatment plan goals, and specific therapeutic modalities applied.
Parity & Audit Risk Note:

High. Major commercial payers audit 90837 frequency. Ensure clinical justification is clearly distinguished from 90834.

2026 Reimbursement Benchmarks:
Commercial In-Net: $125 – $190
Medicare Part B: $145 – $170
Cash Self-Pay: $150 – $250
90834 Individual Psychotherapy

Psychotherapy, 45 minutes

Required Time Threshold: 38 to 52 minutes

Insight-oriented, behavior-modifying, or supportive psychotherapy with the patient for 45 minutes.

Required Clinical Documentation:

  • Exact start/stop timestamps required.
  • Standard individual outpatient session code. Focus on target symptom reduction and homework/intervention review.
  • Treatment plan review at required clinical intervals.
Parity & Audit Risk Note:

Low to Moderate. Standard baseline billing code for weekly outpatient psychotherapy.

2026 Reimbursement Benchmarks:
Commercial In-Net: $95 – $145
Medicare Part B: $110 – $130
Cash Self-Pay: $125 – $200
90832 Individual Psychotherapy

Psychotherapy, 30 minutes

Required Time Threshold: 16 to 37 minutes

Brief individual psychotherapy with the patient.

Required Clinical Documentation:

  • Document specific focus of brief intervention (e.g. check-in, skill reinforcement, brief cognitive reframing).
  • Exact start and stop times required.
Parity & Audit Risk Note:

Low. Commonly used in integrated primary care or brief stabilization visits.

2026 Reimbursement Benchmarks:
Commercial In-Net: $65 – $95
Medicare Part B: $70 – $88
Cash Self-Pay: $80 – $130
90791 Diagnostic & Intake

Psychiatric Diagnostic Evaluation

Required Time Threshold: Typically 60 to 90 minutes (no specific time rule, but comprehensive)

Integrated biopsychosocial assessment, history, mental status exam, diagnosis, and initial treatment recommendations without medical services.

Required Clinical Documentation:

  • Complete biopsychosocial history, family psychiatric history, substance use history, and medical background.
  • Formal Mental Status Examination (MSE) and DSM-5-TR diagnostic formulation.
  • Measurable, individualized initial treatment plan with goals, objectives, and proposed session frequency.
Parity & Audit Risk Note:

Moderate. Generally billed once per episode of care or annually unless a new diagnostic episode begins.

2026 Reimbursement Benchmarks:
Commercial In-Net: $160 – $240
Medicare Part B: $180 – $215
Cash Self-Pay: $200 – $350
90847 Family & Couples

Family Psychotherapy (conjoint with patient present)

Required Time Threshold: Minimum 26 minutes (typically 50 minutes)

Psychotherapy with the patient and family members or partner present.

Required Clinical Documentation:

  • Must explicitly focus on the primary identified patient's diagnosis and treatment plan goals.
  • Document interpersonal dynamics, therapeutic interventions used with the family system, and clinical progress.
Parity & Audit Risk Note:

Moderate. Some commercial plans restrict coverage for couples therapy without an active DSM-5 diagnosis for the identified patient.

2026 Reimbursement Benchmarks:
Commercial In-Net: $115 – $170
Medicare Part B: $125 – $155
Cash Self-Pay: $160 – $275
90839 Crisis Intervention

Psychotherapy for Crisis (first 60 minutes)

Required Time Threshold: 30 to 74 minutes

Urgent assessment and crisis intervention for a patient presenting in high distress with acute, life-threatening, or severe complex safety risks.

Required Clinical Documentation:

  • Document immediate crisis presentation (e.g. active suicidal ideation, psychosis, severe acute trauma, imminent safety risk).
  • Detailed safety plan, crisis de-escalation interventions, coordination with support systems or emergency services.
  • Start and stop times mandatory.
Parity & Audit Risk Note:

Moderate. Requires explicit documentation of acute crisis and immediate safety risk rather than routine distress.

2026 Reimbursement Benchmarks:
Commercial In-Net: $150 – $220
Medicare Part B: $165 – $200
Cash Self-Pay: $200 – $325
90840 Crisis Intervention

Psychotherapy for Crisis (each additional 30 minutes)

Required Time Threshold: Each additional 30 minutes beyond first 74 minutes

Add-on code used in conjunction with 90839 for extended crisis intervention.

Required Clinical Documentation:

  • Must be billed as an add-on to 90839. Document clinical necessity of extended emergency session time.
Parity & Audit Risk Note:

Moderate. Ensure cumulative time across 90839 + 90840 meets the 75+ minute threshold.

2026 Reimbursement Benchmarks:
Commercial In-Net: $75 – $110
Medicare Part B: $82 – $100
Cash Self-Pay: $100 – $175
Modifier 95 / POS 10 Telehealth & Modifiers

Telehealth Synchronous Audio/Video Service

Required Time Threshold: Applied to standard psychotherapy codes

Modifier 95 or Place of Service (POS) 10 indicates that the behavioral health service was provided via real-time interactive telehealth to a patient in their home.

Required Clinical Documentation:

  • Document that service was provided via secure, HIPAA-compliant audiovisual platform.
  • Document patient physical location at time of session and emergency contact protocols in patient's jurisdiction.
  • Use POS 10 when patient is at home; POS 02 when patient is at an external telehealth site.
Parity & Audit Risk Note:

Low. Parity laws in most states mandate equal reimbursement for audio-video telehealth as in-person.

2026 Reimbursement Benchmarks:
Commercial In-Net: 100% of in-person parity in most states
Medicare Part B: Equal to in-person facility/non-facility rate
Cash Self-Pay: Standard clinic rate