Mental Health Billing Codes and Medicare Rates (2026 Guide)

Mental health billing codes come from one small CPT family: 90791 or 90792 for the intake evaluation, 90832, 90834 or 90837 for therapy sessions by minutes, the add-ons 90833, 90836 and 90838 when a prescriber also bills an E/M visit, plus crisis, family and group codes. Which one you bill depends on what happened, how long it took and who provided it. What Medicare pays depends on the code, your locality, the setting and the clinician's provider type.

This guide maps the whole set and links to a full comparison wherever two codes are easy to confuse. Every rate is live from the current CMS release.

Mental health billing codes at a glance

For the full rules on every code, read psychotherapy CPT codes.

Choosing a session code by time

Medicare contractors publish these ranges and require start and stop times or total minutes in the note (First Coast A57520). Two lines decide most claims:

• 37 or 38 minutes. The step from 90832 to 90834. See 90832 vs 90834.
• 52 or 53 minutes. The step from 90834 to 90837, and the one contractors review most. See 90834 vs 90837.

The scheduled slot doesn't matter. A one-hour appointment with 50 minutes of therapy is 90834.

What Medicare pays for therapy

Medicare's allowed amount is the fee schedule amount for the code, locality and setting, times the share for the clinician's provider type. Medicare pays 80% of that after the Part B deductible, and the patient owes 20%.

The 75% is set in 42 CFR 414.53; the E/M limit comes from the CY 2025 rule, which says psychologists, social workers, MFTs and counselors "cannot independently bill Medicare for E/M visits" (89 FR 97929). For a specific code, clinician and ZIP, use Medicare reimbursement by provider type. For the whole code set at your locality as a CSV or PDF, use the behavioral health fee schedule.

Why therapists look up Medicare rates even if they don't take Medicare

Medicare's fee schedule is the reference price for outpatient mental health care. Commercial contracts are often written or reviewed as a percentage of Medicare, EAP session rates get compared against it, and cash-pay practices use it to sanity-check a self-pay fee or a sliding scale. Knowing the Medicare amount for 90834 and 90837 at your locality tells you whether a payer's offer is generous, typical or low.

It also answers the enrollment question. Since January 1, 2024, LMFTs and LPCs can enroll in Medicare, and many practices are deciding whether it's worth it. Three tools help:

• Medicare reimbursement by provider type: what you would be allowed per session under your own NPI.
• Contract check: a payer's rates as a percentage of Medicare for your ZIP.
• Private-practice break-even calculator: how many sessions a week cover your costs at a given rate, insurance or cash.

Telehealth rules for therapy in 2026

Behavioral health telehealth has its own, permanent rules under Medicare, separate from the temporary flexibilities for other services. From CMS's Telehealth FAQ (updated February 26, 2026):

• Anywhere, including home. The Consolidated Appropriations Act, 2021 permanently removed geographic and location restrictions for behavioral health telehealth. Patients in rural and urban areas can be seen at home.
• Audio-only is allowed. Two-way, real-time audio-only technology is permitted for behavioral health services. Mark audio-only Medicare claims with modifier 93.
• In-person visit, later. The law requires an in-person visit within six months before the first mental health telehealth service, effective after December 31, 2027. Patients who start telehealth care on or before that date are treated as established and instead need an in-person visit at least every 12 months after it.
• After 2027, behavioral health keeps home telehealth. From January 1, 2028, most other telehealth returns to rural, facility-based sites, but CMS lists behavioral health as the exception.
• Practitioners can work from home. A therapist with a physical office can provide telehealth from home without enrolling the home address; a virtual-only practice enrolls its home address as a practice location.

On the claim, POS 10 means the patient was at home and is paid at the office (non-facility) rate; POS 02 means the patient was somewhere else and is paid at the facility rate. Medicare identifies telehealth on professional claims by POS rather than modifier 95, but many commercial and Medicaid plans still require the modifier. See place of service codes for the full list.

The psychotherapy, evaluation, family and group codes, crisis psychotherapy and interactive complexity are all on the Medicare Telehealth Services List (MLN1986542).

Incident-to and supervision in behavioral health

A psychiatrist, psychologist or NP can bill a supervised clinician's service under their own NPI (incident-to billing) if every incident-to requirement is met. Behavioral health has two differences:

• General supervision is enough. CMS exempts behavioral health services by auxiliary personnel from the direct supervision requirement; the supervising practitioner can be reachable by phone (MLN1986542).
• Not incident-to a therapist. LCSWs, LMFTs and LPCs can provide services incident to a physician or NPP, but can't have services billed incident to themselves.

Incident-to doesn't work in a hospital or SNF setting, and the person providing psychotherapy must be licensed in the state to provide it.

Documentation every behavioral health claim needs

Contractor reviews of psychotherapy look for the same things (CGS post-payment review, 2021):

1. Time. Start and stop times or total minutes for every timed code.
2. A treatment plan. Goals the sessions are working toward, updated as care goes on.
3. A session note. What was done, the techniques used and how the patient responded.
4. Periodic summaries. Progress over the course of treatment.
5. A valid signature. Legible, from the clinician who provided the service.

All behavioral health guides and tools

• Code choices: 90834 vs 90837 · 90832 vs 90834 · 90791 vs 90792 · 90846 vs 90847 · psychotherapy add-on codes
• Every code: psychotherapy CPT codes
• Rates: behavioral health fee schedule · rates by provider type · contract check
• Rules: incident-to billing · modifier 95 · modifier 93 · place of service codes · facility vs non-facility rates
• Code pages: 90791 90792 90832 90833 90834 90836 90837 90838 90785 90839 90840 90846 90847 90853

Running a group practice with several clinician types and payers? A custom fee sheet prices your codes for each provider type at your locality.