How Often You Can Bill Mental Health CPT Codes, and What Your Notes Must Show
CMS.gov rules on frequency limits and documentation for evaluation, psychotherapy, crisis, family and group, and screening codes. Checked 9/29/26.
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Documentation Requirements at a glance
This page covers documentation requirements for mental health billing: what the codes cover, how payers apply them, and what to document. Psychotherapists and psychiatrists both use these codes, so the sections below call out differences where they matter. Payer rules vary, so confirm current requirements with the payer before you bill.
Documentation requirements come from three places: the CPT code descriptor, the payer medical policy, and state law. The documentation requirements for time-based codes start with the session start and stop times. Strong documentation requirements also cover the diagnosis, the treatment goals the session worked on, and the patient response. If a note does not meet the payer documentation requirements, the claim can be denied or recouped after review. Use the documentation requirements below as a starting point, then check each payer own documentation requirements before you bill. Keep a copy of the payer documentation requirements with your note templates, and review your documentation requirements whenever a payer updates its policy.
What do CMS frequency and documentation rules cover?
CMS (the Centers for Medicare & Medicaid Services) publishes Medicare billing rules. Frequency rules say how often a code can be billed. Documentation rules say what the medical record must show to support the claim. Most detail comes from Medicare Administrative Contractors (MACs), the companies that process Medicare claims for each region, and they post it on CMS.gov as billing articles. These are Medicare rules. Private payers and state Medicaid programs set their own, and often borrow from these. See the non-E/M code tables for the time range of each code.
Three labeled rule sets on this page. Medicare (CMS.gov): sourced below. Private payers: not covered by CMS; ask each payer. State law and state Medicaid: varies by state; never assume a neighboring state's rule.
How often can you bill each code?
Read the “Source” column. Several rules come from one MAC's article and may differ elsewhere.
| Code | Frequency rule | Source |
|---|---|---|
| 90791, 90792 | Once, at the onset of an illness or suspected illness. A repeat is allowed after a break of about 6 months, an inpatient admission, a significant change in mental status, or when the diagnosis needs clarifying.Contractor rule: other Medicare contractors may word this differently. | Contractor article A57480 (WPS) Time ranges → |
| 90791, 90792 with psychotherapy or E/M | Not reported with any psychotherapy code (individual, group, family, crisis) on the same date. E/M codes are not reported with 90791 or 90792. | NCCI Policy Manual, Ch. XI (1/1/2026) Time ranges → |
| 90832, 90834, 90837 | No annual cap appears in the contractor articles reviewed. Medical necessity governs. A session over 90 minutes is paid only if the record shows the face-to-face time and why the extra time was needed.Absence of a cap in these articles is not a guarantee. Your Medicare contractor and each plan may set limits. | A57480 · A59723 (Palmetto) Time ranges → |
| 90846, 90847 with 90832, 90833, 90834, 90836, 90837, 90838 | Allowed on the same date only as a separate, distinct service in a separate time interval, focused on the patient's interactions with family. | NCCI Manual, Ch. XI Time ranges → |
| 90839, +90840 | Not billed with 90791, 90792, 90785–90899 or 90832, 90833, 90834, 90836, 90837, 90838. Time can be non-continuous on the date of service. | CMS, Psychotherapy for Crisis Time ranges → |
| +90785 | Add-on. Not billed if the patient cannot communicate by any means. Can be added to 90853 when medically indicated. | A57520 (First Coast) · A57480 Time ranges → |
| G0442 | Annual alcohol misuse screening.Medicare NCD 210.8: read the NCD. | CMS SBIRT fact sheet Time ranges → |
| G0443 | Up to 4 brief face-to-face counseling sessions per year. No more than 1 intervention per patient per day. | CMS MLN9560465 (April 2026) Time ranges → |
| G0444 | One depression screening per 12 months. Coverage requires a primary care setting with staff-assisted depression care supports.Many behavioral health practices do not meet the primary care setting requirement. Verify before billing. | NCD 210.9 Time ranges → |
| G0396, G0397, G2011 | No frequency limit stated in the CMS documents reviewed.Verify with your Medicare contractor and the payer. | CMS SBIRT fact sheet Time ranges → |
| 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 | Frequency and unit limits are not stated in the CMS sources reviewed. Check the MUE table. Testing is usually prior-authorization driven with commercial payers.Verify with the payer. | CMS MUE page Time ranges → |
| Every code: MUE | A medically unlikely edit (MUE) is the maximum units of one code that one provider can report for one patient on one date of service. CMS posts MUE changes quarterly. The Practitioner Services MUE table effective October 1, 2026 was posted September 1, 2026.Per-code MUE values are not listed on this page. Look up each code in the current table. | CMS, Medicare NCCI MUEs Time ranges → |
What must the medical record show?
Every timed code needs the date of service and the start and end time. The rest depends on the service.
Every record
Legible, with the patient's identification and the dates of service on every page, and the legible signature of the practitioner who provided the care. Records must be available to the contractor on request.
Source: A57520
Time
Time may be documented as start and stop times or as total time. It is required for 90832, 90834 and 90837.
Source: A57520
Psychotherapy with an E/M visit
The two services must be significant and separately identifiable. Document the psychotherapy start and stop times or total time apart from the E/M. A separate diagnosis is not required.
Progress note content
Time spent, the interventions used, a periodic summary of goals, progress toward goals, and a detailed session summary with the patient's participation and goal-oriented outcomes.
Source: A59723 (Palmetto)
Treatment plan
Updated generally every three months, with the estimated duration of treatment and the treatment goals.
Source: A59723
Medical necessity
A psychiatric illness and/or emotional or behavioral symptoms sufficient to alter baseline functioning.
Source: A59723
Sessions over 90 minutes
The record must show the face-to-face time and the medical necessity for the extended time.
Source: A57480
Interactive complexity (+90785)
Record the adaptations used in the session and the reason for using them.
Source: A57065 (CGS)
Crisis (90839, +90840)
Time-based on the total face-to-face time with the patient and/or family.
Source: A57520 · CMS crisis page
Screening and brief intervention
Assessment, clinical impression, diagnosis, start and stop times or total face-to-face time, and the plan of care.
Source: CMS SBIRT fact sheet
A note that supports the claim
This checklist is our recommended standard, built from the CMS sources above. It is stricter than some contractors on one point: we ask for start and end time on every timed code, not just the three psychotherapy codes.
- Patient name and ID; date of service
- Practitioner name, credentials and signature
- Start time and end time (or total time) for every timed code
- Who attended, for family and group sessions
- Interventions used and the patient's response
- Progress toward the treatment plan goals
- Diagnosis, coded to the highest specificity
- Why the service was medically necessary
- For an add-on: the base service time and the add-on time, separately
- For +90785: what was adapted and why
Private payers, Medicaid and state rules
Private (commercial) payers
CMS rules do not bind them. Ask each payer: Does it follow the CPT time ranges? Is there an annual visit limit or prior authorization? How often will it pay 90791? What do its audits look for in a note?
State Medicaid and state law
Varies by state, and managed care plans can differ inside one state. Check the state Medicaid manual and each managed care plan's provider manual. Do not apply one state's rule to another.
Frequently asked questions
How often can I bill 90791?
Once, at the onset of an illness or suspected illness. A Medicare contractor article (A57480) allows a repeat after a break of about six months, an inpatient admission, a significant change in mental status, or when the diagnosis needs clarifying. Commercial payers set their own limits, so ask each one.
Is there a limit on psychotherapy sessions per year under Medicare?
The Medicare contractor articles reviewed (First Coast A57520, Palmetto A59723, WPS A57480) do not state an annual cap for 90832, 90834 or 90837. Medical necessity governs, and a session over 90 minutes needs documented face-to-face time and necessity. Your Medicare contractor or the patient's plan can apply other limits, and commercial payers often do.
What is an MUE and how do I look up a code?
A medically unlikely edit (MUE) is the most units of one code a provider can report for one patient on one date of service, as defined by CMS. CMS publishes the Practitioner Services MUE table quarterly. Download the current table from the CMS MUE page and search for each code you bill.
What does CMS require in a psychotherapy progress note?
Contractor guidance calls for the time spent, the interventions used, a periodic summary of goals, progress toward those goals, and a detailed session summary. It also calls for start and stop times or total time, and for treatment plans updated about every three months. See the documentation section above for the sources.
Can a therapist bill G0444 depression screening to Medicare?
Only if the setting qualifies. NCD 210.9 covers one screening per 12 months in a primary care setting that has staff-assisted depression care supports. Many behavioral health practices do not meet that requirement, so verify with your Medicare contractor before billing.
CMS.gov sources
- Article A57520, Psychiatric Diagnostic Evaluation and Psychotherapy Services (First Coast Service Options; FL, PR, USVI; rev. 1/1/2025)
- Article A57480, Psychiatry and Psychology Services (WPS; rev. 1/1/2026)
- Article A59723, Outpatient Psychotherapy (Palmetto GBA; effective 10/20/2024)
- Article A57065, Outpatient Psychiatry and Psychology Services (CGS; effective 10/1/2025)
- CMS, Psychotherapy for Crisis · CMS SBIRT fact sheet MLN904084 (May 2025) · CMS MLN9560465 (April 2026)
- NCD 210.9, Screening for Depression in Adults · NCD 210.8, Alcohol Misuse Screening and Counseling
- NCCI Medicare Policy Manual, Chapter XI (1/1/2026) · Medicare NCCI Medically Unlikely Edits
Current as of last search (9/29/26). Reconfirm before publishing. Operational billing guidance, not legal advice: confirm anything with real financial exposure with counsel or a compliance officer.
Notes that hold up in an audit
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