Psychiatric Add-On Claim Denials: 5 Easy Fixes

Psychiatric add-on claim denials usually come from one problem: the payer cannot see two separate services. A psychiatrist sees a patient, manages medication and also provides psychotherapy. The claim has to show both.

What the psychotherapy add-on code is

Psychiatric add-on claim denials usually involve two services on one day: an E/M code for the medical visit and a psychotherapy add-on code. The add-on code depends on psychotherapy time: 90833 for 16 to 37 minutes, 90836 for 38 to 52 minutes and 90838 for 53 minutes or more, as Magellan Healthcare explains. See the full list of psychotherapy codes in our glossary.

Why psychiatric add-on claim denials happen

Payers deny these claims when they cannot see two separate services. Four causes come up most:

• Shared time. The note counts the same minutes toward the visit and the therapy.
• Thin notes. Entries like “supportive therapy performed” do not show what was done.
• Payer policy. Some payers limit which E/M levels can pair with an add-on code.
• Modifier rules. Some payers ask for a modifier. Others do not.

Magellan lists the same-time problem, vague notes and cloned notes as common errors. Its example: a 20-minute visit with 16 minutes of psychotherapy leaves only 4 minutes for the E/M service.

One payer example, not a national rule

Policies differ by payer. Blue Shield Promise policy PI0061, effective 7/1/2025, denies the add-on codes when billed with E/M codes 99204, 99205, 99214 or 99215 for the same member, provider and date. The American Psychiatric Association wrote to Blue Shield on July 14, 2026 and asked it to rescind that policy and a separate modifier 25 rule, saying CPT does not require modifier 25 for these codes. See the APA letter. Check the current policy before you bill that payer.

What to document for psychiatric add-on claims

Write the visit note and the therapy note so each stands alone. Record psychotherapy start and stop times, not only total visit time. Describe the interventions, the patient’s response and the treatment goals. Keep medication management and therapy in separate parts of the note. Do not copy forward old notes.

Private payer, Medicare and state rules

Keep these separate. Private payers set rules in their policies and contracts. Medicare follows CMS.gov guidance and your Medicare contractor. State Medicaid programs set their own rules and vary by state. Never apply one payer’s policy to another.

What to do on Monday morning

• Pull your last 30 days of denials for 90833, 90836 and 90838.
• Group them by payer and by the denial code on the remittance.
• Read each payer’s policy for E/M and add-on pairs and modifiers.
• Compare the notes to the documentation list above.
• Appeal where the note supports two separate services.

Our guides on the psychiatry billing guide and the psychiatric billing service checklist help you set this up. If psychiatric add-on claim denials keep coming back, our denied claim follow-up and appeals service can take them on.

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We bill for solo and medium-size mental and behavioral health practices only.

The short version

• Psychiatric add-on claim denials usually mean the payer cannot see two separate services.
• Document psychotherapy start and stop times apart from the visit.
• Payer policies differ on E/M pairs and modifier 25, so read each one.
• Appeal where your notes support both services.

Sources checked (10/27/26)

• Magellan Healthcare: using psychotherapy add-on codes
• Blue Shield Promise policy PI0061
• American Psychiatric Association letter, 7/14/2026

Frequently asked questions