Home › Resources › Billing Terms Glossary › CPT, E/M & HCPCS Code Entries

Billing Terms Glossary

CPT Codes Glossary: Definitions for Therapists and Psychiatrists

This CPT codes glossary lists the This CPT codes glossary defines in plain English for therapists and psychiatrists. Code entries define each CPT, E/M, and HCPCS code that behavioral health practices bill, one code at a time. Each entry shows the time range or level, what it can be billed with, and what to document.

In this section

54 terms defined
Written for psychotherapists and psychiatrists
Source organization linked on every entry

Back to the full billing terms glossary

Quiet behavioral health practice office with a desk and armchairs, the setting for our CPT codes for mental health glossary

CPT 90785

General (all payers)

Also called: +90785; interactive complexity add-on

Definition: CPT +90785 is the interactive complexity add-on code. A Medicare contractor article describes it as an add-on specific to psychiatric services that refers to communication difficulties during the procedure.
Why it matters: It is not a timed code and is not billed if the patient cannot communicate by any means. It is not added to crisis codes 90839 and 90840. Record what was adapted and why. It can be billed with 90853 when medically indicated.
Illustrative example: A therapist uses a play-based approach and involves a caregiver to overcome a communication barrier, and adds +90785 to the psychotherapy code with a note explaining why.

Verify: CPT lists the base codes it can accompany. Confirm the current list and each payer's policy.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · CMS Coverage Database, Article A57065 (CGS)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90791

General (all payers)

Also called: 90791; psychiatric diagnostic evaluation without medical services; psych intake code

Definition: CPT 90791 is the psychiatric diagnostic evaluation without medical services. A psychotherapist or a psychiatrist uses it to assess a new patient, reach a diagnosis, and start a treatment plan. CMS lists 90791 under the name "Psychiatric diagnostic evaluation."
Why it matters: It is normally billed once, at the start of an illness or suspected illness. A Medicare contractor article allows a repeat after a break in care of about six months, an inpatient admission, a significant change in mental status, or when the diagnosis needs clarifying. Under the Medicare NCCI policy manual it is not reported with psychotherapy codes on the same date, and E/M codes are not reported with it. Commercial payers set their own limits.
Illustrative example: A therapist bills 90791 for a new client's intake on Monday and 90834 for the first therapy session the following week.

Verify: No minute range is defined for this code. Medicare rules current as of 9/29/26; ask each commercial payer how often it pays 90791.

Reference source CMS Medicare Learning Network (MLN) · CMS Coverage Database, Article A57480 (WPS) · CMS, NCCI Medicare Policy Manual, Chapter XI

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90792

General (all payers)

Also called: 90792; psychiatric diagnostic evaluation with medical services

Definition: CPT 90792 is the psychiatric diagnostic evaluation with medical services. Prescribers, such as psychiatrists and psychiatric nurse practitioners, use it when the evaluation includes a medical assessment. CMS lists 90792 under the name "Psychiatric diagnostic evaluation."
Why it matters: A Medicare contractor article says a practitioner who performs an evaluation with medical assessment may use 90792 or an E/M code. Under the Medicare NCCI policy manual an E/M is not reported with 90792 on the same date. Frequency follows the same rule as 90791.
Illustrative example: A psychiatrist evaluates a new patient, reviews medical history, and starts medication in the same visit, and bills 90792.

Verify: No minute range is defined for this code. Medicare rules current as of 9/29/26; commercial payers may require 90792 or an E/M for prescriber intakes.

Reference source CMS Medicare Learning Network (MLN) · CMS Coverage Database, Article A57520 (First Coast) · CMS, NCCI Medicare Policy Manual, Chapter XI

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90832

General (all payers)

Also called: 90832; psychotherapy 30 minutes; 16-37 minutes

Definition: CPT 90832 is individual psychotherapy with the patient and/or a family member. The AMA describes it with a typical time of 30 minutes, and a Medicare contractor article (First Coast A57520) quotes the billable range as 16 to 37 minutes.
Why it matters: Choose the code by the face-to-face minutes on the note, not the typical time. A session of 15 minutes or less is not billable as psychotherapy. Medicare contractors require start and stop times, or the total time, for 90832, 90834 and 90837.
Illustrative example: A 30-minute check-in session that ran 10:00 to 10:32 is billed 90832.

Verify: The 16-37 minute range is CPT-defined and quoted by one Medicare contractor. Confirm each payer follows the CPT ranges.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90833

General (all payers)

Also called: +90833; psychotherapy add-on 16-37 minutes; psychotherapy with E/M 30 minutes

Definition: CPT +90833 is an add-on code for psychotherapy, 16 to 37 minutes, reported together with an E/M service on the same date. It is never billed alone.
Why it matters: Psychiatrists and other prescribers use it when medication management and psychotherapy happen in the same visit. Pick the E/M level by medical decision making only, and count the psychotherapy time separately from the E/M. The psychotherapy time does not have to be continuous. The E/M and the psychotherapy must each be significant and separately identifiable.
Illustrative example: A psychiatrist bills 99214 plus +90833 for a visit with a medication review and 25 minutes of psychotherapy.

Verify: Range is CPT-defined and quoted by a Medicare contractor. Confirm payer policy on which E/M codes it accepts with add-ons.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90834

General (all payers)

Also called: 90834; psychotherapy 45 minutes; 38-52 minutes

Definition: CPT 90834 is individual psychotherapy with the patient and/or a family member. The AMA describes it with a typical time of 45 minutes, and a Medicare contractor article quotes the billable range as 38 to 52 minutes.
Why it matters: It is the most commonly billed therapy code. Record the date of service and the start and end time on every note. Choose 90837 only when the session reaches 53 minutes.
Illustrative example: A 50-minute session from 2:00 to 2:50 is billed 90834.

Verify: The 38-52 minute range is CPT-defined and quoted by one Medicare contractor. Confirm each payer follows the CPT ranges.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90836

General (all payers)

Also called: +90836; psychotherapy add-on 38-52 minutes; psychotherapy with E/M 45 minutes

Definition: CPT +90836 is an add-on code for psychotherapy, 38 to 52 minutes, reported together with an E/M service on the same date.
Why it matters: It pairs with office and outpatient E/M codes (99202 to 99215) and with home or residence E/M codes (99341 to 99350) under Medicare contractor guidance. Do not count E/M time toward the psychotherapy time.
Illustrative example: A psychiatrist bills 99213 plus +90836 for a follow-up with a 45-minute psychotherapy portion.

Verify: Range is CPT-defined and quoted by a Medicare contractor. Payer rules on pairing vary.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90837

General (all payers)

Also called: 90837; psychotherapy 60 minutes; 53 minutes or more

Definition: CPT 90837 is individual psychotherapy with the patient and/or a family member. The AMA describes it with a typical time of 60 minutes, and a Medicare contractor article quotes the billable floor as 53 minutes or more.
Why it matters: It draws the most payer and Medicare audit attention, so document exact start and stop times, not estimates. There is no code for a 75-minute or a 90-minute session, and no 46 to 52 minute tier. A Medicare contractor pays a session over 90 minutes only when the record shows the face-to-face time and the medical necessity for the extra time.
Illustrative example: A 58-minute session from 3:00 to 3:58 is billed 90837, and the note shows both times.

Verify: Range is CPT-defined. Some commercial payers require authorization or a policy review for 90837. Confirm with each payer.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90838

General (all payers)

Also called: +90838; psychotherapy add-on 53 minutes or more; psychotherapy with E/M 60 minutes

Definition: CPT +90838 is an add-on code for psychotherapy, 53 minutes or more, reported together with an E/M service on the same date.
Why it matters: The E/M level is chosen separately by medical decision making. Document the psychotherapy start and stop times or total time apart from the E/M. Because the add-on needs 53 minutes, the whole visit is long, so the note must clearly show the two services.
Illustrative example: A prescriber bills 99215 plus +90838 for a visit that includes 55 minutes of psychotherapy.

Verify: Range is CPT-defined and quoted by a Medicare contractor. Confirm payer policy.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Coverage Database, Article A57520 (First Coast) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90839

General (all payers)

Also called: 90839; psychotherapy for crisis first 60 minutes; crisis psychotherapy

Definition: CPT 90839 is psychotherapy for crisis. CMS describes the service as an urgent assessment and history of a crisis state, a mental status exam, and a disposition, and words 90839 as "first 60 minutes." CPT defines the range as 30 to 74 minutes.
Why it matters: Because CMS and CPT word the time differently, confirm the threshold with each payer. CMS says crisis codes are not billed with 90791, 90792, 90785 through 90899, or 90832 through 90838. The time can be non-continuous on the date of service.
Illustrative example: A therapist spends 45 minutes stabilizing a client in acute distress and bills 90839.

Verify: The 30-74 minute range is CPT-defined while the CMS page says "first 60 minutes." Confirm each payer's threshold. Medicare rules current as of 9/29/26.

Reference source CMS, Psychotherapy for Crisis · CMS (Centers for Medicare & Medicaid Services)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90840

General (all payers)

Also called: +90840; crisis psychotherapy each additional 30 minutes; crisis add-on

Definition: CPT +90840 is the add-on code for each additional 30 minutes of psychotherapy for crisis. It is billed only with 90839, once the crisis service reaches 75 minutes under the CPT definition.
Why it matters: Record the start and end time of the whole crisis service so the extra block is supported. Do not bill an E/M or a psychotherapy add-on for the same crisis time.
Illustrative example: A crisis session runs 95 minutes, so the claim shows 90839 plus one unit of +90840.

Verify: The 75-minute threshold is CPT-defined. Confirm each payer's rule.

Reference source CMS, Psychotherapy for Crisis · CMS (Centers for Medicare & Medicaid Services)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90845

General (all payers)

Also called: 90845; psychoanalysis

Definition: CPT 90845 is psychoanalysis. CMS lists it among covered mental health codes.
Why it matters: No minute range is defined. Payers may limit how often it is billed or require review, so confirm policy before you schedule a course of care.
Illustrative example: An analyst bills 90845 for an established psychoanalytic session after confirming the payer's coverage.

Verify: Payer coverage and limits vary widely.

Reference source CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90846

General (all payers)

Also called: 90846; family psychotherapy without the patient present

Definition: CPT 90846 is family psychotherapy without the patient present. CMS says Medicare covers family psychotherapy with or without the patient present when it is medically reasonable and necessary and the patient's treatment is the main purpose.
Why it matters: The note should say who attended and why the session treated the patient's condition. A CMS billing guideline says these codes are not for taking a family history or for E/M counseling. Neither CPT nor the CMS sources reviewed set a minute range, so ask each payer for its minimum.
Illustrative example: A therapist meets with a child's parents, without the child, to work on the treatment plan and bills 90846.

Verify: Payers may apply their own minimum minutes. Medicare rules current as of 9/29/26.

Reference source CMS Medicare Learning Network (MLN) · CMS Coverage Database, Article A57480 (WPS) · CMS, NCCI Medicare Policy Manual, Chapter XI

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90847

General (all payers)

Also called: 90847; conjoint family psychotherapy with the patient present

Definition: CPT 90847 is family psychotherapy (conjoint) with the patient present. The family may include spouses, parents and children, or the patient and other family members.
Why it matters: Under the Medicare NCCI policy manual, 90847 can be reported on the same date as 90832 through 90838 only when it is a separate, distinct service in a separate time interval. It is not reported with 90791 or 90792 on the same date. Document each interval's start and end time.
Illustrative example: A therapist sees a teen alone for 45 minutes (90834) and then meets with the teen and parents for 40 minutes (90847), with both intervals timed in the note.

Verify: No minute range is defined. Medicare rule shown; commercial payers may not allow same-day family and individual codes. Confirm with each payer.

Reference source CMS Medicare Learning Network (MLN) · CMS Coverage Database, Article A57480 (WPS) · CMS, NCCI Medicare Policy Manual, Chapter XI

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90849

General (all payers)

Also called: 90849; multiple-family group psychotherapy

Definition: CPT 90849 is multiple-family group psychotherapy. CMS lists it separately from 90853, which is group psychotherapy other than of a multiple-family group.
Why it matters: Billed per patient, per session. Ask each payer whether it covers 90849, since many cover 90853 only. Record the date and the start and end time.
Illustrative example: A clinic runs a group for several families of adolescents with eating concerns and bills 90849 for each enrolled patient.

Verify: No minute range is defined, and payer coverage of 90849 varies.

Reference source CMS Medicare Learning Network (MLN) · American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 90853

General (all payers)

Also called: 90853; group psychotherapy; group therapy code

Definition: CPT 90853 is group psychotherapy other than of a multiple-family group, reported per patient.
Why it matters: Each patient in the group needs their own note. A Medicare contractor article says the interactive complexity add-on +90785 may be billed with 90853 when medically indicated. Crisis codes are not billed with it. Check the MUE table for unit limits.
Illustrative example: A therapist runs a 60-minute skills group with six patients and bills 90853 once for each patient, each with an individual note.

Verify: No minute range is defined. Ask each payer for its minimum session length and group-size rules.

Reference source CMS Coverage Database, Article A57480 (WPS) · CMS Medicare Learning Network (MLN) · CMS, NCCI Medicare Policy Manual, Chapter XI

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96127

General (all payers)

Also called: 96127; brief emotional or behavioral assessment; PHQ-9 GAD-7 billing

Definition: CPT 96127 is a brief emotional or behavioral assessment with scoring and documentation, per standardized instrument. Screens such as the PHQ-9 and the GAD-7 are common examples.
Why it matters: It is reported once for each instrument, so units matter. Payers differ on which instruments they accept, whether they pay for it alongside a visit, and how many units they allow.
Illustrative example: A psychiatrist administers a PHQ-9 and a GAD-7 at intake and reports 96127 with two units.

Verify: Payer-specific coverage and unit limits. Confirm with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific TermsClaims Processing

CPT 96130

General (all payers)

Also called: 96130; psychological testing evaluation first hour

Definition: CPT 96130 is a psychological testing evaluation service by a physician or other qualified health care professional for the first hour. It covers integrating patient data, interpreting results, and reporting.
Why it matters: Testing is usually authorization-driven, so confirm prior authorization and unit limits before you schedule. +96131 is added for each additional hour.
Illustrative example: A psychologist spends 90 minutes interpreting results and writing the report and bills 96130 plus one unit of +96131.

Verify: Confirm CPT descriptor wording, authorization rules, and unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96131

General (all payers)

Also called: +96131; psychological testing evaluation each additional hour

Definition: CPT +96131 is the add-on code for each additional hour of psychological testing evaluation. It is billed only with 96130.
Why it matters: Record the total evaluation time so the additional hour is supported. Never bill it alone.
Illustrative example: A report that takes 2.5 hours is billed as 96130 plus one unit of +96131.

Verify: Confirm unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96132

General (all payers)

Also called: 96132; neuropsychological testing evaluation first hour

Definition: CPT 96132 is a neuropsychological testing evaluation service by a physician or other qualified health care professional for the first hour.
Why it matters: Neuropsychological testing is commonly authorization-driven. +96133 is added for each additional hour.
Illustrative example: A neuropsychologist bills 96132 plus two units of +96133 for a three-hour evaluation and report.

Verify: Confirm CPT descriptor wording, authorization rules, and unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96133

General (all payers)

Also called: +96133; neuropsychological testing evaluation each additional hour

Definition: CPT +96133 is the add-on code for each additional hour of neuropsychological testing evaluation. It is billed only with 96132.
Why it matters: Document total time. Never bill it alone.
Illustrative example: A neuropsychological evaluation that runs 2 hours is billed as 96132 plus one unit of +96133.

Verify: Confirm unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96136

General (all payers)

Also called: 96136; test administration and scoring by physician or QHP first 30 minutes

Definition: CPT 96136 is psychological or neuropsychological test administration and scoring by a physician or other qualified health care professional, first 30 minutes.
Why it matters: Use it when the clinician personally administers and scores the tests. If a technician does it, the technician codes apply instead. +96137 covers each additional 30 minutes.
Illustrative example: A psychologist administers and scores tests for 75 minutes and bills 96136 plus +96137 units per the payer's rules.

Verify: Confirm CPT descriptor wording and unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96137

General (all payers)

Also called: +96137; test administration and scoring by physician or QHP each additional 30 minutes

Definition: CPT +96137 is the add-on code for each additional 30 minutes of test administration and scoring by a physician or other qualified health care professional. It is billed with 96136.
Why it matters: Track minutes carefully. Never bill it alone.
Illustrative example: A 90-minute administration is billed as 96136 plus two units of +96137, if the payer follows the CPT time rules.

Verify: Confirm unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96138

General (all payers)

Also called: 96138; test administration and scoring by technician first 30 minutes

Definition: CPT 96138 is psychological or neuropsychological test administration and scoring by a technician, first 30 minutes.
Why it matters: Payers set rules on technician credentials and supervision. +96139 covers each additional 30 minutes.
Illustrative example: A supervised technician administers tests for 60 minutes and the practice bills 96138 plus +96139.

Verify: Confirm technician supervision rules and unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 96139

General (all payers)

Also called: +96139; test administration and scoring by technician each additional 30 minutes

Definition: CPT +96139 is the add-on code for each additional 30 minutes of test administration and scoring by a technician. It is billed with 96138.
Why it matters: Track minutes and the technician's role. Never bill it alone.
Illustrative example: A technician's 90-minute session is billed as 96138 plus two units of +96139, if the payer follows the CPT time rules.

Verify: Confirm unit limits with each payer.

Reference source American Medical Association (AMA)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 99202

General (all payers)

Also called: 99202; new patient office visit straightforward

Definition: CPT 99202 is an office or other outpatient visit for a new patient with straightforward medical decision making. Under the 2021 time table it is selected by 15 to 29 minutes of total time on the date of the encounter.
Why it matters: Prescribers pick an E/M level by medical decision making or by total time on the date of the encounter. A new patient, in CPT terms, has not received professional services from the physician or another physician of the exact same specialty and subspecialty in the same group within the past three years.
Illustrative example: A psychiatrist sees a new patient for a brief, straightforward medication question and bills 99202 based on 20 minutes of total time.

Verify: Time wording is from a 2021 table. Confirm current CPT wording, since later CPT editions phrase the times differently.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99203

General (all payers)

Also called: 99203; new patient office visit low complexity

Definition: CPT 99203 is an office or other outpatient visit for a new patient with a low level of medical decision making. Under the 2021 time table it is selected by 30 to 44 minutes of total time on the date of the encounter.
Why it matters: Choose the level by MDM or by total time, not by history and exam alone. Total time counts the physician's or other qualified professional's own face-to-face and non-face-to-face work on the date of service.
Illustrative example: A psychiatrist sees a new patient for a stable condition and bills 99203 after 35 minutes of total time.

Verify: Time wording is from a 2021 table. Confirm current CPT wording.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99204

General (all payers)

Also called: 99204; new patient office visit moderate complexity

Definition: CPT 99204 is an office or other outpatient visit for a new patient with a moderate level of medical decision making. Under the 2021 time table it is selected by 45 to 59 minutes of total time on the date of the encounter.
Why it matters: It is a common level for a full psychiatric intake that includes a medical assessment and prescribing decisions. Support the level with either the MDM elements or documented total time.
Illustrative example: A psychiatrist evaluates a new patient, weighs several medication options, and bills 99204 with 50 minutes of documented total time.

Verify: Time wording is from a 2021 table. Confirm current CPT wording. 90792 may be the better code for an evaluation with medical services on some payers.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99205

General (all payers)

Also called: 99205; new patient office visit high complexity

Definition: CPT 99205 is an office or other outpatient visit for a new patient with a high level of medical decision making. CMS confirms the base time range as 60 to 74 minutes of total time on the date of the encounter.
Why it matters: Use it only when the documentation shows high-level MDM or the total time supports it. High-level codes draw audit attention.
Illustrative example: A psychiatrist manages a patient with severe symptoms and multiple risk factors and bills 99205 with 65 minutes of documented time.

Verify: Confirm current CPT and payer time rules. Prolonged-service codes have separate thresholds.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN) · American College of Surgeons, E/M office visit time thresholds

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99211

General (all payers)

Also called: 99211; established patient office visit minimal

Definition: CPT 99211 is an office or other outpatient visit for an established patient that may not require the presence of the physician or other qualified professional. Time and medical decision making do not apply to it.
Why it matters: It is the lowest E/M level. Payers may limit who can bill it and whether it can be billed with other services.
Illustrative example: A nurse checks a patient's blood pressure after a medication change under a prescriber's supervision, and the practice bills 99211 where the payer allows it.

Verify: Payer rules on who may bill 99211 vary.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99212

General (all payers)

Also called: 99212; established patient office visit straightforward

Definition: CPT 99212 is an office or other outpatient visit for an established patient with straightforward medical decision making. Under the 2021 time table it is selected by 10 to 19 minutes of total time on the date of the encounter.
Why it matters: An established patient, in CPT terms, has received professional services from the physician or another physician of the exact same specialty and subspecialty in the same group within the past three years.
Illustrative example: A psychiatrist confirms a stable patient's refill in a 15-minute visit and bills 99212.

Verify: Time wording is from a 2021 table. Confirm current CPT wording.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99213

General (all payers)

Also called: 99213; established patient office visit low complexity; most common psychiatry E/M code

Definition: CPT 99213 is an office or other outpatient visit for an established patient that requires a medically appropriate history and/or examination and a low level of medical decision making. Under the 2021 time table it is selected by 20 to 29 minutes of total time on the date of the encounter. Current CPT wording states it as 20 minutes that must be met or exceeded.
Why it matters: It is a common level for a routine psychiatric medication follow-up. Choose the level by medical decision making or by total time on the date of the encounter, and document whichever you use. If you add a psychotherapy add-on (+90833, +90836, +90838), choose the E/M level by medical decision making only and do not count the psychotherapy time toward the E/M.
Illustrative example: A psychiatrist sees an established patient for a stable medication follow-up with a prescription refill and bills 99213. If 25 minutes of psychotherapy are also done, the claim adds +90833.

Verify: The time wording differs between the 2021 table and current CPT text. Confirm the current CPT descriptor and each payer's policy.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview · CMS Coverage Database, Article A57480 (WPS)

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99214

General (all payers)

Also called: 99214; established patient office visit moderate complexity

Definition: CPT 99214 is an office or other outpatient visit for an established patient with a moderate level of medical decision making. Under the 2021 time table it is selected by 30 to 39 minutes of total time on the date of the encounter.
Why it matters: It is a common level when a prescriber manages more than one condition or makes a medication change with monitoring. Support the level with the MDM elements or with documented time.
Illustrative example: A psychiatrist adjusts two medications for an established patient and bills 99214 with 35 minutes of documented time.

Verify: Time wording is from a 2021 table. Confirm current CPT wording.

Reference source American College of Surgeons, E/M office visit time thresholds · AMA, CPT code set overview

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99215

General (all payers)

Also called: 99215; established patient office visit high complexity

Definition: CPT 99215 is an office or other outpatient visit for an established patient with a high level of medical decision making. CMS confirms the base time range as 40 to 54 minutes of total time on the date of the encounter.
Why it matters: Use it only when the record supports high-level MDM or the total time. Higher levels draw audit attention.
Illustrative example: A psychiatrist manages a patient in acute decompensation and bills 99215 with 45 minutes of documented time.

Verify: Confirm current CPT and payer time rules. Prolonged-service codes have separate thresholds.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN) · American College of Surgeons, E/M office visit time thresholds

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99341

General (all payers)

Also called: 99341; new patient home or residence visit straightforward

Definition: CPT 99341 is a home or residence visit for a new patient with straightforward medical decision making. One published summary shows the time as 15 minutes or more.
Why it matters: Home and residence visits apply to patients seen in their own homes, a group home, a homeless shelter, assisted living, or a residential substance-abuse facility, and not in skilled nursing settings. Use the place of service that matches where the patient is. Do not count travel time.
Illustrative example: A prescriber visits a new patient at home for a straightforward medication check and bills 99341 with POS 12.

Verify: Time figures are from secondary sources. Confirm current CPT wording and payer rules.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99342

General (all payers)

Also called: 99342; new patient home or residence visit low complexity

Definition: CPT 99342 is a home or residence visit for a new patient with a low level of medical decision making. One published summary shows the time as 30 minutes or more.
Why it matters: Level the visit by MDM or time, and do not count travel time. Match the place of service to the patient's location.
Illustrative example: A prescriber sees a new patient in an assisted living apartment for a low-complexity visit and bills 99342.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99343

General (all payers)

Also called: 99343; deleted home visit code; new patient home visit code that no longer exists

Definition: CPT 99343 is a deleted code. The AMA eliminated it on January 1, 2023, when the domiciliary, rest home, and custodial care codes were merged into the home or residence code set. New-patient home visits now use 99341, 99342, 99344 and 99345.
Why it matters: A claim with 99343 will be rejected as an invalid or deleted code, so check billing templates and fee schedules that still list it.
Illustrative example: A practice management system still shows 99343 in an old superbill template, so the billing team replaces it with the correct current code.

Verify: Confirm against the current AMA CPT manual.

Related terms CPT 99342 CPT 99344 CPT Code Superbill

Reference source UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99344

General (all payers)

Also called: 99344; new patient home or residence visit moderate complexity

Definition: CPT 99344 is a home or residence visit for a new patient with a moderate level of medical decision making. One published summary shows the time as 60 minutes or more.
Why it matters: Document either the moderate MDM or the total time. Do not count travel time.
Illustrative example: A prescriber evaluates a new home-based patient with several active problems and bills 99344.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99345

General (all payers)

Also called: 99345; new patient home or residence visit high complexity

Definition: CPT 99345 is a home or residence visit for a new patient with a high level of medical decision making. One published summary shows the time as 75 minutes or more.
Why it matters: It is the top new-patient home level. Medicare's prolonged home add-on, G0318, is reported with it when Medicare's own threshold is met.
Illustrative example: A prescriber sees a new home-based patient in a psychiatric crisis with complex risks and bills 99345.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99347

General (all payers)

Also called: 99347; established patient home or residence visit straightforward

Definition: CPT 99347 is a home or residence visit for an established patient with straightforward medical decision making. One published summary shows the time as 20 minutes or more.
Why it matters: Use the place of service that matches where the patient lives or is seen. Do not count travel time.
Illustrative example: A prescriber checks in on a stable home-based patient and bills 99347.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99348

General (all payers)

Also called: 99348; established patient home or residence visit low complexity

Definition: CPT 99348 is a home or residence visit for an established patient with a low level of medical decision making. One published summary shows the time as 30 minutes or more.
Why it matters: Level the visit by MDM or time. Document the location so the place of service is correct.
Illustrative example: A prescriber reviews a home-based patient's medication and side effects and bills 99348.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99349

General (all payers)

Also called: 99349; established patient home or residence visit moderate complexity

Definition: CPT 99349 is a home or residence visit for an established patient with a moderate level of medical decision making. One published summary shows the time as 40 minutes or more.
Why it matters: Support the level with the MDM elements or with documented time. Do not count travel time.
Illustrative example: A prescriber changes medication for a home-based patient with two active conditions and bills 99349.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99350

General (all payers)

Also called: 99350; established patient home or residence visit high complexity

Definition: CPT 99350 is a home or residence visit for an established patient with a high level of medical decision making. One published summary shows the time as 60 minutes or more.
Why it matters: It is the top established-patient home level. Medicare's prolonged home add-on, G0318, is reported with it when Medicare's own threshold is met.
Illustrative example: A prescriber manages a home-based patient after a crisis with complex risks and bills 99350.

Verify: Time figures are from secondary sources. Confirm current CPT wording.

Reference source STFM Practice Management Handbook, Home or Residence Visits · UTHealth Houston, 2023 Home or Residence Services

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

CPT 99408

General (all payers)

Also called: 99408; SBIRT 15 to 30 minutes

Definition: CPT 99408 is alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services, 15 to 30 minutes. SBIRT stands for screening, brief intervention, and referral to treatment.
Why it matters: Many commercial payers and Medicaid programs use the CPT codes while Medicare uses G0396. Confirm the correct code and any diagnosis or provider limits.
Illustrative example: A commercial payer accepts 99408 for a 25-minute structured brief intervention.

Verify: Payer-specific. Confirm coverage and provider-type limits.

Related terms CPT 99409 HCPCS G0396 SBIRT Screening

Reference source American Medical Association (AMA) · SAMHSA

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 99409

General (all payers)

Also called: 99409; SBIRT 30 minutes or more

Definition: CPT 99409 is alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services of more than 30 minutes.
Why it matters: Document the tool, the intervention, and the total time. Confirm coverage with each payer.
Illustrative example: A 40-minute SBIRT session is billed 99409 to a payer that follows CPT.

Verify: Payer-specific. Confirm coverage and provider-type limits.

Related terms CPT 99408 HCPCS G0397 SBIRT Documentation

Reference source American Medical Association (AMA) · SAMHSA

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms

CPT 99417

General (all payers)

Also called: +99417; prolonged outpatient E/M service

Definition: CPT +99417 is a prolonged outpatient E/M add-on for extra time beyond the top of the E/M time range, used mostly with commercial payers and Medicaid. Medicare uses its own HCPCS add-on code instead.
Why it matters: Medicare has its own prolonged-service thresholds, so 99417 is not the code to send to Medicare. Confirm each payer's rule and threshold.
Illustrative example: A commercial plan pays 99417 with a level 5 E/M when total time exceeds the payer's threshold.

Verify: Payer-specific and not in the CMS sources checked. Confirm each payer's threshold before billing.

Reference source UTHealth Houston, 2023 Home or Residence Services · STFM Practice Management Handbook, Home or Residence Visits

Categories CPT, E/M & HCPCS Code EntriesClaims Processing

HCPCS G0318

Medicare

Also called: G0318; Medicare prolonged home or residence visit

Definition: HCPCS G0318 is Medicare's prolonged home or residence E/M add-on. It is reported with 99345 or 99350 when time reaches Medicare's own threshold.
Why it matters: One published summary states the thresholds as at least 140 minutes with 99345 and at least 110 minutes with 99350, counting work from three days before to seven days after the visit. Confirm the current CMS rule before you rely on those figures.
Illustrative example: A Medicare home visit with a high-complexity established patient runs long, and the practice bills 99350 plus G0318 if the threshold is met.

Verify: Thresholds come from a secondary source (STFM handbook). Confirm against current CMS guidance.

Reference source STFM Practice Management Handbook, Home or Residence Visits · CMS (Centers for Medicare & Medicaid Services)

Categories CPT, E/M & HCPCS Code EntriesClaims Processing Medicare

HCPCS G0396

Medicare

Also called: G0396; alcohol or substance structured screening and brief intervention 15 to 30 minutes

Definition: HCPCS G0396 is structured alcohol and/or substance (other than tobacco) misuse screening and brief intervention of 15 to 30 minutes. It is the Medicare G-code counterpart to CPT 99408.
Why it matters: Confirm whether the payer wants the G-code or the CPT code. Document the screening tool, the feedback given, and the time.
Illustrative example: A clinic bills G0396 to Medicare for a 20-minute structured screening and brief intervention.

Verify: Confirm which code the payer requires.

Related terms HCPCS G0397 CPT 99408 SBIRT Documentation

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms Medicare

HCPCS G0397

Medicare

Also called: G0397; alcohol or substance structured screening and brief intervention 30 minutes or more

Definition: HCPCS G0397 is structured alcohol and/or substance (other than tobacco) misuse screening and brief intervention of more than 30 minutes. It is the Medicare G-code counterpart to CPT 99409.
Why it matters: Use it only when the documented time exceeds the G0396 range. Confirm which code the payer requires.
Illustrative example: A 40-minute structured brief intervention for a Medicare patient is billed G0397.

Verify: Confirm which code the payer requires.

Related terms HCPCS G0396 CPT 99409 SBIRT Documentation

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms Medicare

HCPCS G0442

Medicare

Also called: G0442; annual alcohol misuse screening

Definition: HCPCS G0442 is the annual alcohol misuse screening code, reported for a 15-minute screening.
Why it matters: Pair it with G0443 when brief face-to-face counseling follows. Confirm frequency limits and whether a payer wants the G-code or a CPT equivalent.
Illustrative example: A clinic screens a Medicare patient for alcohol misuse and bills G0442.

Verify: Frequency limits change. Confirm the current CMS coverage policy.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms Medicare

HCPCS G0443

Medicare

Also called: G0443; brief face-to-face alcohol misuse counseling

Definition: HCPCS G0443 is brief face-to-face behavioral counseling for alcohol misuse, reported for 15 minutes.
Why it matters: It follows a positive screen. Document the counseling content and time. Confirm the payer's frequency limits.
Illustrative example: After a positive screen, a clinician spends 15 minutes on brief counseling and bills G0443.

Verify: Frequency limits change. Confirm the current CMS coverage policy.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms Medicare

HCPCS G0444

Medicare

Also called: G0444; annual depression screening; Medicare depression screening

Definition: HCPCS G0444 is Medicare's annual depression screening code, reported for a 15-minute screening.
Why it matters: G-codes are HCPCS Level II codes used mainly for Medicare and Medicaid. Confirm current CMS and payer frequency limits, since depression screening is typically covered once a year, and confirm whether the payer wants the G-code or a CPT screening code such as 96127.
Illustrative example: A primary care office screens a Medicare patient once in the year and bills G0444.

Verify: Frequency limits and setting rules change. Confirm the current CMS coverage policy.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesBehavioral Health Specific Terms Medicare

HCPCS G2211

Medicare

Also called: G2211; visit complexity add-on; Medicare E/M add-on

Definition: HCPCS G2211 is a Medicare add-on code for the visit complexity inherent to an E/M visit that is the continuing focal point for a patient's health care or part of ongoing care for a single serious or complex condition.
Why it matters: CMS limits when it pays, including limits when the E/M is billed with modifier 25. Read the current CMS FAQ before you bill it. Many commercial payers do not recognize it.
Illustrative example: A psychiatrist who provides ongoing care for a patient's serious mental illness bills G2211 with the office E/M where Medicare allows it.

Time-sensitive: Medicare payment rules for G2211 have changed. Confirm the current CMS FAQ (checked 9/29/26).

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories CPT, E/M & HCPCS Code EntriesClaims Processing Medicare

HCPCS G2212

Medicare

Also called: G2212; Medicare prolonged office E/M

Definition: HCPCS G2212 is Medicare's prolonged office or outpatient E/M add-on, used instead of CPT +99417 when the visit runs past Medicare's own time threshold.
Why it matters: Medicare's thresholds differ from CPT's. Confirm the current CMS time threshold and documentation rules.
Illustrative example: A Medicare patient's visit runs past the CMS threshold, so the practice reports G2212 with a level 5 E/M.

Time-sensitive: Thresholds are set by CMS and can change. Confirm the current CMS rule.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories CPT, E/M & HCPCS Code EntriesClaims Processing Medicare

Can't pin down a billing term or a payer rule?

Tell us what you are seeing on your remittances or denial letters. We will point you to the right answer.

CPT Codes Glossary: Definitions for Therapists and Psychiatrists

In this section

More billing terms

Keep reading

Billing Terms Glossary

CPT & E/M Code Guide

FAQ

Can't pin down a billing term or a payer rule?