Medical Billing Terms P: Psychotherapy Add-On Code, Prior Authorization and PHI

A psychotherapy add-on code is a code a psychiatrist adds to an E/M visit when psychotherapy is also provided. This page defines it with the terms from primary source verification to public health emergency, including prior authorization, progress note and PHI. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms P: Psychotherapy Add-On Code - MCM South Medical Billing Service, LLC

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On this page (23 terms)

Primary Source Verification (PSV)
Prior Authorization
Prior Authorization API
Private Contract
Productivity Metrics
Progress Note
Prolonged Service
Prominence Health Plan
Prompt Pay Law
Proof of Timely Filing
Protected Health Information (PHI)
Provider Data Accuracy
Provider Directory
Provider Enrollment Specialist
Provider Taxonomy Mismatch
Psychiatric Nurse Practitioner (PMHNP)
Psychiatrist
Psychological Testing
Psychotherapist
Psychotherapy Add-On Code
Psychotherapy Notes
Psychotherapy Time Ranges
Public Health Emergency (PHE)

How to use these Psychotherapy Add-On Code definitions

Use this page as a quick reference for Psychotherapy Add-On Code, from Primary Source Verification to Public Health Emergency. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Psychotherapy Add-On Code details with the payer before you bill.

Checklist: put the psychotherapy add-on code definitions to work

Check the psychotherapy add-on code entries above before you send a claim that depends on them.
Share this psychotherapy add-on code page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions psychotherapy add-on code, find the matching entry and note the date you checked it.
Keep your psychotherapy add-on code notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies psychotherapy add-on code before you change a workflow.
Train new staff on psychotherapy add-on code first, then move on to the rest of the glossary.

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Primary Source Verification (PSV)

General (all payers)

Also called PSV; source verification

Definition: Confirming a credential directly with the organization that issued it, such as a state licensing board, instead of relying on a copy the clinician supplies.
Why it matters: Accrediting bodies expect PSV, and it is a common reason applications stall.
Illustrative example: The payer checks a psychologist's license status directly on the state board's website.

Reference sourceNCQAchecked 10/9/26

CategoriesCredentialing & Enrollment Audits & Compliance

Prior Authorization

General (all payers)

Also called PA; prior auth; pre-authorization; precertification; preauthorization

Definition: A payer's approval, required before certain services, that the service meets its coverage and medical necessity criteria.
Why it matters: Services without required authorization are commonly denied and hard to recover.
Illustrative example: A payer requires prior authorization for psychological testing.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesPrior Authorization Terminology

Prior Authorization API

General (all payers)

Also called CMS interoperability and prior authorization rule; electronic prior authorization

Definition: An electronic interface that lets systems exchange prior authorization requests and decisions, encouraged by CMS interoperability rules for certain payers over a phased timeline.
Why it matters: May reduce phone and fax steps over time.
Illustrative example: A payer exposes an API to check authorization requirements.

Reference sourceCMS (Centers for Medicare & Medicaid Services)HL7 FHIRchecked 10/9/26

CategoriesPrior Authorization Terminology AI & Healthcare Automation Terms

Private Contract

Medicare

Also called Medicare private contract

Definition: A written agreement between a beneficiary and an opted-out practitioner in which the patient agrees to pay the practitioner directly and no Medicare payment is sought.
Why it matters: Must meet specific content rules.
Illustrative example: A patient signs a private contract with an opted-out psychiatrist.

Related termsOpt-Out (Medicare)Medicare

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms

Productivity Metrics

General (all payers)

Also called clinician productivity; wRVU productivity

Definition: Measures of how much billable work a clinician delivers, such as sessions, units, or work RVUs.
Why it matters: Used for compensation and capacity planning.
Illustrative example: A group tracks sessions per week per clinician.

Reference sourceMGMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

Progress Note

General (all payers)

Also called session note; clinical note; SOAP note; DAP note

Definition: A record of a session that documents the service, time, interventions, and patient response, and supports the claim.
Why it matters: Payers rely on progress notes to confirm medical necessity and billed time.
Illustrative example: A note shows start and end times, the intervention, and progress toward goals.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesBehavioral Health Specific Terms Audits & Compliance

Prolonged Service

General (all payers)

Also called prolonged services; prolonged E/M; 99417 G2212

Definition: A prolonged service is extra time beyond what is required for the highest level of an E/M service, reported with a prolonged-service add-on code. Medicare and commercial payers use different codes and thresholds.
Why it matters: A prolonged code is not billed with a psychotherapy add-on in the same time. Follow the payer's rule.
Illustrative example: A prescriber's level 5 visit runs long, and the practice checks the payer's prolonged-service rule before billing an add-on.

Reference sourceAmerican Medical Association (AMA)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing

Prominence Health Plan

Private payer

Also called Prominence

Definition: A health plan based in Nevada, sometimes listed next to Blue plans. Whether it is a Blue licensee is not confirmed here, so treat it as a separate plan until you verify.
Why it matters: Assuming a plan is a Blue licensee can send you to the wrong rules and portals.
Illustrative example: A provider checks the plan's own provider site for credentialing and claims rules.

Reference sourceProminence Health Planchecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms

Prompt Pay Law

General (all payers)

Also called prompt payment law; prompt payment statute

Definition: State or federal laws that require payers to pay clean claims within set periods or owe interest.
Why it matters: Gives leverage to follow up on slow payers in states that have such laws.
Illustrative example: A state requires payment of clean claims within a set number of days.

Related termsClean Claim Adjudication

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesAudits & Compliance Payment & Reimbursement

Proof of Timely Filing

General (all payers)

Also called timely filing proof; clearinghouse acceptance report

Definition: Documentation showing a claim was received by the payer before the deadline, such as an acceptance report or payer acknowledgment.
Why it matters: It is the main tool to overturn a timely filing denial.
Illustrative example: A practice attaches a 277CA showing acceptance dates.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals

Protected Health Information (PHI)

General (all payers)

Also called PHI; ePHI

Definition: Individually identifiable health information held or transmitted by a covered entity or business associate.
Why it matters: Applies to claims, notes, and messages that identify a patient.
Illustrative example: A claim containing a patient's diagnosis and name is PHI.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance

Provider Data Accuracy

General (all payers)

Also called provider directory accuracy; provider demographics

Definition: The correctness of a provider's address, phone, specialty, licenses, and network status across payer and public directories.
Why it matters: Federal and state rules and accreditors push payers to keep directories accurate, and errors can delay credentialing or payment.
Illustrative example: A payer directory shows an old address, so members call the wrong location.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesProvider Data Management Terms Contracting & Network Management

Provider Directory

General (all payers)

Also called network directory; find-a-provider listing

Definition: A payer's public list of in-network providers with contact and specialty information.
Why it matters: Inaccurate listings frustrate members and can trigger compliance scrutiny for the payer.
Illustrative example: A member cannot find a therapist listed in the directory who is no longer taking new patients.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesProvider Data Management Terms Contracting & Network Management

Provider Enrollment Specialist

General (all payers)

Also called credentialing specialist; enrollment coordinator

Definition: A staff role responsible for applications, follow-up, and maintaining payer enrollment records.
Why it matters: Provides the internal owner for credentialing deadlines.
Illustrative example: A credentialing specialist tracks every payer application in a spreadsheet.

Reference sourceDataSpring (formerly CAQH)checked 10/9/26

CategoriesCredentialing & Enrollment

Provider Taxonomy Mismatch

General (all payers)

Also called taxonomy mismatch

Definition: A claim edit that fires when the taxonomy on the claim does not match what the payer holds for that provider.
Why it matters: A common, avoidable cause of rejections for new clinicians.
Illustrative example: A claim is rejected because the claim lists one taxonomy and the payer file has another.

Reference sourceNUCCchecked 10/9/26

CategoriesProvider Data Management Terms Denials & Appeals

Psychiatric Nurse Practitioner (PMHNP)

General (all payers)

Also called PMHNP; psychiatric mental health nurse practitioner; psychiatric NP

Definition: An advanced practice nurse specializing in psychiatric care who can diagnose, prescribe, and provide therapy in many states.
Why it matters: Payer credentialing, supervision, and incident-to rules for NPs vary widely.
Illustrative example: A payer credentials a PMHNP as an independent provider in one state but requires collaboration in another.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesBehavioral Health Specific Terms Credentialing & Enrollment

Psychiatrist

General (all payers)

Also called MD psychiatrist; prescriber; psychiatric provider

Definition: A physician who specializes in mental health and can prescribe medication, and who commonly bills E/M codes with add-on psychotherapy codes.
Why it matters: Prescribers bill differently from therapists: E/M plus add-ons, and prescribing-related requirements.
Illustrative example: A psychiatrist bills an E/M with a psychotherapy add-on.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesBehavioral Health Specific Terms

Psychological Testing

General (all payers)

Also called psychological and neuropsychological testing; 96130; 96131; 96136

Definition: Standardized assessment of cognitive, emotional, and behavioral functioning, billed with testing evaluation and administration codes that often require prior authorization.
Why it matters: Testing has time-based codes, authorization needs, and frequent denials for documentation.
Illustrative example: A psychologist bills evaluation and test administration codes with authorization.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesBehavioral Health Specific Terms Claims Processing

Psychotherapist

General (all payers)

Also called therapist; counselor; LCSW; LMFT; LPC; psychologist

Definition: A licensed clinician, such as a psychologist, clinical social worker, marriage and family therapist, or professional counselor, who provides psychotherapy.
Why it matters: Payers set separate credentialing and billing rules by license type.
Illustrative example: A licensed clinical social worker bills psychotherapy codes under an individual NPI.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesBehavioral Health Specific Terms

Psychotherapy Add-On Code

General (all payers)

Also called add-on code; 90833; 90836; 90838

Definition: A CPT add-on code that lets a prescriber bill psychotherapy time on the same day as an E/M service. Codes 90833, 90836, and 90838 correspond to different time ranges.
Why it matters: Both the E/M and the add-on must be supported by documentation; psychotherapy time cannot be counted toward the E/M.
Illustrative example: A psychiatrist bills an E/M plus a psychotherapy add-on for the same visit.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing Behavioral Health Specific Terms

Psychotherapy Notes

General (all payers)

Also called process notes; HIPAA psychotherapy notes

Definition: Notes by a mental health professional that document or analyze conversation contents and are kept separate from the rest of the record, receiving extra HIPAA protection.
Why it matters: They generally require specific patient authorization to disclose and are distinct from progress notes used for billing.
Illustrative example: A therapist keeps private process notes apart from the chart used for claims.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance Behavioral Health Specific Terms

Psychotherapy Time Ranges

General (all payers)

Also called 90832; 90834; 90837; time-based psychotherapy codes

Definition: The CPT time ranges for individual psychotherapy codes: 90832 is 16 to 37 minutes, 90834 is 38 to 52 minutes, and 90837 is 53 minutes or more. The midpoint rule sets each range.
Why it matters: Billing above the documented time is a leading audit and denial cause.
Illustrative example: A 50-minute session is 90834, not 90837.

Related termsCPT Code Documentation Audit

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesClaims Processing Behavioral Health Specific Terms

Public Health Emergency (PHE)

General (all payers)

Also called PHE; COVID public health emergency; telehealth emergency flexibilities

Definition: A public health emergency is a declaration by the HHS Secretary that lets the government use emergency authorities, including temporary flexibilities for Medicare and other programs. The COVID-19 declaration ended in May 2023.
Why it matters: Many telehealth rules began as PHE flexibilities and were later extended or changed by law or rule. Confirm the current status before you rely on one.
Illustrative example: A billing team checks whether a telehealth flexibility that began during the PHE still applies.

Reference sourceHHS (U.S. Department of Health and Human Services)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesTelehealth Terms Audits & Compliance

Quick answer: Psychotherapy Add-On Code

What is a psychotherapy add-on code?

A CPT add-on code that lets a prescriber bill psychotherapy time on the same day as an E/M service. Codes 90833, 90836, and 90838 correspond to different time ranges. Both the E/M and the add-on must be supported by documentation; psychotherapy time cannot be counted toward the E/M.

Frequently asked questions: Psychotherapy Add-On Code

What is prior authorization?

Prior Authorization is a payer's approval, required before certain services, that the service meets its coverage and medical necessity criteria. Services without required authorization are commonly denied and hard to recover.

What is a progress note?

Progress Note is a record of a session that documents the service, time, interventions, and patient response, and supports the claim. Payers rely on progress notes to confirm medical necessity and billed time.

What are psychotherapy notes?

Notes by a mental health professional that document or analyze conversation contents and are kept separate from the rest of the record, receiving extra HIPAA protection. They generally require specific patient authorization to disclose and are distinct from progress notes used for billing.

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Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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