What CPT Codes Do PMHNPs Use for Psychiatric Billing? A Beginner's Guide for Nurse Practitioners
By the NPWise Team | Updated October 2026 | 5-minute read
Quick answer
Psychiatric mental health nurse practitioners (PMHNPs) typically bill 90791 or 90792 (or 99204/99205) for an initial intake, 90832, 90834, or 90837 for therapy-only visits, 99213–99215 for medication management, and an E/M code plus an add-on (90833, 90836, or 90838) when they provide both in one visit. Each claim also needs a diagnosis code and, for telehealth, the right modifier.1
If you're a nurse practitioner building a private practice, knowing these codes is the foundation of psychiatric billing and mental health billing. Get them right and your schedule turns into steady revenue. Get them wrong and you spend your evenings chasing denials. Here's the full picture, from insurance credentialing to getting paid.
Initial intake
90791, 90792, 99204, 99205
Psychiatric evaluation or new-patient E/M visit
Therapy only
90832, 90834, 90837
Billed by session length
Medication management
99213, 99214, 99215
Add 90833, 90836, or 90838 when you also provide therapy
The Main CPT Codes for PMHNPs
Most mental health billing for nurse practitioners comes down to the codes below. Pick the one that matches what you actually did in the visit, and make sure your note supports it.
| Visit type | CPT code(s) | Notes |
|---|---|---|
| Initial intake: psychiatric evaluation | 90791 / 90792 | 90791 has no medical services. 90792 includes medical services, which fits most prescribers. |
| Initial intake: E/M visit | 99204 / 99205 | New-patient office visit, based on medical decision-making or time. |
| Therapy only | 90832 / 90834 / 90837 | 16–37 min / 38–52 min / 53+ min. |
| Medication management only | 99212–99215 | Established patients. 99213 and 99214 are the most common. |
| Medication management plus therapy | 99213–99215 + 90833 / 90836 / 90838 | E/M code plus a psychotherapy add-on: 16–37 / 38–52 / 53+ min of therapy. |
| Interactive complexity | 90785 | Add-on for qualifying services only. |
Common mistake
99214 and 99215 are for established patients. A new patient's first E/M visit is billed with 99204 or 99205, so using 99214 on a first visit is a quick way to get a denial.
How to bill medication management and therapy together
A PMHNP can bill both in one visit. Choose the E/M level based on your medical decision-making, then add the psychotherapy code that matches your therapy minutes: 90833 for 16–37 minutes, 90836 for 38–52, and 90838 for 53 or more. Time ranges follow the AMA CPT code set,1 so document your start and stop times.
How Do PMHNPs Start Billing Insurance?
Once you know your codes, behavioral health billing runs in five steps.
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Get credentialed with each payer
Be in network with Medicare, Medicaid, and the commercial plans you accept, such as Aetna, UnitedHealthcare/Optum, Cigna, and Blue Cross Blue Shield, before you bill them. Start with your NPI through NPPES5 and a complete CAQH profile.6 Insurance credentialing can take months, so apply early.
-
Verify insurance benefits before every new patient
Collect these details first, and make sure they match the insurance card:
- Patient's legal name
- Date of birth
- Address
- Insurance member ID
Then check eligibility using your NPI and tax ID to confirm you're in network, and ask about copay, deductible, coinsurance, and telehealth coverage. Small demographic errors cause denied claims.
-
Match the diagnosis to the condition you're treating
Your ICD-10 diagnosis code, such as anxiety or ADHD, should reflect your documentation and support the CPT code you bill.
-
Submit the claim
Most practices use EHR or billing software and a clearinghouse. The claim carries the same information as the CMS-1500 form: patient details, NPI, CPT code, diagnosis, modifiers, and place of service. Review each claim before it goes out.
-
Get paid
The payer sends an electronic remittance advice (ERA) showing what was paid, adjusted, or denied. With EFT set up, payment goes straight to your bank. Read every ERA to catch denials and underpayments early.
Telehealth Billing for PMHNPs
For live audio-video visits, add modifier 95. Use modifier 93 for audio-only. Use place of service 10 when the patient is at home and 02 when they're somewhere else. Some payers still ask for the older GT modifier or POS 11, so check each plan's written policy.
Check before you bill
Medicare's behavioral health telehealth rules differ from its rules for other services. Confirm current requirements on the CMS telehealth page.2 Aetna, Cigna, and UnitedHealthcare each publish their own telehealth billing guidelines, and they change often.
How Do Insurance Payers Differ?
- Medicare: Medicare pays nurse practitioners 85% of the physician fee schedule when billed under your own NPI.3
- Medicaid: Rates and covered services vary by state.
- Commercial plans (Aetna, UnitedHealthcare/Optum, Cigna, BCBS): Each sets its own PMHNP reimbursement rates and modifier rules, so review your contract and fee schedule.
- Your state: Scope of practice affects what you can bill. See the AANP state practice map.4
Psychiatric Billing FAQs
What CPT code do PMHNPs use for an initial psychiatric evaluation?
Usually 90792, since it includes medical services. Use 90791 when no medical services are provided, or 99204/99205 for a new-patient E/M visit.
What CPT code is used for medication management?
Established-patient E/M codes 99213, 99214, or 99215, depending on medical decision-making or time.
Can a PMHNP bill medication management and therapy together?
Yes. Bill an E/M code plus a psychotherapy add-on (90833, 90836, or 90838), with documentation that supports both.
What's the difference between 90834 and 90837?
90834 covers 38–52 minutes of psychotherapy. 90837 covers 53 minutes or more.
Does Aetna require modifier 95 for telehealth?
Many Aetna plans do, but policies vary by plan and state, so confirm in Aetna's provider resources before billing.
Should I outsource psychiatric billing?
Many small practices do, to reduce denials and save admin time. NPWise offers mental health billing services designed for independent nurse practitioners.
References
- American Medical Association. CPT (Current Procedural Terminology) overview.
- Centers for Medicare & Medicaid Services. Telehealth.
- Medicare Payment Advisory Commission (MedPAC). Improving Medicare's payment policies for Advanced Practice Registered Nurses and Physician Assistants. See also Health Affairs, Rethinking How Medicare Pays Nurse Practitioners and Physician Assistants.
- American Association of Nurse Practitioners (AANP). State Practice Environment.
- CMS. National Plan and Provider Enumeration System (NPPES).
- CAQH. CAQH ProView provider data and credentialing.
Let NPWise Handle the Billing
You became a nurse practitioner to care for patients, not chase claims. NPWise supports independent NPs with private practice billing, credentialing, and front desk services.
Explore NPWise Billing ServicesOr reach us at info@npwise.org | 718-413-0431
This article is for general education and isn't legal, coding, or financial advice. Payer and Medicare rules change often, so always confirm current requirements with each payer and the official CPT code set before billing.