Behavioral health coding covers a broad spectrum of mental, emotional, and substance use disorder diagnoses. This reference reflects FY2026 ICD-10-CM (effective October 1, 2025) and CPT 2026 — which added core psychotherapy codes 90791, 90792, 90832, 90834, 90837, 90847, and 90853 to the CPT telehealth appendices P and T for audio-video and audio-only delivery — and covers the most-billed ICD-10-CM, CPT, and HCPCS codes for licensed behavioral health counselors, social workers, therapists, and community behavioral health organizations across the United States. FY2027 ICD-10-CM updates take effect October 1, 2026; this page will be reviewed once the new code set is finalized.
FY 2027 ICD-10-CM (CMS, eff. 10/1/2026) · CPT 2026 (AMA) · All codes verified billable · Last verified: October 2026
Psychiatric diagnostic evaluation without medical services
~$173
-GT (telehealth), -95
90792
Psychiatric diagnostic evaluation with medical services
~$202
-GT, -25
90832
Psychotherapy, 30 minutes with patient
~$86
-GT, -95, -59
90834
Psychotherapy, 45 minutes with patient
~$114
-GT, -95
90837
Psychotherapy, 60 minutes with patient
~$167
-GT, -95, -59
90838
Psychotherapy add-on, 60 min with E/M
~$137
-Add-on to E/M
90845
Psychoanalysis
~$109
-GT
90847
Family psychotherapy with patient present, 50 minutes
~$110
-GT, -95
90849
Multiple-family group psychotherapy
~$40
-GT
90853
Group psychotherapy (non-family)
~$30
-GT, -95
90863
Pharmacologic management, with psychotherapy
N/A (not paid by Medicare)
-Add-on only
90875
Individual psychophysiological therapy (biofeedback), 30 min
~$60
-59
96127
Brief emotional/behavioral assessment with scoring
~$5
-25
99213
Office visit, established patient, low complexity (15-29 min)
~$95
-25, -59
99214
Office visit, established patient, moderate complexity (30-39 min)
~$136
-25, -59
H0001
Alcohol and/or drug assessment (HCPCS/Medicaid)
N/A
Medicaid, state-specific
H0004
Behavioral health counseling and therapy, per 15 min (HCPCS/Medicaid)
N/A
Medicaid only
H2019
Therapeutic behavioral services, per 15 min (HCPCS)
N/A
Medicaid, state-specific
*Approximate 2026 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.
CPT 2026 (AMA) added 90791, 90792, 90832, 90834, 90837, 90847, and 90853 to Appendix P and Appendix T as telehealth-eligible services, reportable via real-time audio-video or, where permitted, audio-only communication.
Top Denial Reasons for Behavioral Health Claims
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Medical Necessity Not Sufficiently Documented
Payers deny behavioral health claims when the clinical note lacks measurable impairment, treatment goals, or a stated diagnosis tied to the service. Ensure each session note includes a DSM-5 diagnosis, functional impairment level, and therapeutic goals with progress indicators.
⚠
Missing or Invalid Prior Authorization
Many commercial payers and Medicaid managed care plans require prior authorization for ongoing psychotherapy, intensive outpatient programs (IOP), and residential treatment. Always verify auth requirements at intake and re-verify when a patient changes plans mid-treatment.
⚠
Wrong Time-Based Code for Documented Session Length
Billing 90837 (60-min) when the note documents less than 53 minutes of face-to-face time triggers medical necessity denials and audit flags. Document the exact start/stop time and total face-to-face minutes for every psychotherapy session to support the code billed.
⚠
Substance Use Disorder Code Specificity Mismatch
Submitting an unspecified F10.10 or F19.10 code when the record clearly documents dependence (F1x.2x) or a specific stage leads to claim downcoding or denial. Always code to the highest level of specificity supported by the clinical documentation to avoid payer downcoding.
Behavioral Health Billing & Coding Tips
Bill 90837 (60-min therapy) rather than 90834 (45-min) whenever session length supports it — the reimbursement difference can be significant over a full panel.
HCPCS code H0004 (behavioral health counseling per 15 min) is used by Medicaid managed care plans in many states — verify your state’s fee schedule before billing.
Document the place of service carefully: POS 11 (office), POS 53 (community mental health center), and POS 49 (independent clinic) each have different Medicaid rate structures.
Substance use disorder codes (F10-F19) require specifying the substance type AND the stage: abuse (F1x.1x), dependence (F1x.2x), or use (F1x.9x) — do not default to the unspecified version.
What is the difference between behavioral health and mental health billing?
The terms overlap significantly. Behavioral health is a broader term covering mental health plus substance use disorders, eating disorders, and health-behavior change. In billing, behavioral health providers often use the same CPT psychotherapy codes (90832-90837). HCPCS H-codes are specific to Medicaid behavioral health programs.
What CPT code is used for group therapy?
90853 covers group psychotherapy for non-family groups. 90849 covers multiple-family group psychotherapy. Both require a licensed clinician present for the full session. Each patient is billed individually using 90853.
Is H0004 covered by Medicare?
No. H0004 (behavioral health counseling per 15 min) is a HCPCS Level II code used by Medicaid programs. Medicare uses CPT codes (90832-90837) for behavioral health therapy. Verify H0004 coverage and rates with the specific state Medicaid program.
What ICD-10 code is used for substance use counseling?
Z71.89 (Other specified counseling) is used for substance use prevention counseling. For active substance use disorders, use the specific F10-F19 code with the appropriate stage suffix (abuse, dependence, or use). Z71.41 (Alcohol abuse counseling) is also available.
How does OmniMD support behavioral health practices?
OmniMD’s Behavioral Health EHR supports DSM-5 diagnosis coding, HIPAA-compliant telehealth for remote therapy sessions, e-prescribing for prescribing providers, and integrated billing for both CPT and HCPCS behavioral health codes.
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Purpose-built EHR, billing, and practice management for Behavioral Health practices.
