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Psychiatry Billing Codes, Explained for Patients Paying Out of Network

Nearly everything written for patients about out-of-network billing assumes a therapy session with one code, usually 90834 or 90837. Psychiatry claims look different, and the difference changes what comes back. This page explains each code you are likely to see on a psychiatry superbill, using CMS's own 2026 short descriptors, and shows how those codes actually paid in de-identified out-of-network claims. For the reimbursement formula itself, start with the out-of-network reimbursement guide.

The codes on a psychiatry superbill

One visit, two claim lines

When a psychiatrist adjusts medication and does psychotherapy in the same appointment, the claim carries the E/M code and the add-on on separate lines. Several scans in the remittance section of the guide show this pattern: 99214 on one line and 90836 on the next.

Three practical consequences follow:

1. Each line has its own allowed amount. When you call your plan, ask for the allowed amount for every code on the superbill and add them. Asking only about 99214 understates what the visit is worth to the plan.
2. The deductible applies line by line. On a normalized $100 visit split, say, into a $60 E/M line and a $40 add-on line, and a plan that allows both lines in full, a $50 remaining deductible takes most of the first line and none of the second. The remittance then shows a deductible code on one line and coinsurance on the other, for the same visit.
3. The add-on depends on the primary line. In the dataset below, one add-on line was denied with the payer's explanation that an add-on is only considered when the primary procedure is separately reimbursed. If an E/M line is denied, fix that line first.

Intakes: 90792 or a new-patient E/M code

A first psychiatric visit can be billed more than one way. A 90792 describes a psychiatric diagnostic evaluation with medical services. A new-patient E/M code such as 99204 can also be used, and when psychotherapy is part of that visit, an add-on such as 90838 follows it. The Horizon remittance in the guide shows exactly that pairing on an intake. Plans can price these choices very differently, so ask your plan for the allowed amount on whichever codes your clinician tells you they will use.

Telehealth: the place-of-service code matters

A superbill carries a place-of-service code. CMS defines 02 as telehealth provided other than in the patient's home, 10 as telehealth provided in the patient's home, and 11 as an office (CMS place-of-service code set). Plans decide how they pay each one. In the guide's UnitedHealthcare example, a run of telehealth visits was denied with remark M77, a missing, incomplete, invalid or inappropriate place of service, and the same visits paid after the claim was corrected and resubmitted. Before telehealth care starts, ask your plan which place-of-service code and modifier it expects.

What these codes paid out of network

Real claims from an NYC outpatient psychiatry practice, 2019–2026, de-identified: 265 service lines, mostly nurse practitioner and therapist visits, billed to Anthem BCBS and UnitedHealthcare, with smaller Horizon and Independence Blue Cross samples that are suppressed below. Each row shows what the plan paid as a share of its own allowed amount.

Medians include lines where a deductible applied. The E/M and add-on lines behave alike within each payer, which is the pattern you would expect when the same plan terms apply to both lines of a visit. The full table, with interquartile ranges and denial shares, is in the reimbursement guide.

Before you submit a psychiatry superbill

• Every code on its own line, with the add-on directly after the E/M code it belongs to
• A place-of-service code that matches where the visit happened, and any telehealth modifier your plan requires
• The clinician's NPI, license and tax ID, since an unverified NPI or tax form can hold every line (the Horizon example)
• A diagnosis code on each line

The full checklist is in the superbill guide, and the script for calling your plan is on the benefits call page.

Related

How out-of-network reimbursement works · Superbills explained · The benefits call, question by question · What out-of-network psychiatric care costs in New York

Frequently asked questions

Why does my psychiatry superbill have two codes for one visit?

Medication management is billed as an evaluation-and-management code, and psychotherapy done in the same visit is billed as a timed add-on code. Your plan processes the two lines separately, each with its own allowed amount.

What is the difference between 90833, 90836 and 90838?

All three are psychotherapy add-ons used with an evaluation-and-management code. CMS's short descriptors give them as 30, 45 and 60 minutes of psychotherapy with the patient.

What is CPT 90792?

CMS's short descriptor is Psych diag eval w/med srvcs: a psychiatric diagnostic evaluation that includes medical services. 90791 is the same evaluation without medical services.

Why was my add-on code denied?

An add-on rides on its primary code. In the dataset on this page, one add-on line was denied with the payer's explanation that it is only considered when the primary procedure is separately reimbursed. Check whether the evaluation-and-management line was denied first.

Which place-of-service code should a telehealth superbill use?

CMS defines 02 as telehealth provided somewhere other than the patient's home and 10 as telehealth provided in the patient's home; 11 is an office. Plans set their own payment rules for each, so ask yours, because a mismatch is a common cause of denial.

Is 90837 paid more than 99214 plus 90836?

It depends entirely on your plan's allowed amount for each code. Ask for the allowed amount for every code on your superbill, then run the totals in the calculator on the out-of-network reimbursement guide.

Sources

1. CMS Physician Fee Schedule data, 2026 indicators (short descriptors)
2. CMS Physician Fee Schedule look-up
3. CMS Place of Service code set
4. X12 Claim Adjustment Reason Codes
5. X12 Remittance Advice Remark Codes