Behavioral Health Billing
PMHNP Billing & Coding: A Practical 2026 Guide
PMHNPs bill under their own NPI with psychiatry’s CPT codes: 90792 for the evaluation, an E/M code like 99214 for medication management, and +90833 for same-visit therapy. When you bill directly, Medicare pays 85% of the physician fee schedule.
At A Glance
Coding And Claims, Done Right The First Time
- A medication management visit bills an E/M level, such as 99214, plus the 90833 psychotherapy add-on when you also provide therapy.
- The diagnostic evaluation is 90792 when you prescribe, 90791 when it has no medical services.
- Direct vs. incident-to is decided and documented per visit, and changes what Medicare pays.
- Telehealth claims need each payer’s place-of-service code and modifier.
- Scrub every claim before it goes out and work every denial, for Medicare, Medicaid or commercial payers.
The 85% Question
Direct Vs. Incident-To: The Reimbursement Difference
This is the key concept in PMHNP billing, and it’s Medicare specific.
Direct Billing (85%)
Under your own NPI, Medicare pays 85% of the physician fee schedule (42 CFR 414.56). Simple, low-risk.
Incident-To (100%)
Billed under the physician’s NPI at 100%, but only with an established plan and no new problems. Behavioral health allows general supervision, so the physician needn’t be in the suite.
Commercial & Medicaid
The 85% rule is Medicare only. Plans and states set their own commercial and Medicaid rates; check your contract.
Go deeper on incident-to billing for PMHNPs and PMHNP reimbursement rates.
The Codes
CPT Codes PMHNPs Use Most
These are paraphrased for orientation only; check the exact descriptors in the current AMA CPT code set and your payer’s policy. Printable version: PMHNP CPT codes cheat sheet.
| CPT Code | What PMHNPs Use It For |
|---|---|
| 90791 | Psychiatric diagnostic evaluation without medical services. |
| 90792 | Diagnostic evaluation with medical services, the typical prescribing intake. |
| 99202 to 99215 | E/M office visits for medication management and follow-up. |
| 90833 / 90836 / 90838 | Psychotherapy add-ons (~30/45/60 min) with an E/M code; document therapy time separately. |
| 90832 / 90834 / 90837 | Standalone psychotherapy (~30 / 45 / 60 min). See 90834 vs 90837. |
| 90853 | Group psychotherapy, per patient. Check payer limits on group size. |
Full Visibility
See Every Claim From Charge To Paid
Whoever does your billing, you should see each claim’s status (submitted, rejected, denied or paid), aging and open appeals on the same screen, because a denial nobody works becomes a write-off. Our psychiatric billing services report it that way monthly. Comparing billers? Start with what mental health billing costs across the market.
The Claim Cycle
Three Steps Behind Every Paid PMHNP Claim
Map Codes And Payers
List visit types, set the direct vs. incident-to rule for each, and note each payer’s requirements before the first claim.
Scrub And Submit
Check each claim against payer rules and what the note supports, then submit it clean.
Work Denials And Appeals
Follow up on aging, correct and resubmit denials, appeal what should have paid.
Stop The Leaks
Top PMHNP Billing Denial Reasons
Enrollment Gaps
Billing before enrollment is active, or after a CAQH/DataSpring attestation lapsed, denies as “provider not eligible.”
Invalid Incident-To
A new problem or a plan the physician didn’t set breaks the rules, adding compliance risk to the denial.
Missing Therapy Time
Add-ons 90833, 90836, and 90838 need psychotherapy time documented apart from E/M work.
FAQ
Frequently Asked Questions
Can PMHNPs Bill Medicare?
Yes. Medicare recognizes nurse practitioners, who enroll through PECOS, usually with the CMS-855I (a group reassignment goes on the same form), and pays 85% of the physician fee schedule under your own NPI.
Can PMHNPs Bill Medicaid?
Usually, but it varies by state. Every state Medicaid program reimburses nurse practitioners but sets its own enrollment, covered services, rates and supervision rules; check your state’s policy.
What Is Incident-To Billing?
It bills a PMHNP’s service under the physician’s NPI at 100%, but only when the physician started the plan of care for that problem and stays involved. For behavioral health services, Medicare allows general supervision, so the physician doesn’t have to be in the suite. A new patient or a new problem is never incident to. See incident-to billing for PMHNPs.
The PMHNP CPT Quick Sheet, 2026 Edition
Five pages: the ten codes PMHNPs bill most at a glance, which code fits the visit, the E/M level table, what can be billed together, telehealth and Spravato in 2026, and the questions PMHNPs ask most. We email it to you right away.
Want Us To Run Your PMHNP Billing?
PMHNP practices rarely lose money on code choice. They lose it on the 90833 without documented therapy time, the incident-to visit that missed the rules, and the unappealed denial.
Our Ongoing Billing covers all of that, from 7% of collections for a solo provider down to 4.5% for groups of 26 to 50, with a $300 monthly minimum for a solo provider.
This page is general information, not billing, coding, legal or medical advice. Rules, coverage and payment change and vary by payer and state. Before billing, verify every code and rule against the current AMA CPT code set, your CMS Medicare Administrative Contractor, your state Medicaid program, and your payer contracts. CPT is a registered trademark of the American Medical Association. Last reviewed: October 25, 2026.