PMHNP Billing and Coding
PMHNP CPT Codes Cheat Sheet
A scannable reference to the CPT codes psychiatric nurse practitioners use most, grouped by intake, medication management, psychotherapy, and group, with plain-language guidance on picking the right code and pairing add-ons correctly.
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How This Cheat Sheet Works
Psychiatric mental health nurse practitioners (PMHNPs) prescribe, so their coding usually revolves around either an evaluation and management (E/M) office visit, a psychiatric diagnostic evaluation, psychotherapy, or a combination. The descriptors below are paraphrased for quick scanning. For the official language, always confirm against the current-year CPT code set published by the American Medical Association (AMA). CPT is a registered trademark of the AMA.
Informational, not billing or legal advice. Payer rules, coverage, and reimbursement vary. Verify every code, modifier, and pairing against the current CPT code set, your Medicare Administrative Contractor, and each payer’s policy before you submit.
Reference Table
Core PMHNP CPT Codes at a Glance
| Code | Category | Plain-language description (paraphrased) | Time / notes |
|---|---|---|---|
| 90791 | Intake | Psychiatric diagnostic evaluation without medical services | No time threshold; typically non-prescribers |
| 90792 | Intake | Psychiatric diagnostic evaluation with medical services (prescribing, ordering labs, medical assessment) | Usual intake code for PMHNPs who prescribe |
| 99202-99205 | Med management (new) | Office/outpatient E/M, new patient, by level of medical decision making or total time | New-patient med visits |
| 99212-99215 | Med management (established) | Office/outpatient E/M, established patient, by level of medical decision making or total time | Follow-up med visits |
| 90832 | Psychotherapy (standalone) | Individual psychotherapy, about 30 minutes | Range roughly 16-37 min |
| 90834 | Psychotherapy (standalone) | Individual psychotherapy, about 45 minutes | Range roughly 38-52 min |
| 90837 | Psychotherapy (standalone) | Individual psychotherapy, about 60 minutes | Range 53+ min |
| 90833 | Psychotherapy add-on | Add-on: ~30 min psychotherapy with an E/M service, same encounter | Report with an E/M code; never alone |
| 90836 | Psychotherapy add-on | Add-on: ~45 min psychotherapy with an E/M service, same encounter | Report with an E/M code; never alone |
| 90838 | Psychotherapy add-on | Add-on: ~60 min psychotherapy with an E/M service, same encounter | Report with an E/M code; never alone |
| 90853 | Group | Group psychotherapy (other than a multiple-family group) | Billed once per patient per session; not time-based |
Descriptors are paraphrased from the AMA CPT code set. See the AMA Behavioral Health Coding Guide and CMS Billing and Coding: Psychiatry and Psychology Services (A57480) for the authoritative rules.
Grouped by Encounter Type
The Four Groups PMHNPs Use Most
Intake / Evaluation
Because PMHNPs prescribe, the intake is usually 90792 (psychiatric diagnostic evaluation with medical services) rather than 90791 (without medical services). Per the AMA CPT code set, 90792 covers the diagnostic assessment plus medical components such as prescribing and lab review. These evaluation codes are generally reported once at the start of an episode of care.
Medication Management
Ongoing med checks are E/M office visits: 99202-99205 for new patients and 99212-99215 for established patients, selected by level of medical decision making or by total time on the date of the encounter under the AMA office/outpatient E/M guidelines.
Psychotherapy
If psychotherapy is the whole visit, use a standalone timed code: 90832 (~30 min), 90834 (~45 min), or 90837 (~60 min). If psychotherapy is delivered in the same session as medical management, use an add-on (90833, 90836, or 90838) with the E/M code.
Group
Group psychotherapy is 90853, reported once per patient for each session attended. Per the AMA CPT code set it is not time-based, so a longer group session is not reported differently by duration. Bill a separate claim under each patient.
Decision Guide
How to Pick the Right Code
Work through these questions in order:
- Is this the first diagnostic evaluation? If yes and you prescribe or provide medical services, use 90792.
- Is the visit only medication management? Use an E/M code: 99202-99205 (new) or 99212-99215 (established), chosen by medical decision making or total time.
- Is the visit only psychotherapy? Use a standalone timed code: 90832, 90834, or 90837, matched to the psychotherapy time actually spent.
- Did you do both medication management and psychotherapy in one session? Report the E/M code plus a psychotherapy add-on (90833, 90836, or 90838). Per the AMA CPT code set and CMS article A57480, count only the psychotherapy time toward the add-on; time spent on the E/M service does not count toward the add-on.
- Was it a group session? Use 90853 once per patient.
Pairing Rules
Common Pairing and Add-On Rules
Add-Ons Never Stand Alone
90833, 90836, and 90838 are add-on codes. Per the AMA CPT code set they must be reported with a primary office/outpatient E/M code (99202-99205 or 99212-99215) on the same date. They cannot be billed by themselves.
Do Not Mix Standalone and Add-On
For a single encounter, choose either a standalone psychotherapy code (90832/90834/90837) or the E/M-plus-add-on combination, not both for the same psychotherapy service. The add-on family exists specifically for the combined-visit scenario.
Evaluation vs. E/M Same Day
The psychiatric diagnostic evaluation codes (90791/90792) are generally reported once per episode and typically are not billed with an E/M service for the same patient on the same day by the same provider. Follow CMS A57480 and payer edits.
Group Is Per Patient
For 90853, submit one claim per attendee under that patient’s own coverage. Do not roll multiple patients into one claim.
These are general conventions. National Correct Coding Initiative (NCCI) edits, payer policy, and your local Medicare coverage articles govern which combinations are allowed and whether a modifier is required.
FAQ
Frequently Asked Questions
Should a PMHNP use 90791 or 90792 for an intake?
Because PMHNPs prescribe and provide medical services, the intake is usually 90792 (evaluation with medical services). 90791 is the evaluation without medical services, more typical of non-prescribing clinicians. Confirm against the AMA CPT descriptors and your payer’s policy.
Can I bill a psychotherapy add-on without an E/M code?
No. 90833, 90836, and 90838 are add-on codes that, per the AMA CPT code set, must accompany a primary office/outpatient E/M code (99202-99205 or 99212-99215). They are never reported alone.
How do I choose an E/M level for a med-management visit?
Office/outpatient E/M codes (99202-99205 and 99212-99215) are selected by level of medical decision making or by total time on the date of the encounter, following the AMA office/outpatient E/M guidelines. Document whichever basis you use.
Is 90853 time-based?
No. Per the AMA CPT code set, group psychotherapy code 90853 is reported once per patient per session and is not scaled by the length of the group.