PMHNP Billing And Coding
PMHNP CPT Codes Cheat Sheet
You’ll bill most PMHNP visits one of four ways: 90792 for the prescribing evaluation, an E/M code for medication management (99202 to 99205 new, 99212 to 99215 established), 90832, 90834 or 90837 for a therapy-only visit, or an E/M code plus the 90833, 90836 or 90838 add-on when you do both. Group therapy is 90853, billed once per patient. The table and decision guide below show how to pick and pair them.
Start Here
How This Cheat Sheet Works
Psychiatric mental health nurse practitioners (PMHNPs) prescribe, so their coding usually comes down to an evaluation and management (E/M) office visit, a psychiatric diagnostic evaluation, psychotherapy, or some combination. We’ve paraphrased the descriptors below so they’re quick to scan. For the official language, always check the current-year CPT code set from the American Medical Association (AMA). CPT is a registered trademark of the AMA.
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.
The PMHNP CPT Quick Sheet, 2026 Edition
Five pages for the billing desk: 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.
Grouped By Encounter Type
The Four Groups PMHNPs Use Most
Intake / Evaluation
The intake is usually 90792 (psychiatric diagnostic evaluation with medical services), because PMHNPs prescribe. 90791 is the same evaluation without medical services. Per the AMA CPT code set, 90792 covers the diagnostic assessment plus medical components like prescribing and lab review. You’d generally report it 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
When psychotherapy is the whole visit, use a standalone timed code: 90832 (~30 min), 90834 (~45 min) or 90837 (~60 min). When it happens in the same session as medical management, it’s an add-on (90833, 90836 or 90838) that rides 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 isn’t time-based, so a longer group doesn’t get reported any differently. 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 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, only the psychotherapy time counts toward the add-on; time spent on the E/M service doesn’t.
- 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 can’t be billed by themselves.
Do Not Mix Standalone And Add-On
For a single encounter, it’s either a standalone psychotherapy code (90832/90834/90837) or the E/M-plus-add-on combination. Never both for the same psychotherapy service. The add-on family exists for exactly the combined visit.
Evaluation Vs. E/M Same Day
The psychiatric diagnostic evaluation codes (90791/90792) are generally reported once per episode and typically aren’t 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. Don’t roll multiple patients into one claim.
These are general conventions, and they aren’t the final word. National Correct Coding Initiative (NCCI) edits, payer policy and your local Medicare coverage articles decide which combinations are allowed and whether you need a modifier. Our PMHNP billing services review each claim before it goes out, so a pairing the payer won’t accept gets fixed first.
FAQ
Frequently Asked Questions
Should A PMHNP Use 90791 Or 90792 For An Intake?
Usually 90792, the evaluation with medical services. PMHNPs prescribe and provide medical services, so that’s the code that fits most intakes. 90791 is the evaluation without medical services, and it’s more typical of clinicians who don’t prescribe. Check the AMA CPT descriptors and your payer’s policy before you bill.
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’re 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 it isn’t scaled by the length of the group.