Rates & Insurance

In psychiatric care, it is both standard and clinically appropriate for providers—particularly Psychiatric Mental Health Nurse Practitioners (PMHNPs)—to bill using a combination of Evaluation and Management (E/M) codes (e.g., 99213, 99214, 99215) along with psychotherapy add-on codes (e.g., 90833, 90836, 90838) during the same visit.

It is important to note that the psychotherapy add-on codes (90833, 90836, 90838) are distinct from the codes used by therapists, social workers, occupational therapists, physical therapists, or massage therapists.

PMHNP-delivered therapy often includes evidence-based approaches such as motivational interviewing, behavior modification, and mindfulness techniques. While these interactions may feel like a conversational exchange, they are in fact structured therapeutic interventions designed to support measurable psychiatric progress.

In addition, PMHNPs frequently provide medication education that extends beyond standard prescribing discussions. This may include:

Education on how medications interact with brain function, an overview of medication options, including those prescribed in-clinic as well as others available through referral (e.g., Spravato), and information about non-medication treatment options (e.g., TMS). This combination of medical management, psychotherapy, and enhanced patient education is central to supporting long-term mental health outcomes.

Evaluation and Management (E/M) codes are used to document and bill for the medical services provided by healthcare professionals when evaluating a patient’s condition, managing treatment, and conducting consultations, examinations, or follow-up visits.

E/M services may also be billed based on the total time spent on patient care, which can include:

• Reviewing records and prior documentation
• Coordinating with other healthcare providers
• Monitoring prescription drug programs (e.g., PDMP checks for controlled substances)
• Charting and clinical documentation
• Completing prior authorizations and required paperwork

CPT code 90785 is an add-on code used in psychiatric services when certain communication factors make the delivery of care more complex. It must always be billed in combination with another primary psychiatric service code—it cannot be billed on its own.

In short, 90785 captures the added clinical effort required when external factors make psychiatric care more complex than a typical encounter.