Choosing Services and Billing Codes
A practical guide to common therapy billing codes, psychotherapy time, family and group attendance, documentation, telehealth modifiers, and place of service.
In the calendar, choose the client or case, then select Service. Choose the service that describes the care you plan to provide. After the session, review the service against the care actually provided and the time documented before billing.
Use the ? beside Service to return to this guide. Practice owners and administrators can manage the practice’s services in Settings → Practice → Services. For configuration steps, see Setting Up Services, Fees, and Procedure Codes.
Service, code, duration, and fee
A service brings together its name, usual appointment duration, fee, billing code when applicable, and attendance guidance. The calendar uses the selected service to fill in appointment details.
The appointment duration reserves calendar time. The billing code describes the service provided. Review each separately when a session differs from what was scheduled.
Common codes at a glance
These plain-language summaries help distinguish the services. Review current code definitions and payer rules before billing.
| Code | What to distinguish |
|---|---|
| 90791 | Diagnostic assessment without medical services. An introductory call is not automatically a diagnostic evaluation. |
| 90792 | Diagnostic assessment that includes medical services, performed by an appropriately qualified clinician. |
| 90832, 90834, 90837 | Individual psychotherapy, selected using the psychotherapy time ranges below. |
| 90833, 90836, 90838 | Psychotherapy add-ons used with a separately identifiable E/M service. |
| 90846 | Family psychotherapy when the identified client is absent. |
| 90847 | Family psychotherapy with the identified client present. |
| 90853 | Group psychotherapy. An educational class or support meeting is not automatically psychotherapy. |
See CMS psychiatric-service coding guidance. A diagnostic evaluation is a different service from ongoing psychotherapy; the individual psychotherapy time bands do not select its code. Repeat evaluations need a documented clinical reason and a review of the payer’s frequency rules.
Individual psychotherapy time ranges
For individual psychotherapy without an evaluation and management (E/M) service, the usual time ranges are:
| Code | Psychotherapy time provided |
|---|---|
| 90832 | 16 to 37 minutes |
| 90834 | 38 to 52 minutes |
| 90837 | 53 minutes or more |
The threshold for 90837 is 53 minutes of psychotherapy, rather than simply booking a longer appointment. Sessions under 16 minutes do not meet the minimum for these codes. See CMS guidance on psychotherapy time and documentation.
For example:
- A 55-minute appointment scheduled with 90834 prompts a suggestion to consider 90837 if that much psychotherapy is provided.
- A 50-minute appointment scheduled with 90837 prompts a suggestion to consider 90834.
Do not round 52 minutes up to 53 or count note writing, scheduling, or other administrative work toward psychotherapy time. A family member joining an individual session does not automatically make it family psychotherapy; select the code for the service actually delivered. See Medicare NCCI psychiatric-service guidance, Section C.
Calendar suggestions use scheduled duration and allow you to save the appointment. They appear for private-pay and insurance appointments. They leave the service you selected in place.
Document the time actually provided
When your practice enables session time documentation, use the workspace to enter the actual start and end times. If psychotherapy minutes are enabled, enter the time spent providing psychotherapy. Use scheduled times and Use elapsed duration are shortcuts; review their values before saving.
Saving session times does not change the appointment fee. Scheduled time, actual session duration, and psychotherapy minutes can differ. PracticeRunner checks documented psychotherapy minutes against the code’s time range and flags actual sessions too short to support the selected code. Longer elapsed time alone does not establish that the whole session was psychotherapy.
CMS contractor guidance calls for start and stop times or total psychotherapy time. For psychotherapy with an E/M service, exclude E/M time from psychotherapy minutes. The related add-on codes 90833, 90836, and 90838 use the same time bands as their standalone counterparts. See CMS time-documentation guidance.
Attendance and the client receiving the service
For an individual service within a couple, family, or group case, review Client receiving this service. PracticeRunner initially selects the case’s identified client. Change that selection when another member receives the individual service.
Other services may expect the identified client with others, other members without the identified client, or multiple participants. Use the service’s attendance guidance when choosing who attends. Review any attendance alert against who actually attended.
Family psychotherapy
For 90846 and 90847, document who attended, whether the identified client was present, and how the work relates to that client’s treatment. The presence of two people alone does not establish that family psychotherapy was provided.
These codes have a 26-minute minimum. The 53-minute threshold for individual psychotherapy does not convert a family service into 90837. Confirm family-service coverage and authorization with the payer. See CMS family psychotherapy guidance.
Group psychotherapy
Use 90853 for the group psychotherapy provided, with documentation supporting each client’s participation and treatment. Keep other group members’ names out of an individual client’s note. Review payer-specific session length, group-size, and billing requirements rather than applying the individual time bands.
For PracticeRunner’s participant invoices, notes, superbills, and current claim limitations, see Group Therapy Attendance, Participant Billing, Superbills, and Claims.
Consultation cases use consultation services, notes, invoices, and receipts. Choose services appropriate to the professional consultation being provided.
Other code combinations to review
- Evaluation and psychotherapy on the same day: Medicare NCCI rules do not allow 90791 or 90792 to be reported separately with psychotherapy on the same date of service. Check the applicable rules before combining services. See the 2026 NCCI manual, Section C.
- Interactive complexity, 90785: This is an add-on for qualifying communication difficulties, not an extra charge for every difficult session or for an interpreter alone. Document the qualifying factor and how it affected care. It cannot stand alone or be added to family or crisis psychotherapy. See the American Psychiatric Association’s interactive complexity guide.
- Crisis services: 90839 and 90840 describe crisis psychotherapy with separate requirements. A longer routine session is not automatically crisis care. Medicare also distinguishes certain non-office crisis services using G0017 and G0018. Review CMS crisis coding guidance before choosing the service.
This guide does not mean PracticeRunner automatically adds an extra billing line or validates every code combination.
Telehealth modifiers and place of service
A procedure code describes the care. A modifier adds information about how it was delivered, and a place-of-service (POS) code identifies the setting.
| POS code | Setting |
|---|---|
| 11 | In-person care in an office |
| 12 | In-person care at the client’s home |
| 10 | Telehealth received by a client at home |
| 02 | Telehealth received by a client somewhere other than home |
| 03 | School |
For telehealth POS 10 versus 02, consider where the client is, not where the clinician is sitting. An in-person home visit (12) differs from telehealth received at home (10). See the CMS place-of-service code set.
Modifier 95 identifies real-time audio/video delivery, while 93 identifies real-time audio-only delivery. These meanings do not make either modifier mandatory on every telehealth claim. Medicare reporting varies by provider and setting; for example, Noridian does not require 95 on most ordinary Part B telehealth visits. Other payers or settings may require GT or FQ. Confirm the required combination for the payer, clinician, service, and date of care. See Noridian’s Medicare telehealth billing guidance.
In PracticeRunner, review location defaults in Settings → Locations. The workspace header lets you change the appointment location. For an appointment-specific POS or modifier override, open the calendar appointment’s Insurance billing section. See Place of Service and Modifier Codes.
Documentation to support the service
The clinical record should make clear:
- the date, service, clinician, participants, and relevant setting
- actual psychotherapy time when the code depends on time
- the clinical need, interventions, response, and progress toward treatment goals
- the plan and the reason for longer or more frequent treatment when relevant
For family work, explain its connection to the identified client’s care. For groups, retain participant-specific clinical information alongside the shared session information. See CMS documentation guidance. Keep billing-supporting information in the clinical record, separately from private psychotherapy notes; see Progress notes and psychotherapy notes.
Before billing
Review the service, actual psychotherapy time, attendance, and appointment location. Confirm payer-specific coverage, medical necessity, modifiers, authorization, and telehealth requirements with the applicable payer or Medicare contractor. Meeting a time threshold alone does not establish coverage.
For invoices, superbills, and claims, see Billing and Invoicing. For diagnosis codes, see Managing Diagnosis Codes and Client Diagnoses.
CPT is a registered trademark of the American Medical Association. This guide uses plain-language summaries rather than the full code definitions. Check the requirements that apply to your practice and date of service.