2026 Psychiatry Coding and Coverage Guide

Interactive complexity during a mental-health service

Use for qualifying communication factors that complicate delivery, not merely because a patient is anxious, difficult, young, or accompanied by another person.

Psychiatric diagnostic evaluation that includes medical services

Comprehensive diagnostic assessment that includes medical services appropriate to a physician/QHP. It is not a routine medication follow-up and cannot be reported with a same-day E/M service.

About 30 minutes of psychotherapy added to a medical E/M visit

Select only by face-to-face psychotherapy time, separate from E/M work. Document the psychotherapy intervention, target, response, and why it was separately necessary.

About 45 minutes of psychotherapy added to a medical E/M visit

Select only by face-to-face psychotherapy time, separate from E/M work. Document the psychotherapy intervention, target, response, and why it was separately necessary.

About 60 minutes of psychotherapy added to a medical E/M visit

Select only by face-to-face psychotherapy time, separate from E/M work. Document the psychotherapy intervention, target, response, and why it was separately necessary.

First unit of urgent crisis psychotherapy

Urgent assessment and psychotherapy for a life-threatening or complex crisis requiring immediate attention; not a routine high-acuity visit.

Each additional 30 minutes of crisis psychotherapy

Additional crisis psychotherapy beyond the first-unit range.

Psychoanalysis session

Use only when psychoanalysis, not ordinary supportive psychotherapy, is the actual modality and medically necessary.

Initial TMS session with mapping and motor-threshold testing

Initial treatment session including cortical mapping, motor-threshold determination, delivery, and management; report once per treatment course unless payer policy permits a new authorized course.

Subsequent TMS treatment session

Subsequent treatment delivery and management when motor-threshold redetermination is not performed.

TMS treatment session with repeat motor-threshold testing

Subsequent session requiring motor-threshold redetermination plus delivery and management; not routine remapping without clinical need.

Brief standardized emotional or behavioral screening instrument

Brief standardized emotional/behavioral instrument with scoring and documented result; not an informal checklist.

First hour of psychological test evaluation by a clinician

Psychological test evaluation: data integration, interpretation, clinical decision-making, report, and feedback when performed. Do not use for simple scoring alone.

Each additional hour of psychological test evaluation

Psychological test evaluation: data integration, interpretation, clinical decision-making, report, and feedback when performed. Do not use for simple scoring alone.

First hour of neuropsychological test evaluation by a clinician

Neuropsychological test evaluation for brain-behavior/cognitive questions; distinguish from general psychological evaluation.

Each additional hour of neuropsychological test evaluation

Neuropsychological test evaluation for brain-behavior/cognitive questions; distinguish from general psychological evaluation.

First 30 minutes of test administration and scoring by a clinician

Two or more tests, any method, personally administered/scored by the QHP.

Each additional 30 minutes of clinician test administration and scoring

Two or more tests, any method, personally administered/scored by the QHP.

First 30 minutes of test administration and scoring by a technician

Two or more tests administered/scored by a technician; do not use for QHP personal time.

Each additional 30 minutes of technician test administration and scoring

Two or more tests administered/scored by a technician; do not use for QHP personal time.

One automated psychological or neuropsychological test delivered electronically

One automated standardized instrument delivered through an electronic platform with automated result only.

Health-behavior assessment related to a physical illness or injury

Health-focused clinical interview, observations, and decision-making related to a physical condition; not a psychiatric diagnostic evaluation.

First 30 minutes of individual health-behavior intervention

Face-to-face individual intervention targeting behavior that affects a physical condition.

Each additional 15 minutes of individual health-behavior intervention

Additional individual health behavior intervention time.

Each additional 15 minutes of family health-behavior intervention with the patient present

Use only for additional face-to-face family intervention time when the patient is present and the work addresses psychological, behavioral, emotional, cognitive, or social factors affecting treatment or management of a physical health problem. It is not family psychotherapy.

First 30 minutes of family health-behavior intervention without the patient present

Use for face-to-face family intervention when the patient is absent and the work addresses psychological, behavioral, emotional, cognitive, or social factors affecting treatment or management of the patient's physical health problem. It is not family psychotherapy.

Each additional 15 minutes of family health-behavior intervention without the patient present

Additional face-to-face family health-behavior intervention time without the patient present, directed to psychological or behavioral factors affecting treatment of the patient's physical condition.

CBT remote-monitoring device supply for 16-30 monitored days

A qualifying FDA-defined medical device must collect/transmit therapy adherence, response, or digital-therapeutic data for 16-30 days in a 30-day period.

New-patient office visit with low-complexity decision making or at least 30 minutes

Medically appropriate history and/or examination plus low medical decision making, or select by at least 30 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.

New-patient office visit with moderate-complexity decision making or at least 45 minutes

Medically appropriate history and/or examination plus moderate medical decision making, or select by at least 45 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.

New-patient office visit with high-complexity decision making or at least 60 minutes

Medically appropriate history and/or examination plus high medical decision making, or select by at least 60 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.

Established-patient office visit with low-complexity decision making or at least 20 minutes

Medically appropriate history and/or examination plus low medical decision making, or select by at least 20 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.

Established-patient office visit with moderate-complexity decision making or at least 30 minutes

Medically appropriate history and/or examination plus moderate medical decision making, or select by at least 30 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.

Established-patient office visit with high-complexity decision making or at least 40 minutes

Medically appropriate history and/or examination plus high medical decision making, or select by at least 40 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.

Deleted lowest-level office consultation; contract reference only and not billable in 2026

Do not select for a 2026 encounter. Choose the active code that accurately represents the documented service and payer rules.

Office consultation with straightforward decision making or at least 20 minutes

Medically appropriate history and/or examination plus straightforward medical decision making, or select by at least 20 minutes of qualifying physician/QHP time on the date of service. Original Medicare does not recognize this consultation code because EncoderPro status I means not valid for Medicare purposes. A commercial product may recognize it only under its current written rules.

Office consultation with low-complexity decision making or at least 30 minutes

Medically appropriate history and/or examination plus low medical decision making, or select by at least 30 minutes of qualifying physician/QHP time on the date of service. Original Medicare does not recognize this consultation code because EncoderPro status I means not valid for Medicare purposes. A commercial product may recognize it only under its current written rules.

Office consultation with moderate-complexity decision making or at least 40 minutes

Medically appropriate history and/or examination plus moderate medical decision making, or select by at least 40 minutes of qualifying physician/QHP time on the date of service. Original Medicare does not recognize this consultation code because EncoderPro status I means not valid for Medicare purposes. A commercial product may recognize it only under its current written rules.

Office consultation with high-complexity decision making or at least 55 minutes

Medically appropriate history and/or examination plus high medical decision making, or select by at least 55 minutes of qualifying physician/QHP time on the date of service. Original Medicare does not recognize this consultation code because EncoderPro status I means not valid for Medicare purposes. A commercial product may recognize it only under its current written rules.

Commercial prolonged office or outpatient E/M, each additional 15 minutes beyond the CPT threshold

Commercial payer must recognize the code. Within this project scope, use only with 99205 or 99215; 99245 is also a CMS add-on-file primary but only when that commercial payer recognizes consultation coding and prolonged consultation reporting.

Monthly general behavioral-health integration care management

General BHI with assessment/monitoring, care plan, treatment facilitation/coordination, and continuity; it does not require the full CoCM team/registry structure.

First-month psychiatric collaborative care management

All CoCM elements: engagement, initial assessment/rating scale, individualized plan, registry, weekly consultant review, tracking, coordination, and brief evidence-based interventions.

Subsequent-month psychiatric collaborative care management

Ongoing registry tracking, weekly consultant review, coordination, outcome measurement, treatment changes, brief interventions, and relapse-prevention/discharge work.

Each additional 30 minutes of psychiatric collaborative care management

All base CoCM elements must be met and the additional care-manager time must be supported.

CORF rehabilitation social-work or psychology service, each 15 minutes

Face-to-face service that directly relates to or furthers CORF rehabilitation goals.

Brief 15-minute counseling for alcohol misuse

Brief counseling only after a covered alcohol-misuse screen is positive; not for alcohol dependence treatment.

Thirty-minute high-intensity counseling to prevent sexually transmitted infections

High-intensity individual counseling for an adult at increased STI risk, including education, skills training, and behavior-change guidance.

Brief 15-minute behavioral counseling for obesity

Intensive behavioral therapy for obesity for an alert, competent adult with BMI at least 30, furnished in a primary care setting.

First 30 minutes of caregiver behavior-management training

Initial behavior-management/modification caregiver training without the patient.

Each additional 15 minutes of caregiver behavior-management training

Additional caregiver behavior-management training time.

Monthly bundle of four post-discharge behavioral-crisis follow-up calls

Series of telephone follow-up contacts after discharge from an ED, psychiatric inpatient, crisis stabilization, or other qualifying crisis encounter, aimed at ongoing support and safety.

Five-to-ten-minute mental-health interprofessional consultation

Includes required verbal and written report to the treating/requesting practitioner.

Eleven-to-twenty-minute mental-health interprofessional consultation

Includes required verbal and written report to the treating/requesting practitioner.

Twenty-one-to-thirty-minute mental-health interprofessional consultation

Includes required verbal and written report to the treating/requesting practitioner.

Mental-health interprofessional consultation lasting at least 31 minutes

Includes required verbal and written report to the treating/requesting practitioner.

Written-only mental-health interprofessional consultation lasting at least 5 minutes

Written report without the verbal-discussion requirement of G0546 - Five-to-ten-minute mental-health interprofessional consultation-G0549 - Mental-health interprofessional consultation lasting at least 31 minutes.

Treating-practitioner referral work for a mental-health consultation, 30 minutes

Referral service by the treating/requesting practitioner; not consultant-side work.

Digital mental-health treatment device supply plus onboarding

Qualifying device furnished to augment a behavioral therapy plan, with onboarding completed.

First 20 minutes of monthly digital mental-health treatment management

Review device information/patient inputs and perform at least one interactive patient/caregiver communication in the month.

Each additional 20 minutes of monthly digital mental-health treatment management

Additional DMHT management time after the base requirements are met.

APCM add-on for first-month psychiatric collaborative care

First-month CoCM elements for a patient also receiving APCM.

APCM add-on for subsequent-month psychiatric collaborative care

Subsequent-month CoCM elements for a patient also receiving APCM.

APCM add-on for general behavioral-health integration

General BHI elements for a patient also receiving APCM.

Medicare or Medicare Advantage prolonged office or outpatient E/M, each additional 15 minutes beyond the Medicare threshold

Within this project scope, report only with 99205 or 99215 selected by total time and paid to the same practitioner for the same patient and date.

First 30 minutes of psychiatric collaborative care management

CoCM model requirements still apply; use when the 30-minute care-manager threshold is met but the longer 99492 - First-month psychiatric collaborative care management/99493 - Subsequent-month psychiatric collaborative care management threshold is not.