Which CPT Codes Go on a Cash-Pay Psychiatry Superbill?

A cash-pay psychiatry superbill runs on a short list of CPT codes: one code for the intake (90792 or 99205), an E/M code for each follow-up (99213, 99214, or occasionally 99215), and a psychotherapy add-on code (90833, 90836, or 90838) whenever the visit genuinely includes a therapy component alongside medication management. The code does not change what you collect, since your fee is already charged in full. It changes what your patient's insurer will pay back, which code combinations survive a claims review, and whether the claim gets paid at all.

This assumes you have already decided to run an out-of-network cash practice; if that decision is still open, insurance versus cash-pay psychiatry is the place to start. The table below is the reference most psychiatrists actually need, checked against the current AMA CPT descriptors and the 2026 Medicare Physician Fee Schedule.

*National non-facility rate before geographic adjustment, from the 2026 Medicare Physician Fee Schedule, current as of the 2026 conversion factor. A commercial plan's out-of-network allowed amount for your patient will differ from these figures, sometimes substantially, but the ordering tends to hold across payers too: 99205 usually pays a bit more than 90792, and each add-on tier pays more than the one below it.

On Eureka, the CPT codes for each appointment type are set once, on the service itself, and every superbill generated from that appointment carries them automatically, along with the practice's Type 2 NPI. Whatever software runs your billing, this is worth demanding: a code library configured once per appointment type that never needs re-entry by hand on any single superbill.

90792 or 99205: which code fits a psychiatric intake?

Use 90792 for a standard diagnostic intake and reserve 99205 for the cases where the visit's medical decision-making or total time genuinely fits an E/M code better. Both describe a comprehensive first evaluation, but they are not interchangeable on the same claim: Medicare's National Correct Coding Initiative bundles 90792 with 99204 and 99205, so a payer that follows NCCI edits will reject a claim carrying both. Pick one code for the intake, never both.

90792 is the psychiatric diagnostic evaluation with medical services: an integrated biopsychosocial and medical assessment, covering history, mental status exam, relevant physical exam elements, and a diagnostic formulation with a treatment plan. It is the code built specifically for what a psychiatrist or psychiatric nurse practitioner does on a first visit, and it does not require documenting minutes.

99205 is the general new-patient E/M code at the highest complexity level, selected either by 60-74 minutes of total time on the day of the visit or by high-complexity medical decision-making. Some psychiatrists use it for every intake instead of 90792, in part because a longer or more complex first visit can genuinely be documented as high-complexity E/M, and in part because 99205 tends to pay commercial plans' allowed amount a bit better than 90792 does on Medicare's own schedule. There is no single rule for which pays more on every plan, since allowed amounts are set per payer and per region, but the code should still match what actually happened in the room: a straightforward diagnostic evaluation is 90792, and a visit whose medical complexity or duration meets E/M's own thresholds is 99205 or the lower new-patient levels (99202-99204) below it.

Which E/M code fits a routine follow-up?

99214 is the workhorse follow-up code for cash-pay psychiatry: an established-patient visit of moderate complexity, selected by 30-39 minutes of total time or by moderate medical decision-making. Most medication-management follow-ups land here; the full 99214 guide walks through documentation examples for both pathways in more depth than fits here. A shorter, simpler check-in can drop to 99213 (20-29 minutes, or low-complexity MDM), and a longer or more complex visit, a medication change with several comorbid problems, for instance, can justify 99215 (40-54 minutes, or high-complexity MDM).

Since the AMA's 2021 revision, every one of these codes can be selected by either pathway: total time on the date of the encounter, or medical decision-making complexity, whichever the visit actually supports. Total time includes reviewing the chart before the visit, the visit itself, ordering medications or labs, and writing the note afterward, all on the same calendar day. It does not include any separately billed psychotherapy time, which is where the next section matters.

Can you bill an E/M code and a psychotherapy add-on in the same visit?

Yes, and this is the single most useful thing to get right on a psychiatric superbill: document the psychotherapy time separately from the E/M time, then bill both codes. A 60-minute follow-up split into 30 minutes of medication management and 30 minutes of psychotherapy bills as 99214 (by time or by moderate MDM) plus 90833, the psychotherapy add-on for 16-37 minutes. A shorter 25-minute follow-up with a brief therapy component might bill as 99213 plus 90833 as well, if the therapy portion still clears 16 minutes on its own. The two codes run in parallel: the E/M clock and the psychotherapy clock are separate blocks of time within the same encounter, each counted and billed on its own.

That distinction is exactly where cash-pay psychiatrists most often go wrong, and it runs in the direction of overbilling rather than underbilling. A pattern we've seen more than once: a prescriber several months into a new cash-pay practice discovers they have been treating a visit's total time, medication management plus therapy combined, as one number, using it to justify a higher-level E/M code on its own, then adding a therapy code on top of that already-inflated level. The two clocks have to be counted independently and billed as their own codes. The fix, worth adopting from the start, is to write down the E/M time and the psychotherapy time as two separate figures in the note, each supporting its own code, with no overlap between them.

The documentation itself should record start and stop times, or a total time, for the psychotherapy portion specifically, along with the type of therapy performed, the content in enough detail to justify the code, and the patient's response. None of that documentation should describe E/M time, since the two are billed and defended separately.

Should you code by time or by complexity?

Whichever pathway the visit actually supports, and it is worth checking both before you default to the one you always use. A 30-minute follow-up where you adjusted two medications and reviewed a recent lab abnormality may support 99214 by moderate medical decision-making even if the clock only shows 25 minutes. Conversely, a 45-minute visit that is mostly supportive check-in with a stable, simple medication regimen may only support the time-based code for that duration, regardless of how complex the conversation felt. Coding by complexity is often the more favorable path for shorter, high-acuity visits; coding by time favors longer visits with genuinely lower complexity. Whichever pathway you use for the E/M portion, remember it has no bearing on the psychotherapy add-on: that code is selected by its own time band, independent of how you got to the E/M level.

What about very long intakes?

Once the E/M portion of a visit runs past the top of its own code's time band, before the psychotherapy add-on is even counted, a prolonged-services code can capture the extra time. For commercial payers, that is +99417, billable once the base E/M code's maximum time is exceeded: for 99205, that threshold is 75 minutes; for 99215, 55 minutes. Medicare uses a different code for the same purpose, +G2212, with a later starting threshold, since it counts from the maximum of the level-5 range rather than the point most other payers use. Most cash-pay patients are filing superbills with commercial plans, not Medicare, so +99417 is the one to know.

The carve-out that trips people up: the psychotherapy add-on's time comes out of the total first, before you check whether the E/M portion alone crossed into prolonged-services territory. A two-hour intake with 45 minutes of medication-focused E/M work and 60 minutes of psychotherapy would likely code as the appropriate E/M level for 45 minutes, plus 90838 for the 60-minute add-on, with no prolonged-services code needed at all, since the E/M clock never crossed its own threshold on its own. Prolonged services only enter the picture when the E/M time itself, counted separately from any therapy time, runs long.

Do telehealth superbills need different codes or modifiers?

The codes stay the same; add modifier 95 for a real-time audio-video visit, and use place of service 10 if the patient is at home or 02 if they are elsewhere, since most payers key their telehealth reimbursement rules off the modifier rather than the place-of-service code. A small but growing number of commercial and Medicaid plans have adopted CPT's newer 98000-98007 telemedicine series, a separate set of codes built specifically for audio-video visits rather than a modifier bolted onto an in-person code, though Medicare has not adopted them and most payers still expect the modifier-95 approach in 2026. Check a specific plan's policy before switching a patient's superbill over to the new series; the 98000-series guide covers which payers have adopted them so far and what changes on the claim.

Which code combinations get patients the most reimbursement?

"The superbills that survive payer review are the boring ones," says David Cohen, CPA, JD, who reviewed this guide. "Separate lines, separate times, and a code level the note itself can defend. Everything clever eventually gets asked about."

The honest answer is that no combination guarantees a bigger check, since every commercial plan sets its own allowed amount per code and its own out-of-network deductible, a topic covered in full in how superbills work. What you control is coding accurately to what happened in the room, which is the version of "maximizing reimbursement" that also survives a claims review. Two principles hold up across the corpus of practices we've watched build cash-pay panels: split every combined visit into its separate codes with separate fees on separate lines, since a single lumped line item for "follow-up, $350" gets bounced by insurers who need a CPT code per amount, and choose the E/M level the visit's real time or complexity supports rather than defaulting to the same code for every patient regardless of what the visit involved. A 99214 billed for a visit that only supported 99213 leaves a documentation gap that a payer, or your own malpractice carrier, can find later. If you are weighing whether to have your practice file these claims for patients rather than let them self-file, that decision runs through choosing a filing platform rather than a CPT code, and our comparison of Thrizer and Reimbursify covers it.

If your patients ask why their check came back smaller than expected, the honest answer usually points to the plan's allowed amount and deductible rather than your CPT code choice, and it is worth saying so plainly rather than promising a number you do not control.

Payer coding policies vary at the edges, and some plans apply bundling edits like the 90792/99205 rule above a little differently than Medicare does. When a specific claim gets denied over a code choice rather than a benefits issue, a billing consultant or the payer's own provider line will resolve it faster than guessing at the rule yourself.