Psychiatrists who bill a combined med-management E/M visit without the 90833 add-on leave roughly $72 uncollected on every session where real psychotherapy also happened — for a psychiatrist seeing 25 such visits a week, that's over $93,000 a year.
Common Billing Challenges
These are the six billing failure points we see most often in psychiatric practices — and the ones our team resolves systematically from day one.
When a psychiatrist provides both med management and genuine psychotherapy in one visit, both are billable — the E/M code plus 90833. Billing the E/M alone systematically underbills every combined session.
90833 requires the psychotherapy portion documented separately from the E/M — interventions used, patient response, and time spent. A single blended paragraph covering "med management and supportive therapy" doesn't meet the standard and is a common audit trigger.
The carve-out that manages therapy claims doesn't always manage psychiatric medication claims the same way. Routing a medication management claim to the wrong entity is an automatic denial we catch before it happens.
Prescribing controlled substances via telehealth carries federal in-person-exam requirements on top of standard telehealth billing rules — a compliance layer that pure psychotherapy telehealth doesn't carry, and one general billers routinely miss.
90791 (diagnostic evaluation) and 90792 (with medical services) are coded differently — mixing them up either under-codes the initial evaluation or bills the wrong code for a follow-up visit.
Long-acting injectable antipsychotics and office-based opioid use disorder treatment (buprenorphine management) use their own monthly bundled and administration codes that are frequently billed incorrectly or missed entirely.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in psychiatry.
| CPT Code | Description | Common Issue |
|---|---|---|
| 90792 | Psychiatric diagnostic evaluation, with medical services | Confused with 90791 (no medical services) |
| 99213–99215 + 90833 | E/M with psychotherapy add-on, 16–37 min | Add-on missed when session covers both |
| G2086–G2088 | Office-based opioid use disorder treatment | Monthly bundled rate frequently missed |
| H0020 | Methadone administration (OTP) | Bundled weekly rate, easy to double-bill |
| 99408 | Alcohol/substance screening, 15–30 min | Separately billable, often left off the claim |
| 96372 | Injectable medication administration | Billed alongside long-acting antipsychotic J-code |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to psychiatry — not a generic CPC only.
Significantly above the 15.4% industry denial rate for this specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.