CurrentBlue Cross Blue Shield - New MexicoPolicy CPCP 051

Psychiatry/Psychotherapy Services - Professional Provider

Billing and claims processing guidance for psychiatry and psychotherapy services submitted by professional providers to Blue Cross and Blue Shield of New Mexico; applies to providers billing eligible members under plan documents and provider contracts.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPsychiatry/Psychotherapy Services - Professional Provider

Policy CodePolicy CPCP 051

Change TypeNew policy

Effective DateDec . 22, 2025

Next Review DateN/A

Key ActionSubmit accurate documentation and be prepared to provide supporting documentation upon request; claims are subject to review against benefit coverage, provider contract language, and coding policies.

SourceLink

POLICY UPDATE CHANGES

New policy

90791–90863Key CPT codes referenced

Dec . 22, 2025Effective date

CPCP 051Policy ID

Coverage Criteria and Billing Rules

Coverage criteria and billing rules

Covered when the following general expectations and provider responsibilities are met:

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Providers must be licensed in their state to bill behavioral health professional services and should familiarize with state rules for their license type.

Providers are responsible for accurate documentation and submission using valid HIPAA-approved code sets and industry coding guidelines; the Plan reserves the right to request supporting documentation and may review claims for compliance with coding and billing policies.

Refer to the current CPT codebook for complete and authoritative code lists; the tables in this policy are not all‑inclusive and do not replace the CPT codebook.

Psychiatric diagnostic evaluation codes (90791, 90792) may be reported at onset and may be repeated only after an extended break of at least six months without treatment for the condition.

Timed psychotherapy and crisis codes have specified minimum service time requirements and add‑on/mutually exclusive code relationships; providers must observe those requirements when reporting services.

Interactive complexity (+90785) is an add‑on reported only when specified communication complications are present; it is not a standalone code, not intended to represent increased time, and should not be used for routine translation services.

Pharmacologic management (+90863) is reported as an add‑on when performed with psychotherapy; medication management provided by other provider types should be reported with appropriate E/M codes as applicable.

Claims are subject to review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic; plan documents or provider contracts govern in the event of a conflict.

Coding — Diagnostic Evaluation, Psychotherapy, and Related Codes

Psychiatric diagnostic evaluationCPTCovered

90791	Psychiatric diagnostic evaluation (no medical services)
90792	Psychiatric diagnostic evaluation with medical services

Psychotherapy and related add-on codesCPTCovered

90832	Psychotherapy, 30 minutes
90834	Psychotherapy, 45 minutes
90837	Psychotherapy, 60 minutes
+90833	Psychotherapy with E/M, 30 minutes (add-on)
+90836	Psychotherapy with E/M, 45 minutes (add-on)
+90838	Psychotherapy with E/M, 60 minutes (add-on)
90839	Crisis psychotherapy, first 30-74 minutes
+90840	Crisis psychotherapy add-on each additional 30 minutes
90845	Mental health therapy, once per day
90846	Family psychotherapy without the patient

1–10 of 14

1/2

inv-04: Diagnostic evaluation repeat interval

Repeat frequencyPsychiatric diagnostic evaluation codes (90791, 90792) may be reported once at onset and may only be repeated after an extended break in treatment of at least six months from the last time the patient was seen or treated for the psychiatric condition.

Applicable codes90791, 90792

Reason for repeatRepeat permitted only when there has been an extended break in treatment (>=6 months).

Billing noteDo not report 90791/90792 more frequently than allowed; claims are subject to review per Plan rules.

inv-05: Service time minimums

90832 (30 mins)Service time should be no less than 16 minutes.

90834 (45 mins)Service time should be no less than 38 minutes.

90837 (60 mins)Service time should be no less than 53 minutes.

90839 (crisis first)Report for the first 30–74 minutes of crisis; may be reported only once per day.

+90840 (crisis add-on)Each additional 30 minutes beyond the initial 74 minutes (reported with code first 90839).

Documentation, Reviews, and Provider Responsibilities

Documentation Required

Provide documentation and respond to requests

The Plan reserves the right to request supporting documentation. Providers must submit accurate documentation of services performed and are urged to provide any additional documentation upon request; failure to adhere to coding and billing policies may impact claims processing and reimbursement.

Submit claims using valid HIPAA‑approved code sets and industry coding guidelines (CPT, ICD‑10‑CM, HCPCS, etc.).
Be prepared for claim review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic.
Provide additional documentation promptly when requested to support medical necessity, code selection, or billing details.

Definitions — Interactive Complexity

inv-07: Interactive complexity (+90785)

DefinitionInteractive complexity (+90785) is a designated add-on code reported when maladaptive communication factors complicate delivery of psychotherapy; it is not a standalone code.

When presentReport only when clear evidence exists that maladaptive communication factors negatively impact delivery of care (e.g., third-party participants, difficult family communication, young or impaired patients).

LimitationsNot intended to reflect increased time; not to be reported for translation/interpretation; not to be reported with an E/M when no psychotherapy is reported.

Reporting guidanceMay be reported with specified psychotherapy codes (e.g., 90791, 90792, 90832, +90833, 90834, +90836, 90837, +90838, 90853) and is subject to listed not-to-be-reported-with restrictions.