CurrentBlue Cross Blue Shield - TexasPolicy CPCPOS1

Psychiatry/Psychotherapy Services Professional Provider

Billing, coding, and claims processing guidelines for psychiatry and psychotherapy professional providers billing Blue Cross and Blue Shield of Texas; applies to professional provider types delivering behavioral health services.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyPsychiatry/Psychotherapy Services Professional Provider

Policy CodePolicy CPCPOS1

Change TypeNew policy

Effective DateDec 22, 2025

Next Review DateN/A

Key ActionSubmit accurate claims with valid HIPAA-approved code sets and be prepared to provide supporting documentation upon request.

SourceLink

POLICY UPDATE CHANGES

New policy

2025-12-22Policy effective date

90791–90863Key CPT codes

2025-09-17Committee approval

Coverage Criteria

Coverage criteria for psychiatry/psychotherapy billing

Covered when the following billing and documentation expectations are met:

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Providers must submit accurate claims using valid HIPAA-approved code sets and follow industry coding guidelines; Plan may request supporting documentation.

Per policy the Plan reserves the right to request supporting documentation and failure to adhere may impact claims processing and reimbursement.

Covered provider types include psychiatrists (MD/DO), licensed psychologists (PhD/PsyD), independently licensed masters-level clinicians (e.g., LICSW, LCSW, LPC, LMFT), and licensed medical providers (NPs, PAs).

Providers are responsible for familiarizing themselves with state licensing rules and regulations applicable to their practice and for applying independent medical judgment in the provision of care.

Modifiers may be appended where appropriate and must be supported by documentation upon request.

Diagnostic evaluation codes (90791/90792) are intended for initial diagnostic evaluation and may be repeated only after an extended break in treatment of at least six months; psychotherapy codes have specified minimum time thresholds and crisis psychotherapy codes have defined time windows and reporting rules.

The tables of codes in this policy are not all-inclusive; providers should refer to the current CPT codebook for complete reporting guidance and for codes that may or may not be reported with those listed in this policy.

If a conflict arises between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to covered services, the plan documents or provider contracts govern; BCBSTX retains discretionary authority in application of the policy.

CPT Codes and Coding Rules

Psychiatry/Psychotherapy CPT codes and add-onsCPTCovered

90791	Psychiatric diagnostic evaluation (no medical services)
90792	Psychiatric diagnostic evaluation with medical services (e.g., medication)
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)
90785	Interactive complexity (add-on)
90839	Crisis psychotherapy, first 30-74 minutes

1–10 of 15

1/2

inv-03: Diagnostic evaluation repeat interval

Diagnostic evaluation repeat interval90791/90792 may be reported once at onset; may be repeated only after an extended break in treatment (defined as at least six months since last visit/treatment)

Reportable pairing90791 and 90792 may be reported with +90785 (interactive complexity)

Not reportable with crisis codes90791/90792 not to be reported with 90839 or +90840

inv-04: Timing minimums for psychotherapy codes

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

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

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

Reporting note90832/90834/90837 may be reported with +90785; not to be reported with +90833/+90836/+90838, 90839/+90840, 90846, 90847

inv-05: Crisis psychotherapy timing

90839 (first interval)Report for the first 30–74 minutes of crisis (described as crisis therapy, 60 minutes) — may be reported only once per event

90840 (additional intervals)Each +90840 represents each additional 30 minutes beyond the initial 74 minutes and must be coded only with 90839 as the primary code

Not reportable with90839/+90840 not to be reported with +90785, 90791, 90792, 90832/+90833, 90834/+90836, 90837/+90838

Provider Actions and Documentation

Documentation Required

Documentation and Discretion

Providers must submit accurate and complete documentation to support billed services. The Plan reserves the right to request supporting documentation and may use reasonable discretion in interpreting and applying this policy. Providers are expected to code claims using valid, HIPAA-approved code sets and follow industry-standard coding guidelines (including but not limited to UB editor, AMA CPT, CPT Assistant, HCPCS, ICD-10-CM/PCS, NDCs, DRG guidance, CMS manuals, National Correct Coding Initiative). Claim submissions are subject to review against benefit coverage, provider contract language, medical policies, and coding policy rules. Failure to adhere to coding and policy requirements, or to provide requested documentation, may affect claims processing and reimbursement. Upon request, providers are urged to promptly submit any additional documentation needed to support the services billed.

Plan reserves the right to request supporting documentation
Providers must submit claims using valid HIPAA-approved code sets and industry coding guidelines
Claims subject to review against benefit coverage, provider contracts, medical policies, coding software logic, and code edit protocols
Failure to adhere to coding/policy or to provide documentation may impact claims processing and reimbursement
Providers are urged to promptly submit additional documentation upon request

Definitions

inv-07: Interactive complexity (90785)

Definition and purpose90785 (Interactive complexity) is a designated add-on for communication factors that complicate delivery of psychotherapy and should only be reported when clear evidence of maladaptive communication exists

When to report (examples)Report +90785 when one or more are present: third-party participants involved in care (parents, agencies, court/school officials), difficult/discordant or highly emotional caregiver behaviors, mandated reporting/disclosure discussions, or use of play/assistive tools to facilitate communication

Reporting limitationsNot to be reported as a standalone service, not intended to report increased time alone, not for translation/interpretation services, and not to be reported with certain codes (e.g., 90839/+90840, 90847, selected assessment codes)

Allowed pairingsMay be reported with 90832, +90833, 90834, +90836, 90837, +90838, 90853 when individual patient-specific circumstances are met