With all areas of healthcare billing, the challenges of mental health services come uniquely. Whatever the size and composition of your practice, the use of correct CPT coding for mental health evaluation and applicable psychiatry CPT codes to maintain accurate reimbursement as well as compliance with your practice is integral to your overall performance.

For initial assessments, choosing the appropriate cpt code for mental health assessment evaluation can be a significant factor. Codes 90791 (psychiatric diagnostic evaluation without medical services) and 90792 (with medical services) are utilized with regularity, but the correct selection hangs upon services rendered. Accurate documentation is essential—not only for generating payment, but also for creating an effective clinical record that will substantiate subsequent care planning.

Aside from the initial evaluation, continued mental health care frequently includes an extensive variety of psychiatry CPT codes, ranging from psychotherapy visits to medication management. Examples include the frequent use of codes 90832, 90834, and 90837 for psychotherapy (30, 45, and 60 minutes respectively) and E/M (evaluation and management) codes when medical care is delivered along with therapy. Understanding how to properly pair these services and code them according to payer rules can have a huge effect on a practice's revenue cycle and compliance level.

Errors in choosing or using psychiatry CPT codes can result in claim denials, delayed payments, or even audit risk. That is why mental health providers need to be aware of CPT coding updates and payer-specific requirements. Having a comprehensive grasp of how to use the proper CPT code for mental health evaluation and accurate use of psychiatry CPT codes isn't merely a billing best practice—it's a key competence in keeping any mental health practice financially and clinically healthy.

Acquiring mental health coding expertise takes care, education, and in many cases, the collaboration of billing specialists with psychiatric services expertise. With the appropriate

Healthcare billing can be a confusing maze of codes and terminology, but understanding even a few basics can help you make informed choices and avoid unnecessary costs. Let’s take a look at some key elements—ranging from CPT coding to POS identifiers—and also shine a light on an issue many patients may not be aware of: unethical billing practices in US healthcare.
One essential code to know is the CPT code for mental health assessment. When a patient undergoes an initial psychiatric evaluation—typically for diagnostic purposes without medication—the code most commonly used is 90791. This code is reserved for in-depth assessments of a patient’s mental health status and treatment planning. If medical services or medication management is also involved, 90792 is often used instead. Accurate use of these codes, along with clear documentation, is crucial for both compliance and timely reimbursement.
Another critical part of the billing puzzle is POS codes—short for Place of Service. For example, what is POS 11? It refers to services delivered in a physician’s office. It might sound simple, but using the wrong POS code—like billing for office services when they were actually rendered via telehealth or in an outpatient hospital setting—can cause insurance denials or audits. Proper use of POS 11 helps practices stay in line with payer requirements and ensures proper payment.
That brings us to a growing concern across the medical field: unethical billing practices in US healthcare. These might include upcoding (billing for more complex services than were provided), unbundling (billing separately for procedures that should be grouped), or billing for services not rendered. These practices not only burden patients with unfair costs but also increase premiums and damage trust in the healthcare system. It's important for both providers and patients to monitor billing details and ask questions when something doesn’t look right.
Whether you're a provider looking to bill more accurately or a patient seeking transparency in your medical expenses, awareness of these codes and practices is a vital first step. Let’s keep this thread going—share your experiences, ask questions, or post tips on how you’ve dealt with confusing or questionable medical billing.

Hi everyone,

I wanted to open up a discussion around something that doesn't always get a lot of attention but plays an important role in how medical procedures are billed and reimbursed—the PC ratio in medical billing.

For those new to the term, PC stands for Professional Component, and it's often used in procedures that have both a technical and professional portion. A common example is diagnostic imaging. The pc ratio in medical billing helps determine how much of the payment goes to the physician interpreting the results versus the facility providing the equipment and setup.

Understanding this ratio is critical because:

It ensures fair and accurate payment distribution between providers and facilities

It's necessary for properly splitting charges when billing globally vs. separately

Errors in PC/TC ratios can lead to claim rejections or underpayments

I’m curious how others are handling this.

Are you manually calculating the PC ratio or relying on billing software?

Have you run into payer-specific rules or denials related to this?

Any tips for coders or billers trying to learn the ins and outs?

Whether you're a billing pro, a provider, or just getting started in the world of medical billing and coding, your input is welcome. Let’s help each other get a better understanding of this sometimes confusing part of the process.

Looking forward to your thoughts!