Medicare Billing Intelligence
The billing guides independent therapists actually need
Plain-English breakdowns of CPT documentation requirements, OIG enforcement patterns, telehealth rules, and Medicare compliance updates — written for LCSWs, LMFTs, and LPCs in private practice.
CPT Code Guides
CPT Code Guide
CPT Code 90837: The 60-Minute Psychotherapy Billing Guide
The highest-reimbursing individual therapy code carries the highest audit scrutiny. What the 53-minute floor means, how to document start and stop times defensibly, and the OIG patterns that flag high-frequency 90837 billing.
CPT Code Guide
CPT Code 90834: The 45-Minute Psychotherapy Billing Guide
The backbone of most outpatient practices. How to document the 38–52 minute window, why 90834 is the lower-risk default, and the denial reasons that hit this code most.
CPT Code Guide
CPT Code 90791: Psychiatric Diagnostic Evaluation Billing Guide
The intake code every independent therapist uses. What a defensible evaluation note must include, how often it can be billed, and why the mental status exam is the most common missing element on audit.
CPT Code Guide
CPT Code 90785: Interactive Complexity Add-On Billing Guide
The add-on code most therapists underuse. The four qualifying categories, which primary codes it can be paired with, and why applying it to every child session is an audit risk.
CPT Code Guide
CPT Code 90847: Family Therapy With Patient Present
When the identified patient must be in the room, how 90847 differs from 90846, and the documentation requirements for billing family sessions under Medicare.
CPT Code Guide
CPT Code 90846: Family Therapy Without Patient Present
When to bill family therapy without the identified patient in the room, what the patient-centered documentation requirement means in practice, and the denial patterns that hit this code.
CPT Code Guide
CPT Code 90853: Group Therapy Billing Guide
How group therapy is billed per patient per session, Medicare medical necessity requirements for group, and the documentation elements that hold up on audit.
CPT Code Comparison
90837 vs. 90834: Which Code to Bill for Your Sessions
The time-based rules, the documentation differences, and why code selection must always follow actual session length — not reimbursement preference.
CPT Code Guide
CPT 90837, 90834, and 90832: Medicare Billing Requirements Compared
A side-by-side comparison of the three individual psychotherapy codes — time windows, documentation requirements, and the denial patterns specific to each.
Medicare Compliance & Documentation
Documentation
Medicare Medical Necessity Documentation for Mental Health
What Medicare actually requires to establish and maintain medical necessity for ongoing psychotherapy — and the specific documentation gaps that fail audit.
Medicare Billing
Medicare Billing for LCSWs, LMFTs, and LPCs (2024 Rules)
The 2024 expansion that added LMFTs and LPCs as Medicare providers, what changed for each license type, and the enrollment and billing requirements that apply.
Telehealth
Telehealth Medicare Billing Rules for Therapists
Current Medicare telehealth coverage for mental health services — the extensions in effect, originating site requirements, and what remains subject to change.
OIG Compliance
OIG Mental Health Billing Audit Priorities 2025–2026
What the Office of Inspector General is actively auditing in mental health billing, which CPT codes are under scrutiny, and how to assess your practice’s exposure.
Medicare Coverage
Does Medicare Cover Therapy? Coverage Rules for Providers
Medicare Part B coverage for outpatient mental health services, which diagnoses qualify, and what therapists need to understand about billing under current coverage rules.
Patient Access
How Medicare Patients Find Enrolled Therapists
How your Medicare patients search for providers on Care Compare, what “accepting assignment” means to them, and what to tell patients who ask about your Medicare participation status.
Latest Update