One important change for 2025 is the addition of new CPT and HCPCS codes. These codes cover psychiatric services, including telehealth and digital mental health care. They affect how billing is done, what kind of records must be kept, and payment rates. Mental health providers can use these codes to improve how they get paid while following rules.
CPT Code 90792 is often used for psychiatric evaluations that include medical services. This code stays important for mental health workers handling complex cases. Using this code means writing detailed patient histories, checking mental states, and recording medical decisions. It is used for patients with ongoing pain, older adults with brain issues, and those with substance use problems. Using 90792 well helps psychiatric offices earn money by combining diagnosis and medical checks in one service.
New HCPCS codes for 2025 add billing options related to safety planning, phone follow-ups, interprofessional talks, digital device use, and caregiver training:
Telehealth has helped many people get mental health services in the U.S., especially during the COVID-19 pandemic. But rules are changing in late 2025, causing new issues for providers using Medicare and other insurers.
From October 1, 2025, some temporary telehealth flexibilities made for the public health emergency will end. Restrictions on telehealth services will return, including rules about where the patient must be located and where the service can be delivered. These rules will limit payment for many telehealth services outside certain rural or health facility areas. This change is often called the “telehealth policy cliff.”
But mental and behavioral health services are mostly exempt from these limits. Medicare still pays for telehealth mental health services with no location limits. These visits can happen at the patient’s home, using place of service code 10, as long as the diagnosis is a mental health code (F01.A0-F99). This exemption helps patients who have trouble traveling or moving around.
For doctors in Medicare Shared Savings Program Accountable Care Organizations (ACOs), telehealth services from remote patient places stay reimbursable no matter where they are. This rule supports new healthcare models that promote team care and remote patient monitoring.
However, soon patients must have a face-to-face visit within six months before their first telehealth mental health visit and then once a year after, except for rural patients and those treated for substance use disorders. This in-person visit rule adds challenges for practices managing tele-mental health.
Also, some telehealth providers, like occupational therapists, physical therapists, speech-language pathologists, and audiologists, will lose Medicare telehealth billing rights in 2026. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will also have fewer telehealth coverage options, except in behavioral health.
The Hospital at Home program’s Medicare waivers will end on September 30, 2025. Hospitals will have to bill for in-facility care again for acute patients, putting more pressure on hospitals using home care models.
Medical practice administrators and billing teams must update their workflows and keep better records to follow the new CPT and HCPCS codes. Psychiatric services, combined with telehealth, require careful documentation to support billing and pass audits.
Records must include:
If these records are missing or incomplete, claims may be denied, payments delayed, and audit risks increased. Using templates and electronic health record features can help standardize information without losing important clinical details.
HCPCS codes G0546 through G0551 help psychiatric practice by allowing psychologists, social workers, and counselors to get advice from specialists without billing evaluation and management services alone under Medicare.
These codes let providers ask specialists for help using phone, internet, or EHR messaging. This support helps with diagnosis and treatment planning without scheduling extra patient visits. It can reduce wait times and improve access to expert care, helping teams work together with fewer staff shortages.
Billing rules for interprofessional consultations are strict. These services cannot be billed if there was an in-person visit within 14 days before or after the consult. Providers also cannot bill psychotherapy on the same day. Patients must agree to these consults, and time spent must be tracked carefully for correct coding.
New CPT codes that support digital mental health treatments and remote caregiver training show growing use of technology in behavioral health.
For instance, Medicare pays for digital mental health treatment devices through HCPCS codes G0552, G0553, and G0554. These devices collect patient data, offer behavioral help, and keep patients engaged as part of ongoing psychiatric care.
Caregiver training without the patient present can now be done by telehealth. This helps family members and caregivers support patients better at home, filling a gap in long-term psychiatric care.
Because CPT coding and telehealth rules are complex, many practice administrators and IT managers use artificial intelligence (AI) and automation tools to help run mental health offices.
AI can automate billing and paperwork to lower the work load:
For example, Simbo AI offers front-office phone automation and answering services powered by AI. This helps with first patient contact and scheduling for behavioral health offices. Automating phone tasks reduces wait times, lowers no-shows, and frees staff to focus on billing and following new CPT code rules.
Mental health practice leaders should take several steps to handle new CPT codes and telehealth rules:
Good management of psychiatric CPT coding, especially with more telehealth options, is key to keeping mental health practices financially stable and running well. While new codes and policies create challenges, they also offer ways to improve patient care, team cooperation, and the use of technology.
By preparing ahead and using smart automation tools, U.S. mental health practice leaders can handle these changes with more confidence and success.
CPT Code 90792 refers to a psychiatric evaluation with medical services, allowing mental health professionals to conduct comprehensive assessments that may include a mental status exam and medical decision-making.
Understanding CPT 90792 is crucial for accurate billing and reimbursement, which can enhance a practice’s financial health and efficiency.
Providers must document specific elements such as patient history, a mental status examination, medical decision-making, and total time spent during the evaluation.
CPT 90792 should be used when a combined psychiatric and medical evaluation is necessary, particularly for complex cases involving medication, lab tests, or physical examinations.
Common use cases include evaluations for patients with chronic pain, older adults with cognitive impairments, and individuals with substance use disorders.
Best practices include thorough documentation, staying informed about payer policies, using clear language, and linking documentation to medical necessity.
Providers should avoid misuse or overuse of the code, insufficient documentation, and failing to demonstrate medical necessity.
Providers can negotiate with payers, monitor payment trends, and stay updated on fee schedules to ensure fair reimbursement.
Proper use of CPT 90792 can positively influence a practice’s revenue, but balancing thorough evaluations with efficiency is essential.
Trends include telehealth expansion, measurement-based care integration, collaborative care models, and technology advancements influencing coding and billing processes.
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