2025 updated CPT codes for mental health

The American Medical Association (AMA) announced CPT code changes for 2025 in November of 2024, with the new changes slated to take effect on January 1, 2025. These updates build on previous changes and introduce new codes to better reflect current treatment approaches and service delivery methods.

Here’s a highlight of the 2025 CPT and ICD-10 code changes to be aware of:

• Measurement-based care (MBC) integration codes
• New ICD-10 codes for conditions like prolonged grief disorder
• Updated psychotherapy CPT codes with expanded definitions
• New digital therapeutics CPT codes for behavioral health
• Permanent telehealth code additions with specific modifiers
• New prolonged services codes for extended sessions

2025 CPT code changes mental and behavioral health providers should know about

The 2025 updates bring notable changes impacting coding, documentation, and billing workflows for mental health providers.

1. ICD-10-CM updates for mental health

Reflecting advances in diagnostics, the 2025 ICD-10-CM updates include:

New codes

• F32.A: Major depressive disorder, single episode, mild with anxious distress.
• F43.8A: Prolonged grief disorder.

Updated definitions & specificity

• F41.1: Generalized anxiety disorder (GAD) now includes further subcategories for severity.
• F43.1: Post-traumatic stress disorder (PTSD) updated with clearer distinctions between acute, chronic, and delayed onset.

2. CPT code changes for mental health

Revisions and additions to the CPT code set aim for more accurate service representation:

Revised psychotherapy codes

• 90834: (Psychotherapy, 45 minutes) Definition expanded to accommodate sessions with additional therapeutic techniques.
• 90837: (Psychotherapy, 60 minutes) Updated documentation requirements emphasize the specific therapeutic approach used.

New prolonged services codes

• 99417: For billing prolonged psychotherapy services extending significantly beyond the typical 60 minutes.
• 993X0: For prolonged evaluation and management (E/M) services when performed with psychotherapy.

New digital therapeutics codes

(May be Category III codes, verify payer acceptance)

• 989X1: Digital behavioral health interventions, initial setup, and patient education.
• 989X2: Digital behavioral health interventions, monthly monitoring, and feedback.

Behavioral health integration (BHI) codes

• 99494: Care management services for behavioral health conditions includes enhanced definitions and team-based care documentation requirements.

Emphasis on measurement-based care (MBC) codes

• 96127: Brief emotional/behavioral assessment scoring (e.g., PHQ-9, GAD-7).
• 96160: Administration of patient-focused health risk assessment instruments.

Emphasis on collaborative care model (CoCM) codes

For integrated care settings

• 99492: Initial psychiatric collaborative care management (70 mins/first month).
• 99493: Subsequent psychiatric collaborative care management (60 mins/month).
• 99494: Additional 30 minutes of CoCM care per month.

3. Telehealth billing for mental health in 2025

Telehealth remains integral, with updated billing guidelines:

Permanent & expanded coverage

Codes like 90791 (Psychiatric diagnostic evaluation) and 90834 (Psychotherapy, 45 mins) are permanently reimbursable via telehealth. Coverage expands to include services like family therapy (90846) and group therapy (90853) delivered virtually (check payer policies).

Telehealth modifiers

Correct use of modifiers is crucial:

• -95: Indicates service delivered via synchronous audio-visual telehealth.
• -GT: May still be required by some payers for real-time audio-visual communication.
• -93: Allows billing for audio-only sessions when video is inaccessible (verify payer acceptance).

Medicare & cross-state licensing

Medicare continues flexible telehealth support. Billing rules for providers delivering services across state lines are being clarified, though state licensing laws remain paramount. Providers must verify payer-specific telehealth policies and patient eligibility.

4. New mental health billing guidelines

Practical changes impacting billing workflows include:

Updated documentation standards

Progress notes require more detail, linking measurable treatment outcomes to individual care plans per payer requirements.

Time-based services adjustments

Billing thresholds for timed services may be adjusted. For example, psychotherapy sessions exceeding a certain duration (e.g., 55 minutes mentioned as an example requiring specific coding) need accurate CPT code selection to reflect extended time. Refer to the new Prolonged Services codes (e.g., 99417).

Modifier requirements

Increased emphasis on correct modifier use (e.g., -59 for distinct procedural service, -25 for significant, separately identifiable E/M service on the same day as another procedure) to differentiate services and avoid denials.

Group therapy billing

Revised guidelines clarify documentation needs, including individualized patient contributions during group sessions.

The CPT code changes for 2025 can enhance your practice and improve your billing procedures when you take the time to understand them and adjust your billing accordingly. This guide gives you essential information about these changes to successfully implement them into your practices and ensure your billers are prepared to navigate them smoothly.

Ensora Mental Health’s billing platform streamlines and automates parts of your billing process, ensuring everything is handled accurately and efficiently. We keep up with CPT code updates, and our system can detect coding issues and other mistakes so you can reduce claim denials. Ready to improve your billing? Start a free trial with Ensora Mental Health today!