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Psychiatrist Medicare Enrollment

Last updated

Psychiatrists (MD or DO with psychiatric specialty) enroll in Medicare the same way as any physician — via CMS-855I — but have access to a broader set of billing codes than other mental health providers because they are physicians. Psychiatrists can bill both psychiatric service codes and standard evaluation and management (E&M) codes.

Enrollment requirements

  • Medical degree (MD or DO) with completed psychiatry residency
  • Board certification or eligibility in psychiatry (ABPN or AOBNP)
  • State medical license
  • Active DEA registration if prescribing
  • Type 1 NPI (individual)
  • Enrollment via CMS-855I or PECOS

Billing structure

Psychiatric services:

  • Psychiatric diagnostic evaluation (90791 — without medical services, 90792 — with medical services)
  • Individual psychotherapy (90832, 90834, 90837)
  • Psychotherapy for crisis (90839, 90840)
  • Group psychotherapy (90853)

Evaluation and management (medication management): Psychiatrists can bill standard E&M codes (99202-99215) for medication management visits. This is the most common billing model for psychiatrists in outpatient practice — the “med check” visit that doesn’t include psychotherapy.

Combined E&M + psychotherapy (add-on codes): When a psychiatrist provides both medication management and psychotherapy in the same visit, they can bill a combined code:

  • 90833 — psychotherapy add-on, 16-37 minutes, with E&M
  • 90836 — psychotherapy add-on, 38-52 minutes, with E&M
  • 90838 — psychotherapy add-on, 53+ minutes, with E&M

This combined billing is unique to physician psychiatrists — it’s not available to non-physician mental health providers.

Telehealth

Psychiatry was among the first specialties to have permanent Medicare telehealth expansion following the COVID-19 public health emergency waiver period. Telepsychiatry is covered under Part B with the same codes as in-person services.

⚠️ Risk flag: Telehealth prescribing of controlled substances (particularly Schedule II stimulants and buprenorphine) remains subject to DEA telemedicine rules that were extended but not permanently resolved post-PHE. Verify current DEA guidance before prescribing controlled substances via telehealth.

Key applications

  • CMS-855I — individual physician enrollment
  • CMS-855R — reassignment to group

Ask Mae if you have questions about psychiatric billing codes, combined E&M and therapy billing, or telehealth prescribing rules.