CPT code 90785 is an add-on code used to reflect communication difficulties during a psychiatric procedure, such as a psychotherapy session.
December 21, 2023 • Updated on August 18, 2026
By Ashley Abramson • Clinically reviewed by Natalia Tague, Ed.S., LPC, ACS
12 min read
By Ashley Abramson • Clinically reviewed by Natalia Tague, Ed.S., LPC, ACS
As essential as CPT codes are for billing, they can also be confusing. One common source of confusion is CPT code 90785, which reflects “interactive complexity” in a session. Read on to learn more about CPT code 90785, and how you should (and shouldn’t) be using it when filing claims for therapy sessions.
Key insights
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CPT code 90785 is an add-on code used to reflect communication difficulties during a psychiatric procedure, such as a psychotherapy session. It’s always used in conjunction with another CPT code, and never alone. For example, you may add a 90785 code when you’re billing for psychotherapy if communication barriers were present that required additional clinical effort — making the interaction more complex, not longer, due to those challenges.
According to Nadine Thomas, Headway’s provider operations lead, a psychotherapist with any license type can bill this code. “But it only applies to psychotherapy, not family/couples or crisis psychotherapy,” she says. In addition, psychiatrists and nurse practitioners can only use the interactive complexity code when they’re actually conducting psychotherapy.
Code 90785 is only applicable as an add-on to the following CPT codes:
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It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
IInteractive complexity refers to specific communication challenges that complicate treatment and require you to adjust your clinical approach. These challenges often come up in sessions that involve third parties, or when working with clients who have significant behavioral or communication issues. Examples include:
Your documentation must show both what the barrier was and how it impacted the session.
Examples include:
Reimbursement rates vary by insurance plan, geographic location, license type, and many other factors. That said, the average reimbursement rate for code 90785 is around $15 to $30, on top of the rate for whatever code it’s billed alongside. Headway providers may make more, as our partnerships with leading insurance plans allow us to negotiate enhanced reimbursement rates for our providers.
Your documentation for this code should explain which element(s) of interactive complexity were present. The elements can be one or more of the following:
A compliant note must include:
Notes that only state “90785 used due to communication barriers” are insufficient.
"It’s important that your documentation clearly details the circumstances that caused any communication barriers or sentinel events, as well as the agency to which these were reported,” says Headway's senior medical coding specialist Jessica Belvin, CPC, CPMA
If documentation does not clearly describe the interactive complexity factors present during the session, the claim may not meet payer requirements and is at risk of being denied or subject to repayment.
Here are some examples of how you might document interactive complexity in your notes, by each present element:
Maladaptive communication:
Patient’s mother was included for a portion of the intake session. The mother was highly agitated and disagreed with the level of treatment services and proposed objectives of the treatment plan.
Caregiver emotions:
During this initial assessment for this school-aged child there were reports by the divorced parents, reporting declining grades, temper outbursts, and bedtime difficulties. Parents were extremely anxious and repeatedly asked questions about the treatment process. Each parent continually challenges the other’s observations of the patient.
Sentinel event:
During the course of the current visit, the daughter of the patient discloses that her father has recently been the victim of elder abuse by a neighbor. The therapist’s obligations under state statutes to report this as elder abuse are explained to the patient, and the report process is initiated.
Use of devices:
During the session, the patient used assistive communication devices due to ALS-related expressive language difficulties, which significantly impacted the therapeutic interaction and required additional time for both explanation and interpretation of non-verbal cues.
It can be confusing to determine whether you should or shouldn’t use code 90785. Keep in mind a few key scenarios in which interactive complexity isn’t the right code:
The 90785 code cannot be used along with the following codes:
The American Academy of Child and Adolescent Psychiatry also offers helpful guidance on when reporting interactive complexity isn’t appropriate:
Providing high-quality care is enough for any therapist to worry about. You shouldn’t have to stress about billing and administrative work, too. So let Headway handle the hard stuff.
Our free EHR — complete with an integrated telehealth platform, AI-augmented documentation templates, and client communication tools — eases your administrative burden, while our billing support features save you from the hassle of dealing with issues like clawbacks and claim delays. Our guaranteed bi-weekly payments also ensure you get paid on time, every time (at enhanced reimbursement rates, to boot). It’s private practice, simplified.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
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Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
Headway strives to simplify billing insurance so you can focus on providing care. Read our comprehensive guide to mental health billing.
Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
