Mental Health Billing

Mental health billing is the process of submitting and managing insurance claims for behavioral health services — including therapy, psychiatric evaluations, and counseling — so that providers get reimbursed for the care they deliver.

Here's a quick breakdown of the key components:

CPT Codes (What Was Done)
These codes describe the service provided. Common ones include:

• 90791 — Psychiatric diagnostic evaluation
• 90837 — 60-minute individual therapy
• 90834 — 45-minute individual therapy
• 90832 — 30-minute individual therapy
• 90847 — Family therapy with the patient present
• 90839 — Crisis psychotherapy (first 60 min)

ICD-10 Codes (Why It Was Done)
Diagnosis codes justify the medical necessity of treatment — for example, F32.1 (major depressive disorder) or F41.1 (generalized anxiety disorder).

Credentialing
Before billing insurance, providers must be credentialed and enrolled with each payer. This involves CAQH ProView, NPI registration, and payer-specific contracts.

Prior Authorization
Some insurers require pre-approval before covering certain mental health services, especially higher levels of care like intensive outpatient programs (IOP).

Telehealth Billing
Mental health telehealth claims use place of service code 02 (telehealth) or 10 (patient's home), along with modifiers like 95 or GT depending on the payer.

Common Denial Reasons

• Missing or incorrect diagnosis codes
• Services not covered under the patient's plan
• Lack of medical necessity documentation
• Credentialing gaps or out-of-network status

Revenue Cycle Steps
Eligibility verification → Prior auth (if needed) → Service delivery → Claim submission → Payment posting → Denial management → Patient billing

Mental health billing can be complex due to parity laws, varying payer rules, and documentation requirements — which is why specialized billing knowledge in behavioral health is so valuable.

https://mentalhealthbilling.us/therapy-counseling-billing/