Do you handle authorizations and reauthorizations for therapy sessions?

Yes. We track the authorized session count per patient and per payer inside your practice management system, request reauthorization before the count runs out, and log the reference number and approval period on the patient record so the front desk can see it.

How do you bill telehealth psychotherapy across different payers?

Each payer’s current telehealth rule, meaning modifier, place of service and audio-only policy, is stored per payer and applied when the claim is scrubbed. When a payer changes its rule, we update the table once and correct any claims already denied under the old rule.

Our claims keep going to the wrong payer. Why does that happen in behavioral health?

Because many plans carve mental health out to a separate vendor, the card the patient hands you names the medical carrier rather than the company that pays therapy claims. Eligibility verification has to identify the behavioral payer specifically, and we do that before the first session rather than after the first denial.

Can you bill for pre-licensed associates and interns?

Only where the payer allows it, and the answer differs by payer and by state. We map every clinician in the group to every payer you bill, tell you which combinations are billable and under what conditions, and hold sessions that cannot be paid rather than sending claims that will deny.

Do we have to leave our current EHR to work with you?

No. We work inside the practice management system you already use, whether it is a therapy-specific platform or a general one. Your data stays in your system, your account manager is a named person, and a signed BAA covers the work.

Specialty billing

Mental and behavioral health billing that keeps every session authorized and paid

Mental health billing turns on three things a primary care biller rarely has to think about: the clock, the authorization, and which company is actually paying the claim. Behavioral health medical billing means matching session minutes to the psychotherapy code, matching sessions used to sessions approved, and routing the claim to a carve-out vendor whose name is not on the patient’s card. Miss any one of the three and the session was delivered for free.

Time-based psychotherapy codes and the note that supports them

The three individual psychotherapy codes are defined by time. CPT sets 90832 at 16 to 37 minutes, 90834 at 38 to 52 minutes and 90837 at 53 minutes or more, and the note has to show either start and stop times or a total that lands in the range billed. A clinician who schedules fifty-minute sessions and habitually bills 90837 will eventually be asked for records, and a note that says only “60-minute session” does not settle the question.

Prescribers add a second layer. When a psychiatrist or psychiatric nurse practitioner provides an E/M service and psychotherapy in the same visit, the therapy is billed with an add-on code (90833, 90836 or 90838) and only the psychotherapy minutes count toward it. Time spent on medication management belongs to the E/M level and cannot be counted twice. We check the two halves of the note against each other before the claim leaves.

Authorizations counted in units, not dates

Most commercial behavioral plans authorize a number of sessions over a period rather than an open-ended benefit, and some authorize only the diagnostic evaluation before asking for a treatment plan. The clinician’s count of sessions used and the payer’s count drift apart whenever a no-show is recorded as a visit, a session is billed under a different code than the one approved, or two clinicians in the same group see the same patient.

We keep the authorization balance on the patient record inside your practice management system, decrement it as claims go out rather than when appointments are scheduled, and start the reauthorization request while sessions remain. A CO-197 on a long-term patient is almost always a request that was started too late, not one that was refused.

Carve-outs: the payer on the card is not always the payer

Many employer plans carve behavioral health out to a managed behavioral health organization. The patient presents a card from a national medical carrier, but the mental health benefit is administered by a separate vendor with its own payer ID, its own authorization desk and its own provider file. A claim sent to the medical carrier comes back as CO-109, not covered by this payer, and the filing clock keeps running while it does.

Eligibility verification for a therapy practice therefore has to answer a different question than it does in primary care: not just is the patient covered, but who covers the behavioral benefit, what the copay for outpatient mental health is, and whether the clinician is on that vendor’s roster. Employee assistance program sessions are a further wrinkle, with their own authorization numbers and often a different billing code than the payer’s standard benefit.

Telehealth rules that changed and keep changing

Telehealth is a large part of outpatient therapy now and the billing rules for it never converged. One payer wants modifier 95 with place of service 10 for a patient at home; another wants the office place of service with 95; a Medicaid plan may still want GT. Audio-only sessions have their own modifier, 93, and not every plan pays for them. Medicare covers mental health visits furnished to a patient at home by telehealth and has its own set of conditions attached.

We hold the current telehealth rule for each payer you bill and apply it at claim scrubbing, so a rule change becomes one edit to a table rather than a month of CO-4 denials. When a payer changes its policy mid-year, the claims already denied under the old rule are corrected and resubmitted as a batch.

Behavioral health billing across licensure levels

A group practice may have psychologists, licensed clinical social workers, professional counselors, marriage and family therapists and psychiatric nurse practitioners, and payers do not treat them alike. Medicare began enrolling marriage and family therapists and mental health counselors in 2024; before that their sessions were not billable to Medicare at all. Medicaid plans in many states require a level-of-education modifier such as HO, HN or HP on the claim.

Pre-licensed associates working under supervision are the most common source of unpaid sessions we see in group practices. Some plans pay for them under the supervisor’s credentials with specific conditions, many do not pay for them at all, and the answer is payer by payer. We map every clinician to every payer before they see their first insured patient, and the rendering NPI on the claim is always the person the payer has actually credentialed.

Rendering provider, supervising provider and billing provider verified against each payer’s roster
Medicaid education-level modifiers applied per state and plan
Credentialing status tracked so nobody is scheduled with a payer before their effective date

Codes that decide whether the claim pays

Codes and modifiers we watch in mental & behavioral health.

Code	What it is	What goes wrong
90791	Psychiatric diagnostic evaluation, without medical services	Often the only code a plan authorizes at intake; billing a second one within the same episode without a documented reason draws a frequency denial.
90832, 90834, 90837	Individual psychotherapy at 30, 45 and 60 minutes	Time in the note has to fall inside the CPT range for the code billed. 90837 is the code payers request records on most often.
90833, 90836, 90838	Psychotherapy add-on codes billed with an E/M by a prescriber	Only psychotherapy minutes count toward the add-on. E/M time counted twice is the usual audit finding.
90846, 90847	Family psychotherapy without and with the patient present	Identified patient has to be the subject of the session; some plans exclude 90846 or require authorization separate from individual therapy.
90853	Group psychotherapy	Billed once per patient per group; many plans cap the number of group sessions separately from individual sessions.
90785	Interactive complexity add-on	Requires a documented complicating factor such as a third party or communication barrier. Routine use with every child session is denied on review.
90839, 90840	Psychotherapy for crisis, first 60 minutes and each additional 30	Cannot be billed with the standard time-based psychotherapy codes on the same day; documentation must describe the crisis.
96127	Brief emotional or behavioral assessment with a standardized instrument	Scored instrument has to be in the chart. Several plans limit units per day and bundle it with an evaluation code.
Modifier 95, POS 02/10	Telehealth modifier and place of service for patient location	Payers disagree on the combination. A modifier without the expected place of service, or the reverse, returns a CO-4.

Denial patterns

What comes back, and what we do about it.

CO-197
Sessions billed after the authorized count ran out, or under a code the authorization did not cover, on a long-standing patient.
Fix Authorization balance tracked on the patient record and decremented at claim submission; reauthorization requested while sessions remain; denied sessions appealed with the approval history where the payer’s count was wrong.
CO-109
Claim sent to the medical carrier on the patient’s card when the behavioral benefit is administered by a separate managed behavioral health vendor.
Fix Eligibility check identifies the behavioral payer and payer ID before the first session; misrouted claims are redirected to the correct vendor with proof of the original timely submission.
CO-4
Telehealth session denied because the modifier and place of service do not match what that particular payer expects.
Fix Per-payer telehealth rule applied at scrubbing; denied claims corrected and resubmitted in a batch when a payer policy changes.
CO-50
Payer denies 90837 as not medically necessary, or requests records, when a clinician bills the 60-minute code on every visit.
Fix Notes reviewed for documented time and clinical rationale before submission; records sent with the payer’s policy language cited; clinician given feedback where the note does not support the code.
CO-170
Session by an associate-level or newly licensed clinician denied because the payer does not recognize that provider type or has not completed credentialing.
Fix Clinician-to-payer map checked before scheduling; rendering NPI matched to the credentialed provider; sessions held rather than billed where the payer will not pay for the license level.

Mental & behavioral health billing: common questions

Do you handle authorizations and reauthorizations for therapy sessions?: Yes. We track the authorized session count per patient and per payer inside your practice management system, request reauthorization before the count runs out, and log the reference number and approval period on the patient record so the front desk can see it.
How do you bill telehealth psychotherapy across different payers?: Each payer’s current telehealth rule, meaning modifier, place of service and audio-only policy, is stored per payer and applied when the claim is scrubbed. When a payer changes its rule, we update the table once and correct any claims already denied under the old rule.
Our claims keep going to the wrong payer. Why does that happen in behavioral health?: Because many plans carve mental health out to a separate vendor, the card the patient hands you names the medical carrier rather than the company that pays therapy claims. Eligibility verification has to identify the behavioral payer specifically, and we do that before the first session rather than after the first denial.
Can you bill for pre-licensed associates and interns?: Only where the payer allows it, and the answer differs by payer and by state. We map every clinician in the group to every payer you bill, tell you which combinations are billable and under what conditions, and hold sessions that cannot be paid rather than sending claims that will deny.
Do we have to leave our current EHR to work with you?: No. We work inside the practice management system you already use, whether it is a therapy-specific platform or a general one. Your data stays in your system, your account manager is a named person, and a signed BAA covers the work.

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