Mental health & psychiatry billing
Time documented, codes matched, telehealth billed to each payer’s rules.
We bill psychiatry and therapy the way payers read it: psychotherapy coded to documented time, add-ons only with a qualifying E/M visit, crisis and interactive complexity codes used correctly, and telehealth set up for each payer in 2026.
- Full-service rate
- 3% to 6% of collections
- Who we bill for
- Psychiatrists to counselors
- Telehealth
- POS 02 or 10, audio-only rules
- New & smaller practices
- Flexible monthly minimum
What makes mental health billing different
Most behavioral health codes are chosen by the clock. The psychotherapy code depends on the minutes in the note, an add-on pays only with a qualifying E/M visit, and some codes can never be billed on the same day as others. First Coast, a Medicare contractor, flags missing face-to-face time as a concern in Medicare’s error testing of psychotherapy claims.
Who bills matters too. Psychiatrists, psychiatric NPs, psychologists, clinical social workers and, since 2024, marriage and family therapists and mental health counselors each have their own Medicare rules. We bill for all of them inside our full revenue cycle service, at 3% to 6% of collections.
Behavioral health codes and the rule behind each
Medicare rules, from CMS and its contractors. Medicaid and commercial plans can differ, so we bill each to its own policy.
- 90791, 90792Diagnostic evaluation, without or with medical services. Not billed with psychotherapy or an E/M on the same day.
- 90832, 90834, 90837Psychotherapy alone, picked by documented time: 16 to 37, 38 to 52, or 53 minutes or more. Under 16 minutes, no psychotherapy code.
- 90833, 90836, 90838The same time bands as add-ons to an E/M visit, which must be significant and separately identifiable.
- 90785Interactive complexity, an add-on when a communication barrier complicates the visit. Never with crisis codes.
- 90839, 90840Psychotherapy for crisis: the first 60 minutes, then each added 30. Not billed with 90791, 90792 or other psychotherapy.
- G0017, G0018Crisis psychotherapy in a non-facility place other than the office, such as the home. Medicare pays 150 percent.
- 90846, 90847, 90853Family and group psychotherapy. Family therapy goes with individual psychotherapy only in a separate time interval.
- 99492 to 99494, G2214Collaborative care, billed monthly by the treating practitioner, often in primary care, with a psychiatric consultant on the team.
Psychotherapy with an E/M visit, and other add-ons
A psychiatrist or psychiatric NP who manages medication and gives psychotherapy in the same visit bills the E/M code plus a psychotherapy add-on chosen by the psychotherapy minutes. Under the 2026 NCCI policy manual, an E/M is never billed with a diagnostic evaluation (90791 or 90792), and the evaluation is not billed with any psychotherapy code on the same date.
Interactive complexity (90785) is for specific factors, such as caregiver behavior that interferes with the treatment plan, a sentinel event reported to a third party, or play equipment or an interpreter needed to communicate. The American Psychiatric Association’s guide rules it out with crisis codes, family psychotherapy and an E/M alone, and quotes CMS: it should not be billed solely for interpretation.
Crisis sessions are billed by total time, even when it is not continuous, according to CMS’s crisis psychotherapy page.
Telehealth for behavioral health in 2026
Behavioral health is where Medicare telehealth is permanent. Patients can be seen at home anywhere in the country, and audio-only is allowed, according to the CMS telehealth FAQ updated in October 2026. From 2028, audio-only needs a patient who cannot use or does not consent to video.
The in-person rule applies only after December 31, 2027: a new telehealth patient then needs an in-person visit in the 6 months before the first session, and patients who started earlier need one in-person visit every 12 months. POS 10 (patient at home) pays the non-facility rate and POS 02 covers other places. From January 1, 2027, the new BB and BC telehealth modifiers are required where they apply.
Medicaid and commercial plans set their own telehealth rules and codes, so we set them up per payer.
Billing for therapists, counselors and MFTs
Since January 1, 2024, marriage and family therapists and mental health counselors bill Medicare directly, at 75 percent of what Medicare pays a clinical psychologist. They must accept assignment. Addiction counselors who meet the same requirements enroll as mental health counselors.
Medicare does not cover services billed incident to a clinical social worker’s, MFT’s or counselor’s own services, so an associate’s sessions cannot go out under the owner’s number. Under CMS’s mental health coverage booklet, therapists can work incident to a physician, psychologist or NP under general supervision, and CSWs, MFTs and counselors can bill crisis codes, health behavior codes, safety planning (G0560) and general behavioral health integration (G0323).
Why mental health claims deny
Common behavioral health denials, with the reason codes that often carry them (codes vary by payer):
- No time in the note, or a code above what the minutes support (CO-50)
- Add-on with no qualifying E/M on the claim (CO-107)
- Same-day conflicts, such as 90791 with psychotherapy (CO-97 or CO-236)
- Telehealth billed with the wrong place of service (CO-5)
- Sent to the medical plan when another company runs the behavioral health benefit (CO-109)
- Clinician not yet credentialed on the date of service (CO-B7)
- No authorization, or a visit limit reached (CO-197 or CO-119)
Our eligibility and benefits checks find who manages each client’s behavioral health benefit before the first session. Denials that still come back go through our denial management process, and our denial code guides explain each code.
How we run mental health billing
Set up clinicians and payers
License type, NPI and enrollment are checked for every clinician, and each payer’s telehealth, authorization and visit rules are mapped.
Verify benefits first
Before the first session we confirm coverage, who manages the behavioral health benefit and any authorization or visit limit.
Code from the note
Codes are matched to documented time, add-ons to a qualifying E/M, and same-day pairs to NCCI edits before claims go out.
Work every denial
Denials are sorted by payer and reason code, then corrected or appealed with the note inside the payer’s deadline.
Report monthly
Collections, days in A/R, denials by reason and authorizations close to running out, by payer and clinician.
Credentialing for mental health providers
MFTs and mental health counselors can enroll in Medicare in their own right, but only once licensed with two years or 3,000 hours of supervised experience after their degree, so associates cannot. Some plans also run behavioral health through a separate company with its own network: UnitedHealthcare’s credentialing FAQ sends mental health practitioners to Optum Behavioral Health Solutions.
What changes for these providers, step by step: see credentialing for therapists and mental health providers.
Both are psychotherapy without an E/M visit, chosen by documented time. 90834 is the 45-minute code, used for 38 to 52 minutes, and 90837 is the 60-minute code, for 53 minutes or more. The note must show the psychotherapy minutes, and a Medicare contractor flags missing face-to-face time as a concern in its error testing, so we check the minutes before each claim goes out.
Yes, with the E/M code plus a psychotherapy add-on (90833, 90836 or 90838) picked by the psychotherapy minutes. The E/M must be significant and separately identifiable, and the add-on is never billed alone. A diagnostic evaluation (90791 or 90792) cannot be billed with an E/M or with psychotherapy on the same date.
Yes. Behavioral health telehealth to the patient’s home is permanent under Medicare, with no geographic limit, and audio-only is allowed. The in-person visit requirement takes effect only after December 31, 2027. Medicare claims use POS 10 when the patient is at home. Medicaid and commercial plans set their own rules, so we check each one.
Yes, since January 1, 2024. Licensed marriage and family therapists and mental health counselors with a qualifying degree and two years or 3,000 hours of supervised experience can enroll and bill Medicare directly. Medicare pays them 75 percent of the clinical psychologist rate, and they must accept assignment. Enrollment comes first, so see the credentialing section above.
When a specific communication factor complicates the visit: caregivers whose emotions or behavior interfere with the treatment plan, a sentinel event that must be reported to a third party, or play equipment or an interpreter needed to communicate. It is an add-on to diagnostic evaluations and psychotherapy, never billed with crisis codes, and not for interpretation alone.
Our full-service rate is 3% to 6% of monthly collections, set by your volume, with no setup or onboarding fees and flexible monthly-minimum plans for new and smaller practices. It covers eligibility checks, prior authorizations, coding, claims, payment posting, denials and A/R follow-up, plus telehealth setup. Your exact rate comes after a free A/R review. Our guide to medical billing costs shows how to compare quotes.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
How to calculate days in A/R
The formula with a worked example and a calculator, the benchmarks, why a good average can hide old claims, and the fixes that bring days in A/R down.
How much do medical billing services cost?
The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
Send us 90 days of your claims.
We’ll review them free and show you where time, add-on codes or telehealth settings are costing you money.