Beginners Guide to Mental Health Billing for Therapists

Now, our focus here again was let’s not let billing get in the way of providing excellent clinical care. And then we also took this opportunity, this necessity for billing, to enhance our clinical and outcome measurement. So, a few of these are going to be with us for a little while, but that’s something that’s kind of happening. I’m sure, ideally, you’d like to have them all at least available. That’s not quite the case, but you can see that there are some avenues in terms of being able to interact with patients if you’re in a telemedicine environment in a situation that you can still connect with those patients.

Thus, if you think about it, after the first month of practice, providers don’t usually notice the delay because payments are continuously flowing in. It’s likely that the bulk of the solution provider’s clients are doctor’s offices. A telltale sign that who you’re evaluating isn’t a leading mental health clearinghouse is if they don’t have experience integrating with the EHR your organization’s using. To give you an example, there are public payers for every county in the state of Ohio that handle alcohol, drug addiction and mental health services (ADAMHS). However, you’re in a unique scenario within the mental health space where you have to deal with MCOs, mental health EHRs and state-level government ordinances.

CPT Code 96132

If the company says that they don’t back date authorizations, ask nicely for an exception to be made for this “one time” unique situation. The insurance company might not care about you and your practice, but they will care about annoying a newly insured member who will be on the hook for your clinical fees if they don’t grant the authorization. There are “add-on” codes for specific services that can be provided only in combination with other diagnostic evaluation, psychotherapy, and group psychotherapy services. Add-on codes identify an additional part of the treatment above and beyond the principal service. Both the principal service code and add-on code should be listed on the billing form.

And that form has about six clicks that they need to fill out, and it’s all clicks that determine the patient’s progress through the program, their status, their PHQ-9 scores, et cetera. The other set of codes that really comes in with the evaluation and management group is behavior change interventions. So you get a chance to connect with that patient before it gets to be a medical problem. And it’s nice to note that there are facilities there, and depending on who’s reporting this, this may be an option.

CPT Code 96138

And I know that when Jacob comes on, he’ll be talking a little bit about how they’ve worked in his practice environment. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Mental health billing is more difficult than medical billing, largely because of service variations not found in primary or specialty care.

Code is intended for group therapy sessions to support multiple families when similar dynamics are occurring due to common issues confronted in the family members under treatment. 90845 is not time defined, but the service is usually 45 to 50 minutes and is billed once for each daily session. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits.

Again, it was typically established, but they expanded that. And particularly for the codes, it can be reported by physicians or QHPs, the through 443 series. The payments for those visits were adjusted to be similar to CPT codes to 214, which would be your established patient visit codes, office visit codes during the public health emergency.

File Claims Via CMS1500 Paper Form

Essentially, you submit your claims to a clearinghouse, it runs your submission through a series of automated tests and alerts you to any errors. It also usually has a series of pre-established connections to insurance organizations to streamline submission. A clearinghouse is usually a service offered by a third-party organization that acts as a central repository and middle-man to your claim submission process. If you submit a claim and it doesn’t meet all of the requirements, the payer won’t accept it and deny it. Usually, you receive a notification of the claim denial through your practice management (PM) system and your clearinghouse. Anyway, this section lists the industry terms used within mental health billing.

And I like to see these as bookends for a continuum of structures. When you think about how to structure your practices and what works best, there could be a number of variants within this depending on your capabilities and abilities within your practice to deliver this level of care to your patients. These webinars are a collective product of eight of the nation’s leading physician organizations established to catalyze effective and sustainable integration of behavioral and mental health care into physician practices. The mental health billing process is based on the data on your patient’s insurance card.

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However, please note that once a group is collapsed, the browser Find function will not find codes in that group. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Copyright © 2023, the American Hospital Association, Chicago, Illinois. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA.

• The correct use of an ICD-10-CM code listed below does not assure coverage of a service.
• This is yet one more reason why mental health providers choose billing services like TheraThink to help.
• Every provider we work with is assigned an admin as a point of contact.

After all of this and even after Medicare’s electronic submission requirement, some payers STILL don’t have claim submission web portals. So, although you’re technically submitting your claims electronically in this sense, it’s STILL a very manual process. Remember in the definition of MCO where I mentioned that there were 282 of this type of organization in 2019?

This testing is typically performed once during treatment and the medical necessity for such testing should be documented. Repeat testing should only be done if there is a significant change in the patient’s aphasic condition. The diagnosis code(s) must best describe the patient’s condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

+90785 is one of the new add-on codes in the most recent CPT update in 2013. On CMS 1500 forms CPT Add-on codes are simply added on a new line. If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. The contractor information can be found at the top of the document in the Contractor Information Mental health billing section (expand the section to see the details). The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled “I accept”, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement.

If your clearinghouse finds an error, it will reject it and notify you of the same. Every insurance payer has a series of requirements required to receive reimbursement for claims. If you mention the word “billing” to any mental professional, they’ll shutter.

If you’ve mailed in claims, wait 4 weeks to call and verify claims are received. If they haven’t been received, verify their claims address and submit again. You now have all the necessary information to file claims, you know what to charge the patient in person, and you know where to file the claims. In either case, you should have your National Provider Identifier (NPI) and tax identification number (TIN) readily available. You should also understand the type of information required in each section of the form, since different payers may require different information. We have over 2,000 providers across the US ready to help you in person or online.

So it’s towards co-location but at this point there are a few more codes that are a little more focused on behavioral health. So depending on the capabilities and abilities within your practice, this may be something that’s a little bit easier to integrate. In particular with psychotherapy, I did want to call out that there’s two ranges of codes there. Now, these are in our medicine section and so you may have people who are reporting simply psychotherapy, 30, 45, 60 minutes, pretty straightforward. So let’s go ahead and talk on the next slide and we’ll start with those codes that are really on closer to the co-location side, more towards the left hand side.

Hopefully this guide was a helpful introduction to mental health billing claims. You have all the necessary patient and session information to file claims. Now it’s time to check eligibility and benefits to ensure they have coverage that will reimburse you. Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated. If you follow these best practices for your mental health billing, the tedious process will be more bearable.

If the claim has not been received, no corrected claim needs to be submitted, the original claim needs to be submitted. Ensure you refile claims in a prompt manner to make the timely filing window for claims submission. Ask for the claim ID for each date of service that you submitted.