- 8017 Labana Ct, Canton Township, MI 48187
- +1 (734) 418 2537
- info@a2zbillings.com
Specialty billing · mental health & behavioral health
Psychiatrists, psychologists, licensed counselors, and substance use programs each answer to a different mix of coding rules, session-time thresholds, and payer carve-outs, and a claim built for one discipline often fails when applied to another. We run mental health and behavioral health billing as a dedicated workflow, covering psychiatry, psychology, counseling, substance use programs, and telehealth sessions under one accurate, auditable process
Working with psychiatric, psychological, counseling, and substance use programs nationwide.
Our end to end Medical Billing services are designed to comply and perform while we work on different specialities.
We run the full claim cycle for outpatient and specialty mental health care: benefit verification against the correct plan, time-based and non-time-based CPT coding, authorization tracking, and denial follow-up, built around each practice's actual mix of services.
Beyond individual therapy, we bill for integrated care: health and behavior assessment codes for patients managed alongside a medical condition, and the monthly collaborative care codes practices use when a behavioral health manager and psychiatric consultant support a shared treatment plan.
Psychiatric visits are usually billed as an E/M level for medication management, often with a psychotherapy add-on documented against its own separate time. We also handle interventional codes like TMS, along with the prior authorization these procedures typically require.
Psychological and neuropsychological testing splits between administration, scoring, and interpretation, each billed under its own code and rate, including a lower rate for technician-administered testing. We track authorized units through the process so a battery doesn't stall over an expired authorization.
Individual, family, and group sessions are billed against different code families rather than one scaled-up version of another, and we bill directly for licensed professional counselors and marriage and family therapists now that Medicare accepts enrollment from both license types.
Intensive outpatient and partial hospitalization programs are often billed per diem or bundled rather than by individual visit, and substance use records carry an added confidentiality standard under 42 CFR Part 2. We handle that disclosure separately from standard behavioral health claims.
A telehealth claim needs the right modifier for a video or audio-only session, a place-of-service code matched to the patient's actual location, and confirmation the payer covers that format for that discipline. We track these rules payer by payer rather than applying one template.
The recurring denials
To stop backlog from building and choking your practice up, you need to ensure that understand the most common denials and how to avoid them
Coding and documentation
Our Certified Coders are equipped academically as well as with state of the art softwares, to ensure that they append the right codes and modifiers:
Diagnostic evaluations use 90791, or 90792 when a prescriber's evaluation includes a medical component. Individual psychotherapy scales across three time bands, roughly 30, 45, and 53-plus minutes, and family sessions (90846, 90847) and group sessions (90853) sit in their own code family rather than a multiplied version of individual therapy. Psychotherapy add-ons (90833, 90836, 90838) attach to an E/M visit and cannot stand alone. Crisis psychotherapy (90839, 90840) applies to same-day urgent sessions rather than a scheduled visit that runs long. Testing splits between administration and scoring (96136, 96138) and separate interpretation and report codes (96130, 96132), with technician-administered testing billed under its own lower-rate codes (96137, 96139). Health and behavior assessment codes (96156–96171) and the monthly collaborative care management codes (99492–99494) round out integrated behavioral health billing.
Depression and anxiety diagnoses (F32, F33, F41) need the fifth-character detail that separates a single episode from recurrent, or mild from severe, because an unspecified code is one of the fastest ways to trigger a medical-necessity review. Trauma and stress-related diagnoses (F43, including F43.1 for PTSD) and neurodevelopmental codes (F90 for ADHD, F84 for autism spectrum) each carry documentation expectations tied to the assessment tool used. Substance use disorder codes (F10 through F19) come with their own severity qualifiers, and because that record category carries the added 42 CFR Part 2 confidentiality standard, we handle its release and billing disclosures separately from a standard mental health claim.
Substance use disorder codes come with their own severity qualifiers, and the added 42 CFR Part 2 confidentiality standard means release and billing disclosures are handled separately from a standard mental health claim.
Insurance and prior authorization
Not all insurance companies share a uniform mechanism to deal with Mental Health Billing. Each has their distinct set of requirements:
The Mental Health Parity and Addiction Equity Act requires many health plans to apply financial and treatment limits to behavioral care no more restrictively than to medical or surgical care. That still leaves room for prior authorization, visit caps, and network requirements on the behavioral side.
Routine outpatient counseling is frequently open access, while psychological testing, intensive outpatient and partial hospitalization programs, inpatient psychiatric stays, and interventional treatments like TMS typically need authorization before or during care. Group and family therapy sometimes sit under a separate authorization from individual sessions with the same payer.
Licensed professional counselors and marriage and family therapists can now enroll in Medicare and bill directly for services within their scope, expanding who Medicare pays beyond psychiatrists, psychologists, and clinical social workers. Medicare also continues to allow audio-only delivery for behavioral health services when video isn't an option for the patient.
Revenue cycle management
Our dedicated teams for each aspect of the RCM ensure that right steps are taken at the right time to avoid any claim denials as a result of human error.
Confirm which entity actually pays the behavioral claim, copay or coinsurance, visit limits, and authorization requirements before the first appointment.
Log approved units and their expiration across a treatment episode, since psychiatric and substance use care often runs for months.
Apply the code set that fits the actual provider type and session format, not a generic template.
Confirm the note supports the billed time or service level, the add-on ties to a valid primary visit, and the diagnosis carries the specificity the payer expects.
Group denials by the reason behind them so a repeating carve-out or documentation issue gets fixed at the source.
Post payments against the contracted rate to catch underpayment, and issue clear patient statements for out-of-network or self-pay sessions.
Telehealth behavioral health billing
Video and phone-based sessions make up a large share of behavioral health visits, and the claim has to reflect exactly how the visit happened, not just that it happened remotely. That means the correct modifier for a video or audio-only encounter, a place-of-service code that reflects the patient's actual location rather than the provider's office, and confirmation that the specific payer covers that delivery method for that discipline.
We track telehealth policy by payer and by discipline rather than assuming one rule set applies across the board, because a modifier or place-of-service value that works for a psychologist's plan may be rejected on a psychiatrist's claim with the same payer.
Payer categories we track telehealth policy for:
How A2Z Billings helps
A2Z Billing has developed customized pathways to cater to specific claims in Mental Health Billing. Our billers and RCM Experts, avoid using generic and outdated mechanism to handle modernist behavior health billing.
We treat psychiatry, psychology, counseling, and substance use billing as related but distinct workflows, so a claim gets the code set, authorization path, and documentation standard that actually fits the provider who delivered the service.
When a denial reason repeats across a payer or a service line, we correct the underlying cause, whether it's a routing issue, a missing authorization step, or a documentation gap, instead of appealing the same problem one claim at a time.
We keep providers enrolled and active with the commercial networks, Medicaid plans, and carve-out behavioral vendors they bill against, so a lapsed enrollment never becomes the reason a clean claim gets denied.
Frequently asked questions
Group and family therapy use their own codes (90853 for group, 90846 or 90847 for family) rather than a scaled-up individual therapy code, and some payers authorize these formats separately from individual sessions with the same patient.
Substance use treatment records carry an added confidentiality standard under 42 CFR Part 2, which restricts how that information can be shared even with a payer, and intensive programs like IOP or PHP are often billed on a per-diem or bundled basis instead of individual visit codes.
Yes. Licensed professional counselors and marriage and family therapists can enroll in Medicare and bill directly for covered services within their scope of practice, widening the group of behavioral health providers Medicare pays.
Testing authorizations are usually approved for a set number of units or hours, and if administration, scoring, and interpretation exceed that count, the remaining time isn't automatically covered. Tracking units against the approved amount during testing, not after, prevents that gap.
An audio-only session generally uses a different modifier than a video session, where the payer accepts audio-only at all, and the note needs to support why video wasn't used. The rule has to be checked payer by payer.
The monthly collaborative care codes require a documented minimum amount of care-manager time working with a psychiatric consultant on a patient's treatment plan for that month. Falling short of that minimum means the code isn't billable for that period.
Request a consultation
If psychiatry, psychology, counseling, or substance use claims are aging, downcoding, or getting denied for reasons unrelated to the care provided, we can review the current billing process and show where the gaps are. We support practices across the United States.
