Mental health billing services
Billing for therapists, counselors, psychologists and psychiatric NPs, from intake and session time codes to telehealth and behavioral health carve-outs.
Why mental health billing takes specialty knowledge
Mental health billing is driven by time and by who provides the service. Psychotherapy codes are chosen by session length, add-on codes apply when psychotherapy is done with a medical visit or when communication factors make the session more complex, and family and group sessions have their own codes. Many practices see a large share of patients by telehealth, which brings place of service and modifier rules that vary by payer.
Behavioral health benefits are also often managed by a separate company from the patient's medical plan, so the right payer and authorization have to be identified before the first session. SFA Solutions bills for solo therapists and group practices in systems like TherapyNotes and Osmind. We code sessions by documented time, apply telehealth POS and modifiers by payer, track authorization limits, and handle credentialing for licensed clinicians, including Medicare enrollment for counselors and marriage and family therapists.
Common codes we work with in mental health
| Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation without medical services |
| 90832 | Psychotherapy, 30 minutes (16 to 37 minutes) |
| 90834 | Psychotherapy, 45 minutes (38 to 52 minutes) |
| 90837 | Psychotherapy, 60 minutes (53 minutes or more) |
| 90833 | Psychotherapy add-on with an E/M service, 30 minutes |
| 90785 | Interactive complexity add-on |
| 90847 | Family psychotherapy with patient present, 50 minutes |
| 90853 | Group psychotherapy, other than multiple-family group |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where mental health practices lose revenue
Psychotherapy time thresholds
Psychotherapy codes are chosen by actual face-to-face time: 90832 for 16 to 37 minutes, 90834 for 38 to 52 minutes and 90837 for 53 minutes or more. Start and stop times or total time must be documented. Payers review 90837 use closely, so the note must support the longer session.
Add-on codes
When a psychiatric prescriber does psychotherapy with an E/M visit, the therapy is billed with add-on codes 90833, 90836 or 90838 instead of the standalone codes, and the time for each must be separate. 90785 is added for interactive complexity, such as when a third party's involvement or communication barriers complicate the session. Crisis psychotherapy uses 90839 for the first 60 minutes and 90840 for each additional 30.
Telehealth place of service and modifiers
Telehealth sessions are billed with POS 10 when the patient is at home and POS 02 when the patient is somewhere else, and many commercial plans also want modifier 95. Medicare allows mental health telehealth with the patient at home on a permanent basis, and audio-only sessions are allowed in some cases with modifier 93. Commercial plan rules differ, so we check each payer's current policy.
Carve-outs, authorizations and credentialing
Behavioral benefits are often managed by a separate company, such as Optum, Carelon Behavioral Health or Magellan, under the patient's medical plan. Some plans require authorization after a set number of visits. Since 2024, licensed professional counselors, mental health counselors and marriage and family therapists can enroll in Medicare and bill for their services.
What else affects mental health revenue
A/R challenges in mental health
Behavioral health A/R often ages because an authorization ran out of visits or dates while sessions continued, or because the claim went to the medical plan instead of the behavioral health carve-out. High session frequency means a single eligibility or authorization problem can affect many claims before it is caught. Telehealth modifier and POS mismatches also cause denials that are easy to fix but pile up if no one is reviewing them weekly.
Credentialing considerations
Each clinician enrolls under a taxonomy that matches their license, such as clinical social worker (1041C0700X), mental health counselor (101YM0800X), marriage and family therapist (106H00000X) or psychologist (103T00000X). Since January 2024, licensed mental health counselors and marriage and family therapists can enroll with Medicare. Pre-licensed associates generally cannot enroll on their own, and billing their sessions under a supervisor's NPI is allowed only where the specific payer's policy permits it.
Payer considerations
Many health plans manage behavioral health through a separate company such as Optum Behavioral Health, Carelon Behavioral Health or Magellan, and that company handles credentialing, authorization and claims. Medicaid behavioral health is often run by managed care plans with their own authorization rules, and EAP sessions are billed to the EAP vendor with their own codes and limits. Telehealth rules for mental health differ by payer, including Medicare's in-person visit requirements, so check the current policy for each plan.
Mental Health coding details that affect payment
ICD-10 considerations
Payers increasingly deny psychotherapy claims with unspecified diagnoses, so depression should be coded to episode and severity, such as F32.1 (major depressive disorder, single episode, moderate) or F33.1 for recurrent moderate, rather than F32.A or F32.9 when the record supports more detail. PTSD separates acute (F43.11) and chronic (F43.12), and adjustment disorders in F43.2 are coded by subtype. Many plans will not pay psychotherapy when a Z code, such as a Z63 family relationship problem, is the only or primary diagnosis. Co-occurring substance use is coded separately, for example F10.20 for alcohol dependence, uncomplicated, and the diagnosis on the claim should match the treatment plan.
Modifiers to watch
| 95 | Used by many commercial plans on synchronous video sessions, alongside POS 02 or 10 as the plan requires. |
|---|---|
| 93 | Applied to audio-only sessions when the payer allows them, generally when the patient cannot use or does not consent to video. |
| HO | Used by many Medicaid programs to show the service was provided by a clinician with a master's degree, which can affect the payment rate. |
| AJ | Required by some payers on services provided by a licensed clinical social worker. |
| GT | Still required by a few payers, such as some Medicaid programs, for telehealth sessions in place of modifier 95. |
Global periods
Global surgical periods do not apply to psychotherapy or diagnostic evaluation codes, so each session stands alone. The limits that act like a global period come from authorization windows and payer frequency rules, such as limits on how often 90791 can be billed for the same patient.
Medicare considerations
Medicare pays clinical social workers, mental health counselors and marriage and family therapists at 75% of the physician fee schedule amount. Since 2024, Medicare allows behavioral health services to be furnished incident-to under general supervision, which helps practices with auxiliary clinical staff. Medicare covers family psychotherapy only when it is focused on the patient's treatment, so couples counseling without a treated diagnosis is not covered.
Mental Health billing KPIs to track
- Sessions remaining on authorization. Tracking remaining visits and end dates for each client prevents sessions from being provided after the authorization runs out.
- 90837 share of psychotherapy claims. A share well above peers can trigger payer review, so documentation of session time needs to support it.
- Telehealth POS and modifier denial rate. These denials are simple to fix but pile up quickly at high session volume.
- Claims sent to the wrong payer. Claims billed to the medical plan instead of the behavioral health carve-out are a common and avoidable cause of delay.
Mental Health billing audit checklist
- Compare documented session time against the psychotherapy code billed on a sample of notes.
- Confirm add-on codes 90833, 90836 and 90838 are billed only with an E/M and separate time.
- Check that each client's authorization covers the dates and visit count billed.
- Verify telehealth claims use the POS and modifier each payer requires.
- Confirm each clinician is credentialed with the carve-out company that manages the client's plan.
- Review primary diagnoses for specificity and for Z codes that a payer will not accept as primary.
How SFA runs mental health billing
We confirm each patient's behavioral health payer, benefits and authorization needs before the intake visit.
Sessions are coded by documented time, with add-ons, telehealth POS and modifiers applied by payer.
Authorization visit counts are tracked so renewals are requested before they run out.
Most clean claims are submitted within 24 hours, and denials are corrected or appealed with session documentation.
The services that matter most for mental health
Credentialing & Payer Enrollment
Each clinician must be enrolled with every plan and behavioral carve-out, and credentialing is included free with every billing plan.
Learn moreEligibility Verification & Prior Authorization
Identifying the right behavioral payer and authorization limits before the first session helps prevent unpaid visits.
Learn moreMedical Billing
Session time, add-ons and telehealth rules must be applied consistently from claim to claim.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
Mental Health billing questions
How many minutes do I need to bill 90837?
At least 53 minutes of face-to-face psychotherapy. Sessions from 38 to 52 minutes are billed as 90834. Document the actual time in each note.
Which place of service should I use for telehealth?
Use POS 10 when the patient is at home and POS 02 when the patient is somewhere other than home. Many commercial payers also require modifier 95, so we follow each payer's rule.
Can counselors and marriage and family therapists bill Medicare?
Yes. Since January 2024, licensed mental health counselors and marriage and family therapists can enroll in Medicare and bill for their services directly. We handle that enrollment as part of credentialing.
When can I bill 90785?
When specific communication factors complicate the session, such as managing disagreement among family members, involving a third party like a guardian or interpreter that changes the session, or reporting a sentinel event. It cannot be billed with crisis psychotherapy codes.
Do you bill in TherapyNotes and Osmind?
Yes. We work inside the practice management system you already use, including TherapyNotes and Osmind, along with many other EHR and billing platforms.
See what your mental health billing is missing
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