Key Takeaways Prior authorization requirements for behavioral health vary by payer and plan, and they are most common for higher levels of care, psychological testing, and outpatient therapy beyond a session threshold. Approvals are limited by code, number of units, and date range, so tracking each element keeps sessions inside what the payer approved. Concurrent […]
Beyond 90837: How to Bill Crisis, Family, and Interactive Complexity Sessions
Key Takeaways Psychotherapy for crisis is billed with 90839 for 30 to 74 minutes and 90840 for each additional 30 minutes, and it cannot be combined with most other psychiatric codes on the same day. Medicare pays crisis psychotherapy furnished in non-office, non-facility settings such as a patient’s home through G0017 and G0018, at 150% […]
Psychological and Neuropsychological Testing CPT Codes, Explained
Key Takeaways Testing is billed in two parts: evaluation services (96130-96133), billed by the hour, and test administration and scoring (96136-96139), billed in 30-minute units. Who administers the tests determines the administration code: 96136 and 96137 for a psychologist or physician, 96138 and 96139 for a technician. Code 96146 covers a single automated test and […]
How to Bill Collaborative Care (CoCM) and Behavioral Health Integration Codes
Key Takeaways Medicare pays for behavioral health integration (BHI) through two models: psychiatric collaborative care (CoCM), billed with 99492, 99493, 99494, and G2214, and general BHI, billed with 99484, or with G0323 when a clinical psychologist, clinical social worker, marriage and family therapist, or mental health counselor is the treating practitioner. The standalone BHI codes […]
CPT 87798 vs. 87801: Why Medicare Is Denying Multiple Units
Key Takeaways Medicare Administrative Contractors are denying claims that bill one unit of CPT 87798 for each organism detected by a single multiplex infectious disease panel. The National Correct Coding Initiative (NCCI) Policy Manual, Chapter 10, says a test for multiple infectious agents is reported with one unit when one procedure, one methodology, or one […]
Behavioral Health Carve-Outs: Why Mental Health Claims Go to the Wrong Payer
Key Takeaways A behavioral health carve-out moves mental health and substance use disorder benefits from the medical plan to a managed behavioral health organization (MBHO), whose name may not appear on the front of the patient’s insurance card. Claims sent to the medical plan for carved-out services typically deny with CARC 109, which signals the […]
How to Evaluate an Emergency Medicine Billing Company
Key Takeaways An emergency medicine billing company works the professional claim from hospital-sourced data, since federal rules keep insurance questions from delaying emergency screening and stabilization. Its coders need to level ED visits on medical decision making alone, the CPT standard since 2023. Critical care has to be coded by payer, because Medicare and CPT […]
What CMS’s Preliminary 2027 CLFS Rates Mean for Lab Reimbursement
Key Takeaways CMS released preliminary 2027 Clinical Laboratory Fee Schedule (CLFS) rates on Sept. 21, based on private payer data laboratories reported between May and July 2026. Of 1,528 lab codes with a private payer weighted median, 1,171 fall below their 2026 Medicare rate. CMS puts the average potential change at about 16% lower. Genomic […]
What’s the Difference Between Physician Billing and Facility Billing?
Key Takeaways Physician billing covers the professional component: the physician’s exam, interpretation, judgment, and written report. Facility billing covers the technical component: the equipment, technicians, supplies, and overhead used to deliver the service. Modifier 26 reports the professional component only. Modifier TC reports the technical component only. No modifier means one entity is billing both […]
What is Revenue Cycle Management?
Key Takeaways Revenue cycle management (RCM) covers every financial step from scheduling a patient visit to fully resolving the account balance. RCM includes eligibility verification, charge capture, coding, claims submission, payment posting, denial management, and reporting. Medical billing is one part of RCM, not the whole of it. Problems that surface as denials often trace […]