Key Takeaways Medicare’s in-person visit requirement for home-based mental health telehealth does not apply to services through Dec. 31, 2027. Starting Jan. 1, 2028, a new patient needs an in-person visit within six months before the first mental health telehealth service and at least one in-person visit every 12 months after that. Patients who began […]
When Do Behavioral Health Services Need Prior Authorization?
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 […]
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 […]
The Coding and Billing Mistakes Behind Denied Behavioral and Mental Health Claims
Key Takeaways CPT 90832, 90834, and 90837 are separated by strict, non-negotiable time thresholds. Defaulting to 90837 without matching documentation is a common audit trigger. Standalone psychotherapy codes cannot be billed alongside an E/M code on the same date of service. Add-on codes 90833, 90836, and 90838 exist specifically for combined therapy and medication management […]
The Billing Gap Between Telehealth and In-Office Mental Health Visits
Key Takeaways Telehealth and in-office mental health visits require different place-of-service codes, and submitting the wrong one is one of the most common sources of avoidable denials. Modifier requirements vary by payer — and modifier rules for audio-video telehealth have shifted over time, so assumptions based on older workflows may no longer be accurate. Documentation […]
Top Behavioral Health Billing Companies: How to Choose the Right Partner for Your Practice
Key Takeaways Behavioral health billing requires specialization that general medical billing companies often lack. Payer rules, authorizations, and policy changes directly affect reimbursement outcomes. Telehealth billing expertise is now essential for mental health practices. Clear reporting and proactive denial management support long-term financial stability. The best billing partners function as an extension of your practice. […]
Coding Guidance for Smoking Cessation Counseling
The American Psychiatric Association provides a two-page resource discussing procedure coding for smoking cessation counseling. There are a number of different procedure codes that can be used to describe services provided to encourage changes in behavior of individuals who use tobacco. The resource identifies the CPT and HCPCS codes that describe smoking/tobacco cessation counseling, as […]