2300 W Sahara Ave,
Ste 800
Ste 800
Las Vegas, NV 89102
Talk to someone who actually understands and cares about your field.
M-F, 9am-5pm PST
We're ready and eager to meet your billing needs.
Las Vegas, NV 89102
Talk to someone who actually understands and cares about your field.
We're ready and eager to meet your billing needs.
By Alex Trent, MA, MS — psychologist and mental health billing specialist, owner of ePsych Billing. Last updated: September 2026.
It’s Monday morning and you’re already dreading the insurance calls. Which payer did you need to call back? Where did you save that reference number? Why was none of this taught in grad school?
Mental health billing isn’t easy, but it is learnable. Most unpaid claims trace back to a small set of problems: benefits that weren’t verified, codes that don’t match the note, missed filing deadlines and denials that nobody followed up on. The 50 mental health billing tips below are grouped in the order a claim moves through your practice, from intake to payment, so you can fix problems where they start.
Mental health billing is the process of turning therapy and psychiatric services into paid insurance claims or client payments. It includes verifying coverage, coding sessions with CPT and ICD-10-CM codes, documenting medical necessity, submitting claims, posting payments and working denials. It differs from general medical billing because of time-based psychotherapy codes, frequent authorization rules, behavioral health carve-outs and stricter privacy expectations for therapy records.
If you’re new to the topic, our overview of common insurance billing challenges for mental health professionals is a good place to start.
Most billing problems start before the first session. Get these steps right and you prevent denials instead of fixing them later.
Scan the front and back of the insurance card and record the client’s full legal name exactly as it appears on the card, date of birth, address, phone number, subscriber name and relationship, member ID, group number and employer. A single mismatched letter or birth date can get a claim rejected. Collect only the sensitive identifiers (like a Social Security number) that a payer actually requires.
Confirm that the plan is active and that outpatient mental health is covered. Then ask the payer specific questions and write down the answers:
Many health plans hand off mental health benefits to a separate behavioral health company. If you send the claim to the medical plan on the card instead of the carve-out administrator, it will be denied. Keep a running list of which payer IDs and addresses handle mental health claims for each plan, because payers sometimes switch administrators without telling providers.
Clients change jobs, switch plans and let coverage lapse. Re-check eligibility at the start of each plan year (often January 1) and any time a client mentions a new job or card. If coverage lapsed, contact the client right away to collect payment or bill the new policy.
Most commercial plans don’t require authorization for routine outpatient therapy, but some always do, and others require it only for certain services, such as extended sessions, psychological testing or more than a set number of visits. Keep authorization rules per payer and check before every new service you plan to provide.
When a client is close to their authorized number of sessions or the authorization end date, request an extension before the last approved visit. Sessions after an expired authorization are one of the most frustrating denials to recover.
Collecting the client’s share when services are delivered is far easier than chasing balances later. Keep a card on file (with the client’s written consent) for deductible and coinsurance amounts that are only known after the claim processes.
Under the No Surprises Act, providers must give uninsured and self-pay clients a written Good Faith Estimate of expected charges. For ongoing therapy, the estimate can cover up to 12 months of expected services. Review the requirements on the CMS No Surprises Act page.
COBRA coverage is paid monthly by the client, and a missed premium can mean retroactive termination. For clients on COBRA, confirm active coverage more often so you don’t find out months later that the claims will never be paid.
EAPs often cover a set number of free counseling sessions and are an underused source of revenue. EAP sessions usually need their own authorization and are billed separately from regular insurance, so bill the EAP sessions first, then move to the client’s health plan.
Coding errors are a leading cause of denied and underpaid therapy claims. Use this quick reference for the most common outpatient mental health CPT codes.
| CPT code | Service | Time / rule |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation (no medical services) | Intake evaluation; not time-based |
| 90792 | Psychiatric diagnostic evaluation with medical services | For prescribers (MD, DO, NP, PA) |
| 90832 | Psychotherapy, 30 minutes | 16–37 minutes |
| 90834 | Psychotherapy, 45 minutes | 38–52 minutes |
| 90837 | Psychotherapy, 60 minutes | 53 minutes or more |
| 90846 / 90847 | Family psychotherapy without / with the client present | 50 minutes (26 minutes or more) |
| 90853 | Group psychotherapy | Per client, per session |
| 90839 + 90840 | Psychotherapy for crisis | 90839 for the first 30–74 minutes; 90840 for each extra 30 minutes |
| 90785 | Interactive complexity add-on | Added to eligible codes when communication factors complicate care |
Psychotherapy codes are time-based. A 50-minute session is 90834, not 90837. Billing 90837 without documenting at least 53 minutes of face-to-face therapy is one of the most common reasons payers audit therapists.
Bill the intake as 90791 (or 90792 if a prescriber provides medical services), then switch to psychotherapy codes for ongoing sessions. Check whether a payer limits how often 90791 can be billed per client.
Add-on codes can’t be billed alone. Examples include 90785 for interactive complexity, 90840 for extended crisis time and 90833, 90836 and 90838 when a prescriber provides psychotherapy on the same day as an E/M visit. Only add them when the note supports them.
Payers require ICD-10-CM codes on claims, not DSM-5-TR descriptions alone. Use the most specific code the documentation supports; “unspecified” codes invite denials and medical necessity reviews. ICD-10-CM updates take effect every October 1, so check your diagnosis codes each fall.
Don’t bill implied codes, codes that aren’t supported by medical necessity, unbundled services for extra reimbursement or a “close enough” code for a different service. Beyond denials, these patterns create repayment demands and compliance risk.
Most payers pay only one psychotherapy session per client per day. Some allow exceptions, such as a crisis or a separate family session. Call the payer, ask about the specific situation and document the reference number before you bill.
Once you reach 53 minutes, 90837 pays the same whether the session lasts 55 or 80 minutes (unless it qualifies for crisis codes). Plan session lengths with that in mind so you aren’t working for free unless you choose to.
Some payers, especially Medicaid plans, require modifiers that show the clinician’s license level, and telehealth claims often need modifier 95 or 93. Keep a modifier cheat sheet for each payer you’re contracted with.
Most practice management systems and clearinghouses check claims for missing fields and code conflicts before they go out. Turn those edits on, and contact your software vendor when you have a coding or setup question instead of guessing.
Each note should connect the diagnosis, the client’s symptoms and functional impact, the interventions you used and progress toward treatment goals. If an auditor reads the note alone, they should understand why therapy was needed that day.
Because psychotherapy codes depend on time, write down the actual start and stop times (or total minutes) of face-to-face therapy. Rounded or missing times are an easy target in audits.
Review documentation right after the session, check it for completeness and submit the claim within three days. Fast submission shortens your payment cycle and keeps timely filing deadlines far away.
Some payers want treatment plans, authorization numbers or records with certain claims. Requirements vary by payer, so keep a list and send the right documents the first time.
Save the submitted claim, the clearinghouse acceptance report and any payer acknowledgment. If a payer says they never received the claim, you have proof, and proof of timely filing can save a claim that’s past the deadline.
Electronic claims move faster and come with acceptance reports that paper claims don’t have. Medicare, for example, won’t pay a clean electronic claim before day 14 but generally pays within 30 days of receipt. As a rule of thumb, a clean claim should pay in about 30 days. Anything older deserves a follow-up.
Some clearinghouses charge per claim or limit claim volume on lower tiers. Medicare contractors and some Medicaid and Blue Cross plans offer free direct submission portals. Compare the fees, the workflow and the reporting before you commit.
Know what goes in each box, especially the diagnosis pointer, the rendering and billing NPIs, the taxonomy, the place of service and box 22 for corrected claims. The National Uniform Claim Committee (NUCC) publishes the official CMS-1500 instruction manual.
Filing deadlines range from about 90 days to more than a year depending on the payer and your contract. Medicare’s limit is 12 months from the date of service. Put each payer’s deadline in your billing system and treat claims close to the limit as urgent.
For clients with more than one plan, confirm coordination of benefits at intake. Bill the secondary plan only after the primary has processed the claim, and attach the primary’s EOB or electronic remittance data.
A rejection means the claim never entered the payer’s system, usually because of a formatting or data error, so the payer won’t follow up with you. Check clearinghouse reports daily and fix rejections right away, before the filing deadline passes.
Keep phone numbers, payer IDs, claim addresses and portal URLs for every payer and clearinghouse in one shared place. Store logins in a password manager, not a spreadsheet or sticky note.
Payers change submission methods, addresses and policies, often with little notice. Read payer newsletters, and if you bill Medicare, use the free courses from the CMS Medicare Learning Network. Licensed marriage and family therapists and mental health counselors have been able to enroll in Medicare since January 1, 2024.
Electronic remittance advice (ERA) and electronic funds transfer (EFT) let your software auto-post payments and deposit funds directly. That means fewer paper EOBs, less manual entry and fewer posting errors.
Post every payment, adjustment and denial as soon as it arrives. Accurate posting is what makes your aging report reliable, and it’s how you spot underpayments.
An accounts receivable (A/R) aging report groups unpaid claims by age (0–30, 31–60, 61–90, 90+ days). Review it weekly, confirm claims were received and act on anything that isn’t moving. If you don’t have time to watch A/R closely, consider handing it to someone who will.
Check the status of any claim with no response after 30 days. By 60 days, call the payer and confirm the claim number, the paid amount, the payment date and the check or EFT number, or find out exactly what’s holding it up.
When you call a payer, ask about all of that payer’s outstanding claims in one call. Many payer portals also let you check status for several claims without waiting on hold.
Write down the date, the representative’s name, the reference number, what they said and what happens next. That record is your leverage when a promised reprocessing never happens. Stay polite: courtesy with payer reps, clearinghouses and software support gets problems solved faster.
Load your contracted rates into your billing system so underpayments stand out. When a payer pays less than the contract rate, file a reconsideration or appeal. Payers benefit from paying slowly and incorrectly, and practices that don’t check leave money behind.
When you’re in-network, you must accept the payer’s allowed amount. You can collect the client’s copay, coinsurance and deductible, but not the difference between your full fee and the contracted rate.
Out-of-network reimbursement depends on the client’s plan and is often based on the payer’s “allowed amount,” not your fee. Give out-of-network clients a clear superbill with CPT codes, ICD-10-CM codes and your NPI, and explain that their plan decides what it pays back.
Call or check the portal to find out exactly what’s wrong and what would fix it. Many denials come from simple, correctable errors.
Claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) on the ERA tell you why the claim was denied. Fix the underlying process, not just the single claim. Our guide to the most common mental health claim denials covers the biggest culprits.
If the claim had an error, send a corrected claim (frequency code 7 in box 22 of the CMS-1500, with the original claim number). If the claim was right and the payer was wrong, file an appeal with supporting documentation within the payer’s appeal deadline. Faxing is still the fastest route for some payers’ reconsiderations.
Log each denial by payer, reason and CPT code. Patterns such as repeated eligibility or authorization denials point to a front-desk process that needs fixing. Learn more about how to reduce claim denials in your practice.
Payers can take back payments months or years later if documentation doesn’t support the code billed. Audit a sample of your own notes each quarter, and read about the insurance recoupment dilemmas mental health providers face most often.
Most payers want POS 10 (telehealth in the client’s home) or POS 02 (telehealth somewhere other than the home), plus modifier 95 for video or 93 for audio-only, but rules vary by payer. For Medicare, Congress extended telehealth flexibilities and delayed the in-person visit requirement for telemental health through December 31, 2027. Check the CMS telehealth page for updates, and see our take on the growth of telehealth in mental health care.
Never send client information through a regular, free consumer email account. Use a professional domain email (such as you@yourpractice.com) on a service that signs a Business Associate Agreement (BAA), like a paid Google Workspace or Microsoft 365 plan configured for HIPAA, or use your EHR’s secure portal.
Demographics, insurance details, claims and payment records are all protected health information, just like treatment notes. Limit access by role, use strong passwords with multi-factor authentication and get a BAA from every billing vendor and clearinghouse. The HHS HIPAA site explains your obligations.
Your time is best spent with clients. If claims sit unworked, A/R keeps growing or billing eats your evenings, it may be time for professional mental health billing services. Compare how much mental health billing services cost against the revenue you’re currently losing, and watch for the signs your practice needs a billing company.
| Stage | What to check | How often |
|---|---|---|
| Intake | Card copy, demographics, eligibility, benefits, authorization, carve-out payer | Every new client and every plan change |
| Session | Start and stop times, medical necessity, correct CPT and ICD-10-CM codes | Every session |
| Submission | Claim scrubbed and sent within 72 hours; rejections cleared | Daily |
| Payments | ERA posted, contract rates checked, client balances billed | As payments arrive |
| A/R | Aging report reviewed; 30+ day claims followed up | Weekly |
| Denials | Root cause logged; corrected claims and appeals filed | Weekly, with a monthly trend review |
| Compliance | Note audit, authorizations, filing limits, payer policy updates | Quarterly |
Handling billing yourself gives you control, but every hour on hold with a payer is an hour you aren’t seeing clients or resting. A specialized billing company brings payer knowledge, daily A/R follow-up and denial management that a solo practitioner rarely has time for. Read the key reasons mental health professionals use an insurance billing service, or see what ePsych Billing handles for your practice.
Need help now? Contact ePsych Billing to talk with Alex, a psychologist and mental health billing specialist, about what’s slowing down your reimbursements.
The most common reasons are eligibility and coverage problems, missing prior authorizations, CPT codes that don’t match the documented session time, incorrect or unspecified diagnosis codes and missed timely filing deadlines. Most of them can be prevented by verifying benefits before the first session and scrubbing claims before submission.
A clean electronic claim is usually paid within about 30 days of the payer receiving it. Medicare doesn’t pay clean electronic claims before day 14. Paper claims and claims that need extra review take longer, so follow up on any claim that hasn’t been paid after 30 days.
Both are individual psychotherapy codes. 90834 covers 38–52 minutes of psychotherapy, and 90837 covers 53 minutes or more. The code must match the actual time documented in the progress note.
It depends on the payer and your contract. Commercial plans commonly allow 90 days to one year from the date of service, and Medicare allows 12 months. Check each payer contract and track the deadlines in your billing system.
Not when you’re in-network. In-network providers must accept the contracted allowed amount and can collect only the client’s copay, coinsurance and deductible. Out-of-network providers may bill their full fee, subject to state law and No Surprises Act rules.
Outsourcing makes sense when unpaid claims pile up, denials go unworked or billing takes time away from clients. A specialized mental health billing company typically charges a percentage of collections, so compare that cost with the revenue your practice is currently losing.
This article is for general educational purposes. Payer rules, codes and regulations change; confirm current requirements with each payer and official CMS guidance.
Alex is a psychologist and mental health billing expert, and helps mental health professionals collect more revenue as owner of ePsych Billing.