Psychiatry Medical Billing
Psychiatry medical billing is specialty billing and revenue cycle work built for mental and behavioral health practices where a 53-minute therapy session billed as a 45-minute code, an add-on psychotherapy code attached to no primary E/M, or a telehealth claim sent with the wrong place-of-service code is the difference between a paid claim and a denial.
EverCure Billing handles the complete revenue cycle for psychiatrists, psychologists, therapists, and behavioral health groups across the United States: eligibility and behavioral-health benefit checks, prior authorizations, psychiatric coding, claim submission, denial appeals, and aged A/R recovery. Your team treats the patient. We make sure the evaluation, medication management, and therapy work you already did actually gets paid and holds up if a payer looks.
What Is Psychiatry Medical Billing?
Psychiatry medical billing covers every financial step between a patient booking a visit and that money landing in your practice account.
For a mental health practice specifically, that includes verifying behavioral-health benefits before the session including whether the plan carves mental health out to a separate vendor obtaining prior authorization for TMS, Spravato, psychological testing, and higher levels of care, coding each service with the correct CPT, ICD-10, and modifier combination, documenting session time and medical necessity, submitting a clean claim to the correct payer, posting the payment, appealing the denial when the payer pushes back, and chasing the balance until it clears.
General medical billing stops at "submit the claim." Psychiatry billing runs on time-based coding, add-on logic, telehealth rules, and behavioral-health carve-outs a claim only pays when the documented time matches the code, the add-on sits on the right primary service, and the claim reaches the right payer. Those rules make behavioral health one of the most denial-prone and most under-collected areas in medicine.
Why Do Psychiatry Practices Lose More Revenue Than They Should?
Because mental health services are coded on time, stacked with add-on codes, split across telehealth rules, and routed through behavioral-health carve-outs and paneling into those payers is slow and easy to get wrong. These are the specific leaks we see when we run audits on psychiatry practices:
Time-based psychotherapy coding errors
Psychotherapy codes are tied to documented session time 30, 45, or 60 minutes. When start-and-stop time isn't documented, or a 53-minute session is billed as a 45-minute code out of caution, the practice either denies on audit or under-collects on every long session. Over a year that adds up to real money.
Add-on code and E/M pairing errors
When medication management and psychotherapy happen in the same visit, the therapy is billed as an add-on code on top of an E/M not as a standalone therapy code. Attach the add-on to the wrong primary, bill standalone therapy when it should have been an add-on, or miss the E/M entirely, and the line denies or leaves money on the table.
Telehealth place-of-service and modifier errors
Behavioral health is now largely telehealth, and payers are strict about place-of-service codes and the telehealth modifier and they change those rules more often than any other area. The wrong POS or a missing modifier turns a covered session into a denial.
Missing prior authorizations for TMS, Spravato, and testing
TMS, esketamine, psychological and neuropsychological testing, and higher levels of care (IOP/PHP) require authorization before the service and often session-count limits inside the approval. Deliver the service first and the claim denies with no appeal path.
Credentialing and paneling gaps
Behavioral health panels are notoriously hard to join and slow to process, and many close to new providers. A provider seeing patients before enrollment is final, or billing under the wrong rendering provider, produces denials that are painful to unwind.
Behavioral-health carve-out and wrong-payer routing
Many plans carve mental health out to a separate behavioral-health vendor. Send the claim to the medical payer and it denies as 'not covered by this plan' even though the care was fully covered, just by a different entity.
We build the workflow around these six failure points, because they are where mental health practice revenue actually disappears.
What Psychiatry Billing Services Does
EverCure Billing Provide?
Insurance eligibility and behavioral-health benefits verification
We verify active coverage, plan type, deductible status, coinsurance, session limits, and critically whether mental health is carved out to a separate behavioral-health payer, before the patient arrives, so care isn't delivered on a claim that was never going to reach the right payer.
Prior authorization support
We prepare and submit authorization requests for TMS, esketamine, psychological and neuropsychological testing, and IOP/PHP levels of care, attach the required clinical documentation, follow up with the payer until a decision is issued, and track the approved session count and expiry dates so approvals don't lapse or run out mid-treatment.
Psychiatry medical coding
Our coders work from your notes to assign the correct CPT, ICD-10-CM, and add-on codes matching psychotherapy codes to documented time, pairing therapy add-ons to the right E/M, applying interactive complexity and crisis codes where supported, and linking each diagnosis to its service so claims clear medical-necessity edits. Coding and billing are handled together, so coding errors are caught before the claim goes out, not after it's audited.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for payer-specific edits, add-on-to-primary logic, telehealth POS and modifier rules, time-band validation, and diagnosis-to-service linkage before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification because behavioral-health payers do pay below contracted rates, and most practices never catch it.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the documentation the payer is actually asking for. We also feed denial patterns back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar TMS, testing, and evaluation claims and anything approaching a timely filing deadline.
Patient billing and support
Clear patient statements, balance explanations, and a support line so your front desk isn't spending its day explaining coverage and coinsurance to patients.
Provider credentialing and payer enrollment
New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment through PECOS with special attention to behavioral-health panels, which are the slowest and most restrictive in the industry, so a new clinician isn't sitting idle waiting on a panel.
Billing audits and compliance review
Periodic internal review of time documentation, add-on usage, telehealth coding, and medical necessity to reduce audit exposure before a payer finds it first with audit-defense documentation prepared for high-scrutiny codes like the 60-minute psychotherapy code and same-day E/M plus therapy.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, and payer performance in plain language, not a data dump.
Which Psychiatry Services
Do You Bill?
Psychiatric diagnostic evaluations initial intake evaluations with and without medical services, coded correctly so the first visit pays at the right level.
Individual psychotherapy 30-, 45-, and 60-minute sessions matched to documented time, so long sessions are paid as long sessions.
Medication management (E/M) visits new and established patient E/M for psychiatric medication management, leveled to the documentation.
Psychotherapy with E/M (add-on) combined med-management-plus-therapy visits billed as an E/M with the correct psychotherapy add-on, not as two competing standalone codes.
Crisis psychotherapy crisis sessions and their add-on time coded to the documented crisis duration.
Family and group psychotherapy family therapy with and without the patient present, and group psychotherapy, coded to the correct format.
Interactive complexity the interactive complexity add-on applied where the encounter genuinely meets the criteria and the note supports it.
Transcranial Magnetic Stimulation (TMS) initial mapping and subsequent treatment sessions, billed against the authorization and session count, with global and re-treatment rules tracked.
Psychological and neuropsychological testing evaluation, administration, and scoring units billed correctly, with prior authorization and time/unit rules handled.
Telehealth sessions synchronous audio-video (and, where covered, audio-only) sessions coded with the correct place-of-service and telehealth modifier for each payer's current policy.
Non-covered and self-pay services clear self-pay and patient-responsibility handling so your practice isn't absorbing the cost of services a plan was never going to cover.
Which Psychiatry CPT and ICD-10 Codes
Do You Work With?
| Code / Range | What It Covers |
|---|---|
| 90791, 90792 | Psychiatric diagnostic evaluation (without / with medical services) |
| 90832, 90834, 90837 | Individual psychotherapy 30 / 45 / 60 minutes |
| 90833, 90836, 90838 | Psychotherapy add-on billed with an E/M service |
| 90785 | Interactive complexity add-on |
| 90839, 90840 | Crisis psychotherapy (first 60 min + each additional 30) |
| 90846, 90847 | Family psychotherapy (without / with patient present) |
| 90853 | Group psychotherapy |
| 99202–99215 | New and established patient E/M (medication management) |
| 90867–90869 | TMS initial mapping, subsequent delivery, re-mapping |
| 96130–96139, 96146 | Psychological and neuropsychological testing and evaluation |
| F32.-, F33.- | Major depressive disorder, single episode / recurrent |
| F41.- | Anxiety disorders (generalized, panic, other) |
| F43.- | Reaction to severe stress and adjustment disorders (incl. PTSD) |
| F31.- | Bipolar disorder |
| F90.- | Attention-deficit / hyperactivity disorder |
| F20.- | Schizophrenia |
| F10–F19 | Mental and behavioral disorders due to substance use |
Code sets update annually, and payer rules especially telehealth place-of-service and modifier policy update more often than that. Keeping current on both is part of the service, not an extra.
Which Modifiers and Codes Actually Decide
Whether a Psychiatry Claim Gets Paid?
More than any modifier, the place-of-service code decides telehealth payment in behavioral health office, telehealth in the patient's home, and telehealth other than home are treated differently by different payers. Get it wrong and the session denies. We set POS to each payer's current policy, not a single default.
Synchronous telehealth. Confirms a real-time audio-video service. Required by most payers on telehealth claims, and its interaction with POS is payer-specific.
Significant, separately identifiable E/M. Used where a separate E/M is billed alongside another service on the same day, and heavily reviewed so it has to be documented properly.
Distinct procedural service. Used to correctly separate legitimately distinct services under bundling edits, rather than have them denied as duplicative.
Provider type. Identify services rendered by a clinical psychologist or clinical social worker where the payer requires the rendering-discipline modifier.
Behavioral-health level-of-provider modifiers. Required by many Medicaid and behavioral-health plans to indicate the clinician's licensure level; the exact set varies by state and plan.
Mandated services and reduced services, applied where the encounter genuinely fits, so the claim reflects what actually happened.
The theme in psychiatry is that time documentation, add-on-to-primary pairing, and telehealth POS/modifier accuracy decide payment far more than any single procedure modifier. That's exactly what we scrub before submission.
How Does Compliance Work in Psychiatry Billing?
Time documentation
Time-based psychotherapy codes are only defensible when the note supports the time billed. We build time capture into the workflow so the 45- and 60-minute codes stand up to review instead of being downcoded.
Add-on and same-day E/M discipline
Psychotherapy-plus-E/M and same-day service combinations are audited patterns. We hold the add-on and modifier logic to the documentation standard so combined visits are paid correctly and survive scrutiny.
Telehealth compliance
Telehealth POS and modifier rules shift frequently and vary by payer and state. We track current policy per payer so covered telehealth is billed compliantly and doesn't deny on a technicality.
Medical necessity and frequency
E/M levels and session frequency carry medical-necessity and, for some plans, authorization limits. We link the diagnosis, level, and frequency to the documentation so claims aren't submitted unsupported.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI which matters especially in behavioral health, where records carry heightened sensitivity secure data transfer, and no PHI on personal devices or unsecured channels.
How Does
Onboarding Work?
Free billing audit
We review a sample of recent claims, denials, and your aged A/R to identify where revenue is being lost and how much of it is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your service mix, top behavioral-health payers, telehealth setup, current denial patterns, and internal handoffs, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R old money is usually the fastest win.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call to go through what's working and what needs to change.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, Practice Fusion, CareCloud, Epic, and Cerner, along with behavioral-health platforms such as TherapyNotes, SimplePractice, and Valant.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide, with a growing footprint in Indiana and New Jersey.
What Does Psychiatry Billing Cost?
Our psychiatry billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on service mix, monthly claim volume, payer mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the Business Assessment is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Psychiatry Billing?
We code and bill together.
In psychiatry, most lost revenue is a coding decision a downcoded session, an add-on on the wrong primary, a mis-set telehealth POS. Handling coding and billing in one workflow means those errors are caught before the claim drops, not surfaced later in an audit.
We handle the whole behavioral-health tangle, not just easy claims.
Carve-outs, telehealth rules, TMS and testing authorizations, and slow BH paneling take real attention. That's the work we don't write it off and move on.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, and your service mix, reachable directly.
Direct access to leadership.
We're built to stay close to our clients. When something goes wrong, you're not escalating through four layers to get an answer.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating. Most billing companies just resubmit.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, and collections every month, explained clearly.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Psychiatry Practice Leaving Money on the Table?
Most mental health practices don't know their real denial rate, how much of their aged A/R is still collectible, or how many long sessions are being under-coded until someone actually looks.
That's what the Business Assessment is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Psychiatry Billing
Yes. We match every psychotherapy code to the documented session time so long sessions are paid as long sessions, and we build time capture into the workflow so those codes hold up on review.
Because most services are coded on time, stacked with add-on codes, split across telehealth rules, and routed through behavioral-health carve-outs. We check each of those before the claim goes out.
Yes. We handle both together, which is how coding errors get caught before submission rather than in an audit the single biggest source of lost behavioral-health revenue.
Yes. We set the place-of-service and telehealth modifier to each payer's current policy, and we track those rules as they change, because they change often.
Yes. We verify at eligibility whether mental health is carved out to a separate payer and route the claim to the correct entity, so it isn't denied by the medical plan.
Yes. We prepare and submit the request, attach the clinical documentation, follow up until a decision is issued, and track the approved session count and expiry dates.
Yes. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment are all available with particular attention to behavioral-health panels, which are the slowest to join.
Yes. We log into your current system and work inside it, including behavioral-health platforms. There is no software to buy and no migration required.
Both. Aged A/R is usually where the fastest recovery is available, so we start working it in parallel with new claim submission.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices with the extra care behavioral-health records require.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.