Specialties
Mental Health Billing Services
Therapy practices bill a small set of codes many times a week, so a single rule applied wrongly repeats across every session. Payment depends on session time matching the code, every clinician being credentialed under the right NPI, telehealth sessions carrying the right place of service, and authorizations covering the number of visits actually delivered.
- Psychotherapy codes matched to documented session time
- LCSW, LPC, LMFT and psychologist credentialing tracked per payer
- Session authorizations and behavioral health carve-outs monitored
Why therapy practices lose money on routine sessions
Psychotherapy is billed by time, and the time ranges behind each code are narrow. A session documented at 37 minutes is a different code from one documented at 38, and notes without start and stop times or total minutes give a payer an easy reason to downcode or deny on audit.
Most therapy groups also bill for several kinds of licensed clinicians. Each one needs their own credentialing with each payer, claims must show the right individual rendering NPI under the group's billing NPI, and whether sessions by associates still working toward full licensure can be billed at all is decided by each payer and state.
Behavioral health benefits are often managed by a separate company from the patient's medical plan. The card may name one insurer while claims and authorizations go to another, and plans that limit sessions or require authorization after an initial number of visits deny the sessions that run past the approval.
Psychotherapy and telehealth codes for therapy practices
The codes non-prescribing clinicians use most. Times are face-to-face time with the patient or family.
| Codes | Service | Billing notes |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation without medical services. | Used for the intake assessment. How often it can be repeated is set by each payer. |
| 90832, 90834, 90837 | Individual psychotherapy: 16 to 37 minutes, 38 to 52 minutes, and 53 minutes or more. | Bill the code whose range includes the documented time. |
| 90846, 90847 | Family psychotherapy without the patient present, and with the patient present. | Both describe sessions of about 50 minutes; the patient's presence decides the code. |
| 90853 | Group psychotherapy, other than a multi-family group. | Each group member's session is documented in their own record. |
| 90839, 90840 | Psychotherapy for crisis: first 60 minutes, then each additional 30 minutes. | Requires documentation of an urgent, high-distress situation and the time spent. |
| 90785 | Interactive complexity add-on. | Added when communication factors, such as involving a guardian or interpreter, make the session more complex. |
| POS 02, POS 10, modifier 95 | Telehealth place of service (other than home, and patient's home) and the synchronous telehealth modifier. | Medicare uses POS 02 and 10 on professional claims; other payers set their own telehealth rules, so we set the rule per payer. |
CPT is a registered trademark of the American Medical Association.
Official sources: CMS MLN: Medicare and mental health coverage (external site), CMS NCCI Policy Manual, chapter 11 (psychiatric services) (external site), CMS: Physician fee schedule relative value file (code descriptors) (external site), CMS: Place of service code set (external site), CMS Claims Processing Manual, chapter 1 (external site), Federal Register: CY 2025 PFS final rule (external site)
Common reasons therapy claims deny
Session time does not support the code
Missing start and stop times, or a 90837 billed for a session documented under 53 minutes.
Clinician not credentialed with the plan
A new therapist sees patients before their enrollment is effective, or claims go out under the wrong NPI.
Claim sent to the medical plan, not the behavioral health administrator
The carve-out vendor was never billed, so the claim is denied as the wrong payer.
Authorized sessions used up
Visits continue after the approved number of sessions or past the approval end date.
Telehealth POS or modifier wrong for the payer
Each payer's telehealth billing rules differ, and one practice-wide default rarely fits all of them.
Diagnosis outside the plan's policy
The primary diagnosis billed is not one the plan accepts for psychotherapy, which we check against the plan's policy before the claim goes out.
How we bill for therapy groups
Step 1: Map every clinician to every payer
License type, NPI and credentialing status per payer, so no session is scheduled with a clinician the plan will not pay.
Step 2: Check time against code
Session times in the note are compared with the code before the claim is released.
Step 3: Track authorizations by session count
Remaining visits and end dates are tracked so renewal requests go in before the approval runs out.
Step 4: Apply payer telehealth rules
Each payer's POS and modifier requirements are applied to telehealth sessions automatically.
Insurance, out-of-network and private pay
Many therapy practices mix in-network insurance, out-of-network clients who submit their own claims with a superbill, and fully private-pay clients. Each needs a different process: claims for in-network plans, accurate superbills with diagnosis and CPT codes for out-of-network clients, and a good faith estimate for uninsured or self-pay clients under the No Surprises Act.
Medicare is a special case. Clinicians who are eligible to enroll in Medicare cannot simply charge Medicare patients privately for covered services; they must either bill Medicare or formally opt out. Licensed marriage and family therapists and mental health counselors can now enroll in Medicare, alongside clinical social workers and psychologists.
Official sources: CMS: Marriage and family therapists and mental health counselors (external site), eCFR: 42 CFR 405.425 (effects of opting out) (external site), eCFR: 45 CFR 149.610 (good faith estimates) (external site)
Frequently asked questions
Which code do we bill for a 50-minute therapy session?
90834, which covers 38 to 52 minutes of psychotherapy. 90837 applies from 53 minutes. The documented time, not the scheduled slot, decides the code.
Can associates or pre-licensed clinicians bill insurance?
It depends on the payer and the state, and the answer differs between plans, so we check each plan's policy before an associate sees that plan's clients. Billing an associate's session under a supervisor's NPI is only appropriate where the plan's policy allows it.
Do therapy sessions need prior authorization?
Many plans allow routine outpatient therapy without authorization, but some require it from the first visit or after a set number of sessions, and intensive services usually need approval. The behavioral health administrator on the plan sets the rule.
How should telehealth therapy be billed?
With the place of service and modifier each payer requires, for example POS 10 when the client is at home. Rules have changed more than once, so they are kept per payer rather than as one setting.
Can we see Medicare patients on a private-pay basis?
Only if the clinician has formally opted out of Medicare, or their profession is not eligible to enroll. Otherwise covered services must be billed to Medicare.
Related services and specialties
Related services
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Medicare, Medicaid and commercial enrollment, CAQH upkeep and revalidation dates tracked so providers can bill from day one.
Learn more about Credentialing and Provider EnrollmentPrior Authorization
Authorization requirements checked, requests submitted with clinical support, and approvals matched to claims before the service date.
Learn more about Prior Authorization
Specialties
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Medication management with psychotherapy add-ons, psychiatric evaluations, and authorization-heavy treatments such as TMS, ECT and esketamine.
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ABA billing by provider level, authorized units and hours, assessment and caregiver guidance codes, autism mandates, BCBA credentialing and session notes.
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Running a therapy group with several payers?
Talk to us about clinician credentialing, session authorizations and telehealth rules, or start with a free audit.