Mental Health Billing Services – Why Are They Necessary?


Billing for mental health treatments may be intimidating and very complicated due to the existence of several sets of codes and comprehensive guidelines governing which codes should be used for certain services.

That is why Mental Health billing services are vital. They can assist practitioners inappropriately charging for their services, assuring payment, and creating a consistent revenue flow for their firm.

How intricate? Extremely intricate.

Dissecting it

Medicare, Medicaid, and private insurers pay for mental health treatments based on filed insurance claims.

Payment is made when an error-free claim is filed. On the other side, when claims are presented incorrectly, they are refused, resulting in payment delays.

Therefore, what information does a mental health insurance claim form include, and how do insurers determine how much to pay?

While the claim structure varies across insurers, the information necessary is consistent.

The first section of the claim contains the provider’s tax identification number, the practitioner’s individual National Provider Identifier (NPI), an organizational or group NPI, the practitioner’s license number, and the location of the treatment.

The next section contains demographic and insurance information about the patient.

Information like as:

The patient’s full name as it appears on their insurance card

  • Gender
  • Birthdate
  • Address

Insurance member identification number

Number of the group

Number of Prior Authorization

Claims are addressed

The next section of the claim comprises two basic kinds of mental health codes: ICD-10 codes and Current Procedural Terminology (CPT) codes.

ICD – 10 codes inform insurers about the reason for a patient’s therapy and include the following:

  • Diseases
  • Symptoms and Signs
  • Exceptional Findings
  • Complaints

Extrinsic sources of harm or sickness

CPT codes inform insurers about which procedures are reimbursable and include the following:

  • Tests
  • Evaluations
  • Treatments

Any additional medical treatment that the healthcare practitioner does

Because all insurers utilize ICD – 10 codes on claims, they serve as the diagnostic bible. They adhere to a standardized format, which makes it easy to choose the most correct code for a given situation.

The bulk of ICD-10 codes for mental health are “F” codes and are classified as follows:

• F00 – F09 – Organic mental illnesses, including symptomatic disorders

• F10 – F19 – Psychoactive drug abuse-related mental and behavioral problems

• F20–F29 – Schizophrenia, Schizotypal diseases, and Delusional illnesses

• F30–F39 – Mood and depression illnesses, as well as bipolar disorders

• F40–F49 – Schizophrenia, Anxiety, Stress-Related, and Somatoform illnesses

• F50–F59 – Behavioral disorders caused by physiological problems

physical variables

• F60 – F69 – Adult Personality and Behavior Disorders

• F70 – F79 – Intellectual and Developmental Disabilities

• F80 – F89 – Developmental abnormalities that are both pervasive and specific

• F90 – F98 – Behavioral and emotional issues often manifest themselves in adolescents.

adolescent and childhood

• F99 – Unspecified Mental Illness

CPT codes for psychiatry are included in the CPT code set’s psychiatry section. Numerous codes apply to treatments that must be delivered by certified medical professionals such as psychiatrists, clinical psychologists, licensed professional counselors, licensed marital and family therapists, and licensed clinical social workers.

The most frequently used CPT codes are as follows:

• 90837 – 60-minute psychotherapy

• 90834 – 45-minute psychotherapy

• 90791 – Non-medical psychiatric diagnostic assessment

• 90847 – Psychotherapy with family members (in the presence of the client) – 50 minutes

• 90853 – Psychotherapy in groups (other than of a multiple-family group)

• 90846 – Psychotherapy with family members (without the client present) – 50 minutes

• 90875 – For use in conjunction with other psychiatric therapies or procedures

• 90832 – 30 minute psychotherapy

• 90838 – 60-minute psychotherapy with evaluation and management (E/M) services

• 99404 – Intervention in preventive medicine and/or risk factor reduction (s)

given to a certain person (separate procedure)

Modifiers are sometimes required to transmit extra information to the insurer. There are several modifiers, but only a handful are widely used.

The following are frequently used CPT Code Modifiers:

– Modifier 25 – Used when a distinct E/M service is required on the same day (provided by the same source). Nota – The 25 modifier does not apply to codes 99201–99215 or 99341–99350.

– Modifier 59 – Used to refer to a unique non-E/M procedural service performed on the same day as the E/M procedure. The documentation must justify the existence of a distinct session.

– Modifier GT – Used in conjunction with interactive audio and video telehealth services.

– Modifier UT – Used when the practitioner encounters a patient who is experiencing a crisis.

Selecting the appropriate codes might be somewhat challenging.

Thus, although it is necessary to have a good grasp of mental health billing, it is also crucial to understand how a mental health billing service may help prevent claim rejections.

For these reasons, using a billing service is critical to a mental health practice’s long-term success.