Behavioral Health Billing: The Ultimate Guide to Maximizing Revenue and Compliance
What is Behavioral Health Billing?
Behavioral health billing refers to the process of submitting claims and receiving reimbursement for mental health and substance abuse treatment services. It involves unique behavioral health billing codes, compliance with CMS behavioral health billing guidelines, and effective revenue cycle management (RCM) strategies.
Why Is Behavioral Health Billing Important?
Proper billing for behavioral health services ensures:
- Accurate reimbursement for providers
- Compliance with CMS and insurance regulations
- Reduced denials and delays in payments
- Optimized cash flow for behavioral health practices
Understanding Behavioral Health Billing Codes
according to AMA (American Medical Association) these are the most commonly used categories :
CATEGORY A [Counseling Risk Factor Reduction and Behavioral Change Interventions]
Preventive Medicine: 99401, 99402, 99403, 99404, 99411, 99412
Behavior Change Interventions: 99406, 99407, 99408, 99409
CATEGORY B [Do not require larger collaboration outside of practice]
Psychotherapy: 90832, 90833, 90834, 90836, 90837, 90838, 90853
Developmental Behavioral Screening: 96127, 96110, 96161
CATEGORY C [Increased Collaboration Under Integrated Care]
Adaptive Behavior services: 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158
Health Behavior Assessment and Intervention: 96156, 96158, 96159, 96160, 96161, 96164, 96165, 96167, 96168 96170, 96171
CATEGORY D [Most comprehensive codes for an expansive coordination model]
General Behavioral Health Integration Care Management: 99484
Psychiatric Collaborative Care Management: 99492, 99493, 99494, G2214
Cognitive Assessment and Care Plan Services: 99483
Inter-professional Digital Services: 99446, 99447, 99448, 99449, 99451, 99452
CoCM General Management (Medicare): G0511
Psychiatric Collaborative Care Model (Medicare): G0512
HCPCS codes
There are three levels of HCPCS codes:
- Level 1 — Numerical CPT Codes
- Examples: 90791, 90834, 90837
- Level 2 — Alphanumeric Codes, often representing non-physician services not covered by Level 1 codes
- Examples: H0001, H0002, H2020
- Level 3 — Local, state-based codes, often developed by each state’s Medicaid agencies. These codes were discontinued in 2003 as Level 1 and Level 2 codes became standardized nationally.
Most mental health providers only code using Level 1 codes. Some providers working with Medicaid clients are required to use Level 2 alphanumeric codes that are provided by non-physicians.
To get reimbursed correctly, providers must use the right behavioral health procedure codes
learn in detail about behavioral health billing by downloading this guide from CMS
struggling with your behavioral health billing and coding? working hard but still have billing and coding errors?
learn in detail about our behavioral and mental health billing services
CMS Behavioral Health Billing Guidelines & Compliance
To stay compliant with Medicare and Medicaid, providers must adhere to CMS guidelines, including:
- Using correct CPT and HCPCS codes for each service
- Ensuring medical necessity documentation
- Following state-specific regulations for telehealth services
- Understanding prior authorization requirements
Common Compliance Mistakes to Avoid
- Using incorrect billing codes – Leads to claim denials
- Missing documentation – Causes compliance violations
- Improper credentialing – Prevents reimbursement from payers
Behavioral Health Accounts Receivable Management
Effective behavioral health accounts receivable management is crucial to maintaining financial stability. Here’s how to optimize your AR process:
1. Reduce Claim Denials
- Verify patient insurance eligibility before appointments
- Ensure correct documentation and coding
2. Streamline Payment Collections
- Implement automated payment reminders
- Offer multiple payment options for patients
3. Leverage Behavioral Health RCM Companies
- Outsourcing to behavioral health RCM companies can help providers:
- Increase revenue
- Reduce administrative burden
- Improve claim approval rates
Top Behavioral Health Billing Companies
rgtrend
feedbacks from practices that work with us makes us confident that we are one of the best choices for you .
we got positive feedback for
- affordability: lowest percentage in the USA starting at 2.49%
- our exclusive idea of having a practice success manager and customer support
- hippa compliant doctor lead billing and coding services
- 3% denial rate
View our medical billing services for small practices here
PLUTUS HEALth
also have a good reviews,they are :
- hippa compliant
- 5% denial rate
- 95% claim claim
Therathink
they are well-known name,
- suitable for hospitals and large clinics
- ICD10 Ready, HIPAA Compliant
- good customer support
How to Improve Your Behavioral Health Billing Process
1. Train Your Staff on Coding Best Practices
- Keep updated on billing codes for behavioral health
- Conduct regular audits to ensure accuracy
2. Use Advanced Billing Software
- Automate claim submissions and tracking
- Ensure compliance with CMS guidelines
3. Work with a Behavioral Health Billing Partner
- Reduce claim rejections
- Improve collection rates
Frequently Asked Questions
What is the best behavioral health billing company?
the best behavioral health billing company depends on your needs for example
- if you are a small practice and you want the lowest percentage you may consider rgtrend or resilience billing
- if you are looking for well know name you may consider therathink
What are the essential behavioral health codes?
Common codes include 90837 for 60-minute psychotherapy and 96127 for emotional/behavioral assessment. also check AMA coding guidelines for behavioral health here
How can I reduce claim denials in behavioral health billing?
Ensure correct coding, proper documentation, and insurance verification before services are provided.
Mastering behavioral health billing requires staying updated with CMS guidelines, using correct billing codes, and optimizing your RCM process.
Ready to streamline your behavioral health billing? feel free to contact us today for expert revenue cycle management and compliance consultaion!