Behavioral Health Medical Billing Services
Behavioral health billing is time-based, and the time has to be in the note. It is also the specialty where payers most often carve benefits out to a separate manager, so a claim sent to the medical payer is not late, it is at the wrong address.
Codes this specialty bills most
| Code | Description | Watch for |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | Typically once per episode of care. A second one needs a documented reason. |
| 90834 | Psychotherapy, 45 minutes with patient | Covers 38 to 52 minutes. The actual time has to be recorded. |
| 90837 | Psychotherapy, 60 minutes with patient | 53 minutes or more. Frequently audited where it is the practice's default code. |
| 90853 | Group psychotherapy, other than a multiple-family group | Billed per patient. Group size can affect coverage under some policies. |
The denials this specialty sees
Time documentation is the first and most avoidable problem. 90837 requires 53 minutes or more of psychotherapy. A note saying "60 minute session" does not establish that, because the session includes time that is not psychotherapy. Start and stop times, or a stated number of psychotherapy minutes, is what survives an audit.
Practices billing 90837 for nearly every session should expect review at some point. That is not an accusation of anything; it is simply how payers select audit targets.
The second pattern is not a denial at all. It is a rejection for wrong payer, because the plan carved behavioral health out to a separate manager. The claim never entered adjudication. See CO-109.
Third is authorization and session limits. Many plans authorize a fixed number of sessions, and the claims past that number deny cleanly. Track the count and request the extension before the limit, not after.
Our billing service verifies which entity holds the behavioral benefit during eligibility rather than discovering it from a rejection.
Payer notes
Federal parity law requires that behavioral health benefits are no more restrictive than medical benefits, which is worth knowing when a plan applies session limits that its medical side would not. It is a real argument on appeal.
Carve-out arrangements are common and are not always visible on the member's card. Verify with the plan.
Common questions
How should we document time for 90837?
Record the actual psychotherapy minutes, ideally as start and stop times. "60 minute session" describes the appointment, not the service, and an auditor will read it that way.
Our claims keep coming back saying wrong payer. Why?
The plan has almost certainly carved behavioral health out to a separate benefit manager. The card shows the medical payer, so the claim looks right. Verify who holds the behavioral benefit during eligibility and send the claim there.
Can we appeal a session limit?
Sometimes. If the plan applies limits to behavioral health that it does not apply to comparable medical care, parity law is a legitimate basis for appeal. It needs a clinical justification for continued care alongside it.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.