Billing for Mental Health Providers: Key Differences and Best Practices

Billing for mental health services isn’t the same as billing for general medical care. It comes with its own set of codes, coverage rules, and documentation expectations. For medical billing licensees, understanding these differences is essential for avoiding denials, improving collections, and supporting provider compliance.

This article breaks down what makes mental health billing unique—and how to manage it effectively.

1. Understand the Service Types and Code Structure

Mental health providers often bill based on time, not just procedure. Common service types include:

• Psychotherapy (individual, group, or family)

• Evaluation and management (E/M) visits for medication management

• Psychological testing or assessments

• Telehealth therapy sessions

Key CPT code ranges to know:

• 90832–90838: Individual psychotherapy

• 90791–90792: Psychiatric diagnostic evaluations

• 90846–90847: Family or couples therapy

• 96130–96136: Psychological and neuropsychological testing

Always confirm whether sessions are time-based and if additional services (like E/M) can be billed concurrently.

2. Time-Based Coding Requires Accurate Documentation

Unlike many other specialties, mental health billing depends heavily on time documentation. For example:

• 90834 (45 minutes of psychotherapy)

• 90837 (60 minutes of psychotherapy)

If the provider documents only general notes without time spent, the claim may be downcoded or denied.

Best practice: Ensure providers consistently document session start and end times or total duration in their notes.

3. Understand Payer Limitations and Coverage Rules

Mental health coverage varies widely between payers. Some common differences include:

• Limits on the number of therapy sessions per year

• Pre-authorization requirements for specific services

• Restrictions on telehealth or group therapy billing

• Separate deductible or copay structures for behavioral health

Best practice: Verify benefits before services begin, and keep a record of coverage details for reference.

4. Watch for Same-Day Service Restrictions

Many payers won’t allow a provider to bill both psychotherapy and a medical E/M service on the same day—unless specific conditions are met and modifiers are applied (e.g., modifier 25).

This is especially relevant for psychiatrists who provide both therapy and medication management.

Best practice: Use proper modifiers, and ensure services are separately documented and clearly distinct.

5. Handle Telehealth Billing Carefully

Telehealth has become common in mental health care—but billing rules differ by payer and state.

Key considerations:

• Confirm which CPT codes are eligible for telehealth

• Use the appropriate POS (place of service) and telehealth modifiers (e.g., 95 or GT)

• Track payer-specific updates, as telehealth rules continue to evolve

Best practice: Keep a payer-specific cheat sheet for telehealth billing rules to avoid confusion.

6. Know When to Use Add-On Codes

Some psychotherapy sessions include additional services, like crisis intervention or interactive complexity. These often require add-on codes:

• 90785: Interactive complexity

• 90839/90840: Psychotherapy for crisis

Best practice: Confirm when these codes are applicable and that documentation supports their use.

Mental health billing requires attention to detail, a strong grasp of time-based coding, and careful management of payer rules. By understanding what sets this specialty apart, medical billing licensees can provide valuable support to mental health providers—and reduce the risk of claim rejections or revenue loss.

If you're planning to work with mental health clients, consider building a checklist or template specifically for behavioral health billing. It’s one of the easiest ways to stay organized and consistent.