The prevalence of mental health disorders in the United States has been increasing over time. All segments of society have experienced increased mental stress and psychosocial well-being. In fact, psychiatrists are successfully diagnosing, treating, and preventing mental, emotional, and behavioral disorders using various techniques. Depending on the patient’s needs, treatments may include multiple forms of psychotherapy, medications, psychosocial interventions, and other modalities such as electroconvulsive therapy (ECT). While they strive to provide high-quality mental health care, submitting claims for reimbursement is a significant challenge because of the wide range of services available and the numerous psychological approach to mental health coding and billing rules and payer regulations. Collaboration with psychiatry or mental health billing companies can assist practitioners in filing accurate claims and receiving appropriate and timely payment.
Let’s have a look at the psychological approach to mental health billing:
Anxiety, bipolar disorder, depression, anorexia, schizophrenia, substance abuse, OCD, ADHD, and PTSD are all conditions treated by psychiatrists. However, billing and coding mental health services differ from billing and coding other medical conditions. That’s why mental health services encountered the following challenges while mental health billing and coding:
- Patients in a medical setting are billed for standard services such as laboratory tests, x-rays, and so on, which are nearly identical for all patients and vary only slightly in terms of time taken.
- Therapy, psychological testing, and medical treatments are all examples of mental health billing services. Insurers have specific rules regarding how they pay for different mental health services, making billing difficult.
- Inpatient psychiatric care requires pre-authorization, which adds to the complexity of mental health billing.
- It is challenging to convince payers that the prescribed treatment is appropriate for the patient. Insurers typically limit the number of sessions that can be billed per day.
Solution: Submission of Accurate Claims
Payment rates for standard behavioral and mental health services are typically lower than those for other specialties. Knowing how to bill for mental health services is critical for obtaining proper reimbursement. The approach can be:
1. Understand the codes and how to use them
Accurate procedure coding is required for proper reimbursement. Mental health coding mistakes can result in late payments or claim rejections. Frequent errors can lead to audits or even fraud and abuse charges, leading to exclusion from managed care networks. To ensure correct and up-to-date procedure codes, physician coding service providers always cross-check CPT codes with the most recent AMA CPT manual. The following are the most used CPT codes by therapists:
Psychiatric Diagnostic Evaluation: 90791
(As per time with the patient and/or family member)
- 90832: 30 minutes for sessions that run between 16 and 37 minutes
- 90834: 45 minutes for sessions that run between 38 and 52 minutes
- 90837: 60 minutes for sessions that run 53 minutes or more
- 90845: Psychoanalysis
- 90846: 50 minutes of family psychotherapy without the patient present
- 90847: 50 minutes of family conjoint psychotherapy with the patient present
- 90849: Multiple-family group psychotherapy
- 90853: Group psychotherapy add-on code
Add-on codes for services can only be provided in conjunction with other diagnostic evaluations, psychotherapy, and group psychotherapy services. Add-on codes identify a component of the treatment that is distinct from the primary service. The billing form should include the primary service and add-on codes. To capture interactive complexity, the codes for interactive psychotherapy were removed and replaced with add-on codes.
Interactive Complexity Add-on Code: 90785
Psychotherapy for Crisis
- 90839: Psychotherapy for the crisis, first 60 minutes
- 90840: Add-on for every additional 30 minutes of psychotherapy for crisis, used with code 90839
Pharmacologic Management Add-on Code
An add-on code that captures medication prescribing and review is Code 90863 and must be billed in conjunction with a code for a psychotherapy service.
Outside of Medicare, 90863, pharmacologic management, including medication prescription and review, can only be used in conjunction with psychotherapy services as an add-on to primary psychotherapy (90832, 90834, 90837).
2. Correctly Use Mental Health CT Code Modifiers
Mental health therapists should use CPT code modifiers to report their license level and those that best describe their services. Examples of Modifiers are:
- Synchronous Telehealth Services: Modifier 95
- Synchronous Telehealth Services [Medicare]: Modifier GT
- Significant, separately identifiable E/M service provided on the same day as the procedure or other service by the same physician: Modifier 25
- Distinct Procedural Service: Modifier 59
- When a provider encounters a patient in crisis: Modifier UT
- Licensed Clinical Social Worker (LCSW): Modifier AJ
- EAP or Employee Assistance Program Visits (EAP): Modifier HJ
- Mental Health Program (MHP): Modifier HE
- Doctorate Level or Clinical Psychologist (Ph.D. or PsyD): Modifier AH
- Psychiatrist (MD): Modifier AF
Need for Outsourcing!
The mental health billing process includes completing an intake assessment that covers all the information needed to manage the patient’s psychological billing during the care process for insurance reimbursement. The documentation must also show that the care is medically reasonable and necessary. Before services are provided, you must verify insurance benefits to ensure that the patient has active coverage with the insurance company. This can be complicated as covered benefits differ between providers and insurance plans.
With all the complexities involved, it’s clear that expert assistance would make mental health billing and coding much more manageable. Hiring a mental health billing outsourcing company such as 24/7 Medical Billing Services is a practical option to reduce the risk of denials and optimize reimbursement. At the same time, you focus on providing the psychological care your patients require.