Psychiatric NP billing services for practices that mix medication management with psychotherapy, route claims through behavioral carve-outs, and can't afford a biller who's still learning the codes.
Psychiatric coding isn't harder than other specialties it just runs on a different rulebook, and most billing teams have never opened it.
Bill under the NP's own NPI and Medicare pays 85% of the physician fee schedule. Bill incident-to a supervising physician and it pays in full but only when every condition is actually met. Get it wrong and you're either underbilling or carrying a compliance risk.
A patient's medical plan and their behavioral health benefit are often managed by two different companies entirely Optum, Carelon, Magellan. Verify the wrong one and the claim goes to the wrong place before it's even denied.
A PMHNP visit is rarely just a med check. When therapy happens in the same appointment, it needs an E/M code plus a time-documented psychotherapy add-on miss the add-on and half the visit goes unpaid; get the combination wrong and the whole claim denies.
None of these are exotic. They're the everyday gaps that quietly add up over a year and every one is preventable.
An NP starts seeing patients before enrollment is complete with every payer, and those early claims deny or sit for reprocessing.
Claims billed under a physician when supervision requirements weren't met or billed at 85% when the visit could have qualified for the full rate.
Psychotherapy codes are time based. A note without the minutes gives the payer an easy, automatic reason to deny.
The psychotherapy add-on that belongs with a medication management visit gets left off — the practice collects for half the appointment.
Long-acting injectables, esketamine, and TMS commonly require authorization. Miss one and the service simply isn't paid.
The wrong place-of-service code or a missing modifier turns a covered psychiatric telehealth visit into a denial.
Claims sent to the medical plan instead of the behavioral health payer bounce back and delay payment for weeks.
From the moment an appointment is scheduled to the day the last dollar is collected one team, not a rotating cast relearning psychiatric coding each time.
We confirm eligibility and benefits, check whether behavioral health is carved out, and verify the NP is credentialed with the responsible payer.
Coders review the documentation, assign codes that reflect what actually happened in the room, and claims go out scrubbed and clean.
Denials get worked to resolution, payments are posted and reconciled, balances are pursued, and you get plain reporting on where your money is.
Our coders work with the psychiatric code set daily — evaluations, therapy, add-ons, and the diagnosis specificity payers expect.
Diagnostic evaluation — without or with medical services. 90792 is usually correct for a PMHNP's initial evaluation.
Psychotherapy — roughly 30, 45, and 60 minutes of therapy.
Psychotherapy add-ons billed with an E/M service for blended medication + therapy visits.
Evaluation & management new and established patients, by decision-making or time.
Crisis psychotherapy — first hour and each additional block.
Family & group therapy — family sessions and group therapy.
Interactive complexity — added when a third party or communication barrier complicates the session.
Diagnosis coding matters just as much: F32/F33, F41, F31, F20, and F90 need the specificity payers expect unspecified codes are a common denial trigger. Modifiers matter too, including 95 for synchronous telehealth and 25 when a separate service justifies it.
A clean claim pays the first time. When one doesn't, we work it until it's resolved not rebilled blindly.
Every claim is scrubbed against edits built for psychiatric billing code pairings, modifiers, matching diagnoses, place-of-service, and completed authorizations before it ever reaches a payer.
Every denial gets a root cause review credentialing, documentation, coding, or authorization — then correction, appeal with supporting notes, and follow-up until it's resolved.
Remittances and EOBs are posted and reconciled, contractual adjustments applied correctly, and underpayments caught against the fee schedule and pursued.
Aging reports are worked by payer and by bucket so claims move not settle into the 90- and 120-day columns where recovery gets hard.
Substance use records fall under 42 CFR Part 2, with confidentiality protections stricter than HIPAA — we bill with those constraints in mind from the start.
We're not here to tell clinicians how to practice. We help tighten what matters for the claim: documented psychotherapy time, medical decision making that supports the E/M level, incident-to detail, and medical necessity.
We bill inside the platforms behavioral health practices already use, and connect to your clearinghouse without disrupting your workflow.
Faster, cleaner credentialing — NPs bill sooner and lose fewer early claims.
Fewer denials — claims are coded correctly and scrubbed before they go out.
Full capture of blended visits — therapy add-ons and medication management both get billed.
More predictable cash flow — follow-up happens consistently, not sporadically.
Lower overhead no hiring, training, or retaining an in-house specialty biller.
Clinician time back spent on patients, not claims and appeals.
When it genuinely qualifies. Incident-to requires that a physician established the plan of care, the visit addresses an existing problem, and a physician is present in the office suite, among other conditions. We review each encounter and bill incident-to only where it's appropriate — never as a default.
As a blended visit: an E/M service plus a psychotherapy add-on (90833, 90836, or 90838), with therapy time documented. Many practices bill only the medication piece and lose the therapy revenue entirely we make sure both parts are captured.
Yes. We handle enrollment and credentialing, including CAQH setup and payer applications, and track effective dates so claims aren't submitted before the NP is active with a plan.
We do, with the correct place-of-service code and modifier for each visit, including audio-only options. Most telehealth denials come down to exactly these two details.
Most often it's missing psychotherapy time, diagnosis codes that aren't specific enough, or unmet incident-to requirements. We trace the pattern behind your denials and fix it at the source.
During benefit verification we confirm whether services route to the medical plan or a behavioral health payer like Optum, Carelon, or Magellan, then submit to the correct one with the right credentialing and authorizations.
We track which services need authorization — long-acting injectables, esketamine, TMS — obtain it before the service, and keep it on file so the claim isn't denied for a missing auth.
Onboarding connects your practice management system, transfers open AR, and confirms payer enrollments. Cleaner claims and faster payments typically show within the first few billing cycles, with older AR improving as we work through the backlog.
We'll show you exactly where revenue is being lost and what it would take to recover it — no changes made until you've seen the specifics.