Psychology billing services
Your notes are fine. The claim is where the money goes missing.
We bill for psychologists, therapists and counselors only. Carve-out routing, session-time coding, testing authorizations, and denial appeals handled by people who work the 908xx and 961xx code families every day.
Private practices · Group practices · Clinics · Hospital outpatient behavioral health
The authorized visit count ran out. Same-day services were read as a duplicate. And the testing claim went to the medical payer when the behavioral health benefit was carved out. Three fixable problems, one line item paid.
The problem
Small claims, large leaks
Psychology practices lose money in ways that would never happen in cardiology or orthopedics. A therapist can see a full panel, document every session, submit every claim on time, and still watch a quarter of the revenue sit unpaid ninety days later.
The reasons are rarely dramatic. A claim went to the medical payer when the behavioral health benefit was carved out to Optum. A 90837 was downcoded because the note recorded a session length of "about an hour" instead of start and stop times. A new associate saw eighteen patients before her credentialing file cleared, and every one of those claims came back with a CO-B7.
Our psychology billing services exist for that specific set of problems. We handle claims, denials, posting and follow-up for psychologists, therapists, counselors and the practices that employ them. Nothing here is general medical billing repackaged for behavioral health.
Who needs this
Built for practices where the claims are small and constant
A psychology practice might submit 400 claims a month averaging $120 each. There is no single high-dollar claim worth chasing for three hours, which is exactly why unworked denials quietly become write-offs.
Solo and small practices
Clinicians billing four or five payers between sessions, with no admin staff and no time to sit in a payer phone queue.
Group practices
Multiple clinicians, multiple license types, often multiple states. Credentialing and payer routing get complicated fast.
Clinics and CMHCs
Individual therapy, group programs and psychological testing running under one tax ID with different authorization rules for each.
Hospital outpatient behavioral health
Departments where professional claims get lost behind facility billing and nobody owns the follow-up.
Integrated primary care
Physician groups that added a psychologist and found their E/M front-desk workflow does not fit time-based therapy codes.
Telehealth-first organizations
Practices billing across state lines where place of service and modifier rules change by payer and by date of service.
Why billing is different here
Three structural facts separate psychology from the rest of outpatient medicine
The clock is the claim
CPT ties 90832 to 16–37 minutes, 90834 to 38–52 minutes, and 90837 to 53 minutes or more. A missing time entry is not a documentation nitpick. It removes the basis for the code you billed.
Carve-outs change everything
UnitedHealthcare routes behavioral health through Optum. Cigna routes through Evernorth. Blue plans and Medicaid managed care often sit with Carelon or Magellan. Same card, different payer ID, different portal, different filing window. Bill the address on the card and you get CO-109.
Payers watch this specialty closely
Extended psychotherapy, repeat diagnostic evaluations and testing batteries all draw review. Commercial plans have audited providers whose 90837 use runs well above peer averages. That is manageable, but only if coding and documentation were built to survive it.
Common billing challenges
What actually shows up on your remittance
Every item below produces a denial we see weekly in psychology and counseling practices.
Session length and the midpoint rule
Notes that say "50-minute session" for a 52-minute appointment invite downcoding. Notes without start and stop times invite recoupment. The fix is a documentation habit, not an appeal strategy.
Same-day service combinations
Family psychotherapy with the patient present billed the same day as individual therapy will bounce as a duplicate or bundle unless the payer's policy allows it, with separate documentation. Interactive complexity is an add-on to diagnostic evaluation, individual psychotherapy and group psychotherapy, but not to family psychotherapy or crisis codes. Getting that wrong produces a CO-97 every time.
Testing units and authorization
The 2019 overhaul retired the old 96101 and 96118 families. Evaluation services now bill in one-hour increments, administration and scoring in 30-minute increments, and the first-hour code must be reported before any add-on. Most commercial payers require prior authorization naming the referral question and planned instruments.
Authorization that expires quietly
Routine outpatient therapy is often authorization-free for an initial block of visits, then moves to concurrent review. Testing, intensive outpatient and ABA almost always need approval up front. Most authorization denials in this specialty trace back to a visit count running out, not to a missing initial approval.
Credentialing gaps
Behavioral health panels close and reopen without notice, and CAQH profiles need re-attestation roughly every 120 days. Medicare allows retroactive billing for a limited window after the effective date; commercial payers usually do not. One unenrolled clinician can create five figures of unbillable charges in a month.
Diagnosis codes payers accept
Relational and social Z codes are not covered as a primary diagnosis by most plans, which produces PR-204 and an awkward patient conversation. ICD-10 also keeps moving: F32.A arrived in the FY2022 update, and practices still submitting habitual old codes get rejected at the clearinghouse.
Telehealth details
Place of service 10 for the patient's home and 02 for other originating sites carry different rates. Modifier 95 covers audio-video, 93 covers audio-only for many commercial plans, and Medicare uses FQ for audio-only behavioral health. Medicare's in-person requirement tied to tele-mental health has been delayed repeatedly by Congress, so the correct answer depends on date of service rather than a policy memo from two years ago.
How our services work
The full cycle, or the part of it you want covered
This is the order the work happens in for a typical practice.
Specialty coding review
Before a claim goes out we check that the code matches documented time, that add-ons are attached to eligible base codes, that the diagnosis supports the service, and that license-specific modifiers are present where the payer or state Medicaid program requires them. For prescribing clinicians in integrated settings we handle E/M plus psychotherapy add-on pairs such as 99213 with 90833, and the modifier 25 questions that come with them. We also flag patterns that create audit exposure and explain what documentation would need to support them.
Eligibility and claim submission
Claims go out on an 837P file, usually within 24 to 48 hours of receiving charges. Eligibility runs through 270/271 transactions before the appointment where the schedule allows it, which catches terminated coverage and carve-out routing before a session happens rather than six weeks after. Scrubbing rules are built per payer, because the plan that wants the rendering NPI in loop 2310B and the plan that wants a taxonomy code are not the same plan.
Denial management and appeals
Every denial gets categorized and worked, not just the large ones. Missing-information and authorization denials go to the team that can fix the underlying data. Medical necessity denials get an appeal with the treatment plan, progress notes and a written argument tied to the payer's own coverage policy. Deadlines in behavioral health are frequently shorter than on the medical side, with some plans allowing 90 days from remit for a first-level appeal.
Payment posting
We post from 835 electronic remittances and from paper EOBs, line by line. Contractual adjustments are checked against your loaded fee schedules, so underpayments surface instead of disappearing into the write-off column. Patient responsibility is calculated correctly for deductible-heavy plans, which matters when the same patient returns weekly and small errors compound.
Accounts receivable follow-up
Aging is worked in buckets on a written cadence. Claims at 30 days get a status check, claims at 45 get a call or portal inquiry with a documented reference number, and anything approaching timely filing gets escalated. You receive an aging report with payer-level detail rather than a single total.
Compliance and documentation support
We review documentation against what payers audit: start and stop times, medical necessity, treatment plan goals and updates, risk assessment where indicated, and telehealth consent. We keep the distinction between progress notes and psychotherapy notes clear, since psychotherapy notes under 45 CFR 164.501 are separately protected and are not the billing record. Practices treating substance use disorders also need 42 CFR Part 2 handling, which carries its own consent rules. For clinicians participating in MIPS we track measure reporting so the payment adjustment is not a surprise.
Working inside your software
We work in your system rather than asking you to change it: SimplePractice, TherapyNotes, TheraNest, Valant, Tebra, AdvancedMD, athenahealth, Netsmart, Qualifacts, Epic and eClinicalWorks, with clearinghouses including Availity, Office Ally and Waystar. If your EHR handles scheduling and notes but not billing well, we run the claim side externally and reconcile against your schedule.
Benefits of outsourcing
What changes in the first two quarters
- Clean claim rates improve because scrubbing rules are written per payer and updated when policies change
- Days in A/R drop when follow-up happens on a schedule instead of when someone finds time
- Denials get appealed rather than adjusted off, which recovers revenue most small practices never see
- Clinicians stop spending evenings on hold with payer call centers
- Credentialing and carve-out routing get tracked by people who do it full time
- Per-payer reimbursement reporting gives you real numbers to take into contract negotiations
Outsourcing does not remove your responsibility for documentation or clinical decisions. It removes the administrative load around them.
Why providers choose us
Behavioral health is all we bill
That focus is the reason we know Optum and UnitedHealthcare are functionally different payers, that testing authorizations need the referral question spelled out, and that a licensed counselor in one state may bill under a modifier another state's Medicaid program does not recognize.
Practices also stay because of how we communicate. You get a named contact, not a ticket queue. Reports arrive on a set schedule with denial reasons explained in plain terms. If something in your documentation is going to cause a problem with a payer, we tell you before the claim goes out.
Who we work with
Practices across the country
We provide psychology billing services in USA markets nationwide, including practices billing multiple state Medicaid programs and managed care organizations.
Frequently asked questions
Questions we get from practice owners
Why does one payer pay 90837 without question while another downcodes it to 90834?
Can we bill individual and family therapy for the same patient on the same day?
How do you handle behavioral health carve-outs?
We do psychological testing. How is that billed now?
What happens to claims for a clinician who is still being credentialed?
Do you process employee assistance program sessions?
Which telehealth modifiers and place of service codes do you use?
How do you handle patient balances in a weekly therapy practice?
Talk to us
Send a recent aging report. We'll tell you what's recoverable.
If your A/R over 90 days is climbing, if denials are being adjusted off because nobody has time to appeal them, or if you are adding clinicians faster than your process can credential them, the numbers will show where the money is going.
- A read on your current denial mix, by reason code
- Which aged claims are still inside appeal and filing windows
- A straight answer on what would change, and what would not
Start a claims review
Share an aging report and a sample of denied claims. We walk through what we find, no obligation attached to the conversation.
