A therapist documents a 50-minute session, bills a full hour, and the claim comes back denied for a missing start and stop time. It happens every week in counseling practices nationwide and it's exactly the kind of gap this service exists to close.
No documented start/stop time. Payer downcodes to 90834 or denies outright.
Note supports the time billed. Claim clears on the first pass.
The difference is almost always in the note, not the code.
A dermatology claim and a psychotherapy claim carry the same basic parts a CPT code, a diagnosis, a provider number. Underneath, behavioral health runs on rules that trip up billers who learned the trade in primary care or surgery.
Commercial plans often route mental health benefits to a separate managed behavioral health vendor Optum, Carelon, Magellan with its own portal and fee schedule. Verify the medical plan alone, and a month of sessions can bill to the wrong entity.
90832 covers ~30 minutes, 90834 ~45, and 90837 an hour or more. Because 90837 pays more, payers watch how often it's billed the note has to reflect actual time, not a rounded habit.
Panels for LCSWs, LPCs, and LMFTs close often and enrollment runs long. Reimbursement varies by license type Medicare pays LMFTs and counselors at 75% of the physician fee schedule as of Jan 1, 2024.
A video visit from home generally uses POS 10, elsewhere 02. Modifier 95 signals synchronous audio-video, 93 flags audio-only. Miss one and a clean claim gets kicked back.
Across the practices we take on, the same issues surface no matter the size of the group. Any one on its own is manageable stacked across a full roster, they turn into a receivable that quietly grows while the schedule stays full.
Every new client goes through eligibility and benefits verification that checks the actual behavioral health plan, not just the medical card: copay, deductible, coinsurance, visit limits, and whether an authorization is needed to begin.
When a plan requires prior authorization, we request it and track the approved units so the practice doesn't run past them without noticing. From there, the work moves through coding review, claim submission, payment posting, denial handling, and A/R follow-up.
Behavioral health plan verified, not just the medical card.
Approved units tracked so the practice never runs past them.
We keep the money moving in the background.
Accurate coding is where behavioral health claims are won or lost. We work daily across the code sets counseling practices use most.
90791 without medical services, 90792 when a prescriber performs it with medical services.
Chosen by documented session length never by the higher-paying option.
90847 with the patient present, 90846 without both timed sessions.
Billed per patient in the group.
90839 for the first 60 minutes, add-on 90840 for each additional 30.
90785 is commonly missed and just as commonly misapplied we tie it to the note.
Each stage feeds the next. A claim doesn't stall because no one owns the next step.
Every claim is scrubbed against code combinations, modifiers, place of service, and diagnosis linkage before it leaves. We confirm clearinghouse acceptance rather than assume it.
Denials get worked, not filed away. We read the remittance, fix the real reason, and track denials by payer so patterns become visible and actionable.
Payments are posted from ERA/EOB and reconciled against the actual contracted rate which is how underpayments get caught and disputed.
Aging claims are worked by age and by payer, ahead of the filing deadline not whenever someone gets to it.
Typical timely-filing window for commercial plans. A claim that slips past it is usually money gone for good.
Filing window Medicare generally allows the A/R follow-up schedule is built around each payer's actual date.
Records tied to substance use disorder treatment fall under 42 CFR Part 2, which limits how that information can be disclosed including for billing without specific consent. We handle protected information accordingly and keep billing communication within those limits.
We don't write clinical notes, and we don't code services the documentation doesn't support. When a payer audits or requests records, we help assemble and submit the response.
Most counseling practices run on a behavioral-health-specific EHR. We work inside the systems providers already use.
Verification, submission, and follow-up stop being an after-hours task.
Instead of piling up until someone has time, shortening the gap between service and payment.
Carve-outs, authorizations, and filing deadlines fewer claims fall through avoidable cracks.
What was billed, what was paid, what's outstanding instead of a vague sense that collections feel low.
We work in behavioral health billing specifically, not as one line item inside a general medical billing shop. That focus is the reason we know a therapy claim routes to a carve-out before it denies, why an associate's claims need a particular setup, and how a given payer treats 90837.
General billers learn these lessons one denial at a time. We already know where the traps are, because behavioral health is the work, day in and day out. Practices reach real people who can explain a denial, walk through a payer issue, and give a straight answer about where a claim stands.
If your claims are aging, your denials are stacking up, or you're spending clinical energy on payer portals, a short conversation is the fastest way to see whether we can help.