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Mental Health Billing Services (MHBS) codes the combined medication-management-and-psychotherapy visits. E/M level by medical diagnosis or time, plus the psychotherapy add-on (90833, 90836, 90838) for the documented therapy minutes, with modifier 25 where the payer wants it. Then we send each component to the payer responsible for it, since on most plans the E/M and the add-on do not go to the same place. We bill telepsychiatry, TMS, esketamine, ECT, and long-acting injectables to their own rules. Our team makes sure charge capture is safe without losing anything on every visit.
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Psychiatry-trained coders review every combined visit for missed add-ons
Telepsychiatry POS and modifier discipline (POS 10, modifiers 95/93/FQ)
Procedural billing: TMS, esketamine/Spravato, ECT, long-acting injectables
HIPAA and 42 CFR Part 2 compliant workflow
Psychiatry medical billing is the coding and claim submission process for prescriber-led mental health care. Unlike therapy-only billing, it combines evaluation and management (E/M) coding for medication management with psychotherapy add-on codes (90833, 90836, 90838) when therapy happens in the same visit, plus the psychiatric diagnostic evaluation (90792), telepsychiatry modifiers, and procedural codes for TMS, esketamine, ECT, and long-acting injectables. Each component may route to a different payer or behavioral health carve-out.
Psychiatrists routinely manage medication and provide psychotherapy in a single encounter. That is two billable services: the E/M for the medical work and a time-based psychotherapy add-on for the therapy. Bill the E/M alone and the therapy goes unpaid. Bill only the therapy and the medical work is under-coded. This is the largest source of silent revenue loss in psychiatry, because nothing denies the money just never shows up on the remittance.
We confirm the routing per payer and send each component where it adjudicates, which is the difference between one clean claim and a denial that has to be reworked.
The psychiatry billing problems include situations in which the claim pays, the remittance looks normal, and the money that should have been there simply isn’t.
A psychiatrist spends 20 to 30 minutes on therapy inside a medication-management visit, then bills only the E/M. The add-on (90833, 90836, or 90838) goes uncaptured. Nothing denies and no alert fires, so the loss is invisible until someone audits the charge capture. Across a full panel, this is the most expensive miss in psychiatry.
We review combined visits against the documented psychotherapy time, add the correct time-band add-on, and apply modifier 25 on the E/M where the payer requires it.
Under the 2021 guidelines, office E/M levels by medical decision-making or total time. A psychiatry visit managing several medications, real comorbidity, and a controlled substance often supports 99214 or 99215, but it defaults to 99213 out of habit. One level down on thousands of visits a year is a large number nobody decided to give away.
We level each E/M to what the note documents, by MDM or time, and flag visits whose documentation supports a higher level than was selected, without pushing past what the record actually shows.
Many practices still use POS 02 for home sessions, miss audio-only modifiers, or rely on outdated telehealth flexibilities. Medicare behavioral health telehealth is permanent, but POS and modifier rules must be correct to avoid underpaid home visits and denied audio-only claims.
We bill POS 10 for home telehealth at the non-facility rate, modifier 95 for audio-video, and the correct audio-only modifier per payer, with the patient's location and modality documented on every encounter.
TMS (90867/90868/90869), esketamine REMS, ECT (90870), and injectable buy-and-bill each have their own coding, observation, and reimbursement-timing rules. If billed like a standard visit, they can deny or underpay; with buy-and-bill, the practice has already paid for the drug, so the loss is acquisition cost, not just a service fee.
We bill each procedural line to its own rule set, pair J-codes with 96372 administration for injectables, and track REMS observation and prior authorization so the drug spend comes back.
The work (deep credentialing, eligibility, and denial methodology) spans the whole psychiatric claim, organized by the phase where revenue is worth to claim or not.
We review every encounter for the correct E/M level by MDM or time, missed psychotherapy add-ons, interactive complexity (90785), and prolonged-service eligibility. When a note supports a higher level than the clinician selected, we flag it back rather than letting the under-coded charge go out.
We pair the E/M with 90833, 90836, or 90838 by documented therapy minutes, apply modifier 25 per payer, and code standalone psychotherapy (90832–90837) or crisis psychotherapy (90839, 90840) where those apply instead. The add-on always rides with its primary E/M, never alone.
We handle POS 10 and POS 02 selection, modifier 95, 93, and FQ discipline, and the documentation of location and modality on every claim, aligned to the current rules that make behavioral health telehealth permanent under Medicare rather than the expired pandemic flexibilities.
We bill TMS (90867/90868/90869), esketamine/Spravato REMS administration, ECT (90870), and long-acting injectables with the J-code plus 96372, and we manage the prior authorization and reimbursement timing that decide whether buy-and-bill drug spend comes back whole.
We identify the medical-versus-carve-out routing per payer (Optum, Carelon, Evernorth, Magellan), scrub claims before submission, and send clean claims to the entity that adjudicates each component, which is where psychiatry’s split-billing denials start.
We work aging AR to resolve and rework denials, including MHPAEA parity appeals, then feed the cause back to charge capture so it stops recurring. The full denial methodology lives on our denial management service page.
A solo or small psychiatry practice rarely needs a full-time in-house biller. Almost never finds one who already knows combined-visit coding, telepsychiatry rules, and TMS or esketamine billing at the same time. Outsourcing trades a fixed salary, benefits, and turnover risk for a percentage of collections that moves with the practice. It also scales: adding a prescriber or standing up an esketamine line does not mean hiring and training again. When a new psychiatrist comes on, the same team hands off to credentialing and enrollment and eligibility verification so billing and onboarding move together instead of in sequence.
Psychiatry billing rewards coders who understand the encounter, not just the code list. Here is how the pieces fit, and where the documentation has to back them up.
The E/M is the primary code and the psychotherapy add-on is secondary. They measure different work, and the therapy time is counted separately from the time spent on medication management and medical decision-making. The add-on bands are fixed ranges: 90833 for 16 to 37 minutes, 90836 for 38 to 52, 90838 for 53 or more. Only prescribers (MD, DO, PMHNP, PA) bill E/M codes, so only they bill these add-ons.
The 2021 office E/M guidelines level the visit by medical decision-making or by total time on the date of service, whichever the documentation supports. Psychiatry drives MDM higher than people expect: multiple chronic conditions under active management, controlled-substance decisions, and a documented suicidality risk assessment all raise the complexity. Coding to that complexity is the difference between a 99213 and the 99214 the visit actually was.
Psychiatrists bill 90792, the diagnostic evaluation with medical services, because the intake includes the medical and prescribing assessment. 90791 is the evaluation without medical services, used by non-prescribers such as therapists and psychologists. The two are a frequent and costly mix-up; billing 90791 for a psychiatrist’s intake under-codes the work and misstates who performed it.
Crisis psychotherapy bills 90839 for the first 60 minutes, with a 30 to 74 minute range, and 90840 for each additional 30 minutes. Interactive complexity, 90785, is an add-on for the communication difficulties that complicate some sessions, appended to an eval or a psychotherapy code when the criteria are met. Neither is a throwaway; both depend on documentation that shows the criteria were present.
G2211 is a Medicare add-on that recognizes the complexity of ongoing, relationship-based care, which fits psychiatry’s longitudinal medication management well. It is Medicare-specific. Commercial and Medicaid coverage varies, and some payers are discontinuing it in 2026, so it is billed where it is recognized and never assumed to pay everywhere.
TMS bills 90867 for initial treatment planning, 90868 for each subsequent delivery, and 90869 for re-planning. ECT bills 90870. Long-acting injectables bill the drug’s J-code plus 96372 for administration. Esketamine is administered under a REMS program with a required observation period. Across the procedural lines, the recurring risk is buy-and-bill: the practice purchases the drug up front, so prior authorization and reimbursement timing decide whether that acquisition cost comes back.
A generalist biller can process a psychiatry claim. The question is whether they catch what makes psychiatry pay, line by line.
Psychotherapy add-on capture
Parity (MHPAEA)
E/M leveling
Carve-out routing
Telepsychiatry rules
Procedural billing (TMS/esketamine/ECT/LAIs)
Modifier 25 discipline
Pricing model
We bill psychiatry in all 50 states, and multi-state telepsychiatry makes the state layer part of daily work. Medicaid behavioral health runs through different programs and modifier schemes in each state, controlled-substance and PDMP rules vary, and licensure follows the patient’s location. The 18 states below carry the most psychiatry volume, each with one program and one nuance worth naming.
The split-billing problem defines psychiatry payer work: the medication-management E/M adjudicates on the medical side while the psychotherapy add-on routes through the behavioral health carve-out.
Aetna administers behavioral health largely in-house through Aetna Behavioral Health, so the carve-out routing is cleaner than most, but the E/M and the psychotherapy add-on can still adjudicate under different rules within the same plan. The common denial is a modifier 25 mismatch on the combined visit. We confirm Aetna's current modifier 25 policy before submission and bill the combined visit to match it.
Cigna routes behavioral health through Evernorth, so the psychotherapy add-on belongs with Evernorth even when the E/M bills to Cigna medical. Add-on acceptance varies by plan, and a claim built for one entity bounces at the other. We verify add-on acceptance per plan and route each component to the payer that adjudicates it.
With UnitedHealthcare, the psychotherapy benefit sits with Optum through Provider Express even when the medication-management E/M bills to UHC. Submitting the add-on to UHC medical instead of Optum is a standard preventable denial. We enroll with Optum, route the add-on there, and keep the E/M on the medical side where it belongs.
Anthem manages behavioral health clinically through Carelon, formerly Beacon Health Options, while the contract stays with Anthem. That dual structure confuses member IDs and routing, and it is a frequent denial source. We keep the Anthem and Carelon sides straight on enrollment, routing, and authorization so the combined visit lands correctly.
BCBS is 33 independent state plans, and behavioral health routing changes with each. Some run it internally, some carve to Lucet or another vendor. A psychiatry claim that works in one state's Blue plan can be denied in another over routing alone. We treat each Blue plan as its own payer and maintain the per-state routing and prefix logic.
Medicare pays psychiatry E/M directly and recognizes G2211 for longitudinal care. It also makes behavioral health telehealth permanent, with the home as an approved originating site and audio-only cover, which matters for a specialty that runs heavily virtual. We bill the E/M and add-on to Medicare's rules, apply G2211 where appropriate, and code telepsychiatry to the permanent behavioral health policy.
Medicaid behavioral health runs through state programs and managed care organizations, each with its own routing and modifier rules, including state-specific touches like Ohio's U-modifiers on behavioral claims. A psychiatry practice billing across state lines faces a different rulebook in each. We bill to the specific state program and MCO rather than a generic Medicaid template.
Most psychiatry practices losing revenue can’t see exactly where. The audit finds it in under 48 hours, usually in missed add-ons, under-leveled E/M, or procedural underpayment.
They bill two codes. The E/M code covers the medication management, leveled by medical decision-making or total time, and a psychotherapy add-on (90833, 90836, or 90838) covers the separately documented therapy minutes. The add-on is never billed alone; it sits on the same claim as the E/M, and many payers also want modifier 25 on the E/M.
Yes. 90833 is the psychotherapy add-on for 16 to 37 minutes of therapy during the same visit as an E/M service, and 99214 is a common established-patient E/M for medication management. They are billed together when the note documents both the medical work and the separately timed psychotherapy. Many payers also require modifier 25 on the E/M, so confirm the plan's policy.
Often, but it is payer-dependent. Modifier 25 signals a separately identifiable E/M service on the same day as another service. Some payers require it on the E/M when a psychotherapy add-on is also billed; others process the pair without it. Billing it where it is not needed, or omitting it where it is, both cause denials, so the policy has to be checked per payer.
Both are psychiatric diagnostic evaluations. 90792 includes medical services and is the intake code prescribers use, since it covers the medical and prescribing component. 90791 has no medical services and is used by non-prescribers such as therapists and psychologists. Billing 90791 for a psychiatrist's intake under-codes the work and is a frequent error.
Because CPT defines them that way. 90833 covers 16 to 37 minutes of psychotherapy, 90836 covers 38 to 52, and 90838 covers 53 or more. The documented therapy time has to fall inside the band billed, counted separately from the E/M time. Rounding to a tidy number instead of the documented minutes is what triggers time-based coding denials.
Yes, and for behavioral health it is permanent, not a temporary extension. Under the Consolidated Appropriations Acts, Medicare permanently removed geographic and originating-site restrictions for behavioral health telehealth, so the patient's home is an approved originating site, and audio-only behavioral health is covered when the patient cannot use or decline video. A separate rule requires an in-person visit within six months of starting telehealth and annually after.
G2211 is a Medicare HCPCS add-on that recognizes the complexity of ongoing, relationship-based care, which fits psychiatry's longitudinal medication management. It is a Medicare code first. Commercial and Medicaid coverage varies, and some payers are discontinuing it in 2026, so it should never be treated as universally paid.
TMS uses three codes: 90867 for the initial treatment planning, 90868 for each subsequent delivery session, and 90869 for re-planning if the course changes. TMS carries strict medical-necessity and prior-authorization requirements, usually including documentation of failed medication trials, so the authorization has to be in place before the course begins or the sessions deny.
Esketamine is administered in-office under a REMS program, so billing pairs the drug with the in-office observation and administration, with the patient monitored for a set period after dosing. Many practices acquire the drug under buy-and-bill, which puts real acquisition cost at risk if prior authorization and REMS documentation are not in order before administration.
Because the behavioral benefit is often carved out. On many commercial plans the medication-management E/M adjudicates on the medical side while the psychotherapy add-on routes through the behavioral health carve-out, such as Optum, Carelon, or Evernorth. Sending both to one entity triggers preventable denials. The components have to be routed to the payer responsible for each.
MHBS bills on a percentage of collections, with no setup fees, no software fees, and no long-term contract. [VERIFY: pricing model and range] A percentage model means the fee moves with what the practice collects, and every engagement starts with a free billing audit so the practice sees the recoverable revenue before committing.
Yes. Long-acting injectable antipsychotics bill as two lines: the drug's J-code and the administration under 96372. Under buy-and-bill, the practice purchases the drug and carries the cost until the claim pays, so prior authorization, correct J-code units, and reimbursement timing all matter. A denied or underpaid LAI claim means the practice absorbs a real drug cost, not just a service fee.
We support the billing side of it. Controlled-substance prescribing brings PDMP checks, EPCS requirements, and documentation that affects the medical decision-making behind the E/M level. We code to that documentation. The prescribing itself stays with the clinician under their DEA registration; our role is making sure the visit complexity it reflects is captured on the claim.
Yes. We bill inside TherapyNotes, SimplePractice, Valant, and Kareo/Tebra, among others. Nothing migrates, and your clinicians keep the documentation workflow they already use. We work from the encounter as documented, which is also how our coders catch the missed add-ons and under-leveled visits that direct EHR auto-submission lets through.
Our free audit identifies it in under 48 hours: we review your denials, your payer mix, your carve-out routing, and your AR, then tell you exactly where the revenue is leaking and what it would take to recover it.
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