Talk to an Expert
Federal enforcement of the 2024 MHPAEA Final Rule is paused but mental health parity law is not. MHPAEA’s statutory requirements enacted in 2008, the 2013 final rule, and the Consolidated Appropriations Act, 2021 (CAA) comparative-analysis mandate all remain fully enforceable. And where federal agencies stepped back, state regulators have stepped in: in April 2026, Connecticut fined all five of its major insurers for parity violations, and Nevada’s Division of Insurance has flagged at least 16 carriers.
For behavioral health providers, the practical stakes have never been higher. Behavioral health claims are still denied at far higher rates than comparable medical claims, and parity arguments, backed by comparative analyses and state enforcement findings are now the strongest ground for overturning those insurance claim denials.
This guide covers what actually changed in 2026, which parity obligations remain enforceable, how Connecticut and Nevada rewrote the enforcement playbook, and the exact steps to build parity into your appeals, documentation, and payer strategy.
The Trump Administration announced in May of 2025 that it would delay enforcement of certain provisions of the 2024 Final Rule until such time as the Agencies completed their review of the rule. On March 30, 2026, the Agencies informed a Federal District Court that they intended to publish a new proposed MHPAEA regulation by December 31, 2026, instead of defending the 2024 rule in the ERIC lawsuit. However, the non-enforcement policy is still in place until either final litigation has concluded or eighteen (18) months have passed, whichever comes later.
Nevertheless, several critical protections remain fully enforceable:
No not at the federal level. Since May 15, 2025, the Departments of Labor, Health and Human Services, and the Treasury have applied a non-enforcement policy to the provisions of the 2024 Final Rule that are new relative to the 2013 rule including the provisions that would have applied to 2025 and 2026 plan years. The policy remains in effect until the litigation challenging the rule concludes, plus an additional 18 months.
The pause followed the ERISA Industry Committee’s (ERIC) January 2025 lawsuit challenging the rule in the U.S. District Court for the District of Columbia. Rather than defend the 2024 rule as written, the Departments have told the court they are reconsidering it and have signaled their intent to publish a new proposed MHPAEA regulation. Until that rulemaking lands, providers are operating under the pre-2024 framework which is far from toothless.
The non-enforcement policy suspends the new provisions of the 2024 Final Rule — it does not suspend mental health parity law. Fully enforceable today:
On September 9, 2024, the Departments of Labor, Health and Human Services, and the Treasury issued a final rule updating the MHPAEA regulations. Most provisions applied to plan years beginning on or after January 1, 2025. Three of the most consequential provisions carried a later date — plan years beginning on or after January 1, 2026 — and all of the new provisions are now covered by the federal non-enforcement policy described above. They still matter: they preview where regulation is heading, and several states are enforcing equivalent standards under their own laws.
The four provisions with the greatest impact on behavioral health providers:
If a plan covers a mental health condition or substance use disorder in any classification, it must provide meaningful benefits — including coverage of a core treatment — for that condition in every classification where it provides meaningful medical/surgical benefits.
Plans may not design nonquantitative treatment limitations (NQTLs) using information, evidence, sources, or standards that systematically disfavor access to MH/SUD benefits compared with medical/surgical benefits.
Plans must collect and evaluate outcomes data to determine whether their NQTLs contribute to material differences in access between MH/SUD and medical/surgical benefits and take reasonable steps to address material differences they find.
Detailed required elements and response timeframes for the NQTL comparative analyses that the CAA 2021 already requires plans to perform and document.
Quantitative treatment limitations (QTLs) are numerical limits — visit caps, day limits, copays, coinsurance. Nonquantitative treatment limitations (NQTLs) are non-numerical restrictions on the scope or duration of benefits: prior authorization, concurrent review, step therapy, medical-necessity criteria, network admission standards, and reimbursement-rate methodologies.
Nearly every behavioral health denial worth appealing involves an NQTL. Parity law requires that the processes, strategies, evidentiary standards, and other factors a plan uses to apply an NQTL to MH/SUD benefits be comparable to — and applied no more stringently than those it uses for medical/surgical benefits in the same classification. That comparability requirement is the legal hook for every appeal strategy in this guide.
MHPAEA applies to most but not all of the coverage behavioral health practices bill: employer group health plans (both insured and self-funded), individual-market plans, Medicaid managed care organizations (MCOs), CHIP, and Medicaid Alternative Benefit Plans. Retiree-only plans are exempt, and narrow small-employer exceptions exist. The CAA, 2023 also sunset new opt-out elections for self-funded non-federal governmental plans, pulling more public-employee plans into parity.
The distinction that matters most in practice is who enforces — because it determines where your parity complaint goes:
Filing a parity complaint with the wrong regulator wastes months. Confirm the plan’s funding status ask the plan directly, or check the patient’s Summary Plan Description before you escalate. Our eligibility verification team confirms funding status and behavioral health carve-out routing at intake
With federal enforcement paused, state insurance regulators are now the primary parity enforcers and 2026 produced the first major actions. Connecticut fined all five of its major insurers following its April 2026 NQTL Annual Report, and Nevada’s Division of Insurance flagged at least 16 carriers for likely parity violations, with carrier-specific examinations to follow. Both states built their cases on the insurers’ own data submissions which means the findings are ready-made evidence for your appeals.
On April 15, 2026, the Connecticut Insurance Department released its Nonquantitative Treatment Limitation (NQTL) Annual Report and announced fines against all five major insurers operating in the state — Aetna, Anthem, Cigna, ConnectiCare, and UnitedHealthcare — under Connecticut’s strengthened parity law (SB 10), which raised the maximum penalty forty-fold, from $15,000 to $625,000 per insurer per year. Penalty amounts will be finalized through the department’s administrative enforcement process, weighted by the nature, severity, and duration of each violation.
The findings came from the insurers’ own submissions:
All five insurers were found to have non-comparable, inadequate MH/SUD networks driven by more stringent reimbursement-rate structures the “ghost network” problem, documented by a regulator, in writing.
Nevada’s Division of Insurance, in a report dated December 31, 2025, identified likely parity violations across at least 16 carriers the first time the state named non-compliant insurers publicly. Insurer groups cited for violations or areas of concern include UnitedHealthcare, Aetna, Elevance Health, Cigna, Centene, Molina Healthcare, Select Health, Prominence, and Renown Health. Regulators documented higher out-of-network denial rates and lower reimbursement for MH/SUD services, and more frequent prior authorization: one insurer required prior authorization for 5% of medical/surgical benefits but 22% of MH/SUD benefits.
Nevada has not yet imposed fines carrier-specific market-conduct examinations come next but the report already recommends that carriers reprocess incorrectly handled claims and compensate consumers for losses.
Connecticut and Nevada are not outliers. Georgia’s insurance office has ordered roughly $25 million in parity-related penalties and payments, California’s SB 855 codified generally accepted standards of care into state law, and HHS has expressly encouraged states the primary MHPAEA enforcers for fully insured coverage to act. Monitor your own state insurance department’s parity reporting: a state NQTL report naming your payers is ready-made evidence for appeals and formal complaints.
Parity Violations Become the Most Common Ground for Appealing Denials
BH claims are denied at approximately twice the rate of medical claims. Initial denials range from 15% to 25%. This is because BH services are subject to more stringent utilization management techniques than medical/surgical services.
Common parity violations affecting BH providers include:
Since January 1, 2026 insurers must disclose the specific NQTL criteria used to deny BH treatment upon written request. Request the NQTL comparative analysis before writing an appeal. When you receive the comparative analysis from the insurer show a material difference in how the limitation was applied to BH services vs. medical/surgical services, cite it verbatim in your appeal.
Insurers are intensifying documentation reviews for BH claims. Psychotherapy beyond eight-to-twelve sessions continues to be scrutinized more closely than other types of BH claims. Insurers expect you to provide documentation supporting your BH patient’s:
Additionally, as you submit requests for prior authorization for higher levels of care (e.g., residential SUD treatment or in-patient psychiatric hospitalization), you must provide clinical summaries detailing your patient’s diagnosis(es), risk assessment(s), medication regimen(s), and measurable medical necessity criteria.
To support your appeals, you should also:
Model request language:
“Pursuant to the Mental Health Parity and Addiction Equity Act, as amended by Section 203 of Division BB of the Consolidated Appropriations Act, 2021, we request the comparative analysis performed for the nonquantitative treatment limitation applied to the above-referenced claim — specifically [name the NQTL] — including the factors, evidentiary standards, and processes used, and a demonstration that this limitation is applied to mental health and substance use disorder benefits no more stringently than to medical/surgical benefits in the same classification.”
BH appeals route differently than medical appeals at most large payers. Submitting appeals to incorrect addresses may cost you processing time and cause procedural denials.
Appeals for clinical necessity and medical necessity issues go to Evernorth Behavioral Health Central Appeals Unit located at PO Box 188064, Chattanooga TN 37422. Appeal window: 180 days.
Use Provider Express online portal to send appeals. Appeal window: 65 days from the adverse determination. The Wit v UBH injunction extended through 2031 dictates that UBH must utilize generally accepted standards of care rather than more conservative internal guidelines. Use this argument explicitly when citing conflicting internal policies cited by UBH in a denial.
On February 3, 2026, the federal district court in Wit v. United Behavioral Health extended its injunction for five more years — through February 3, 2031 — requiring UBH/Optum to use coverage criteria that accurately reflect generally accepted standards of care (GASC) and applicable state law, rather than more restrictive internal guidelines.
Operationally, this means any UBH/Optum denial that rests on internal criteria stricter than recognized specialty-society standards — ASAM criteria for substance use levels of care, LOCUS/CALOCUS for psychiatric levels of care — is vulnerable. Cite the injunction explicitly in the appeal: UBH is barred from applying guidelines that deviate from generally accepted standards of care.
Determine whether BCBS assigns BH care responsibility to Carelon Behavioral Health, Magellan or manages it themselves. Appeal windows vary depending on affiliate.
Send appeals via Availity or in writing. Appeal window: 180 days. If Aetna’s BH Clinical Policy Bulletin utilizes more restrictive criteria than the corresponding medical CPB ask Aetna to provide NQTL comparative analysis.
As barriers to accessing MH/SUD services decline due to increased transparency resulting from the new parity regulations, demand for these services will likely increase. Therefore, providers interested in expanding their payer network participation should immediately contact area health plans and express interest in becoming part of their respective networks.
The Trump Administration intends to issue a new proposed MHPAEA regulation by December 31, 2026. Providers must stay abreast of federal and state regulatory activity especially as it relates to:
| Item | Details |
| 2024 Final Rule effective date | Plan years beginning on or after January 1, 2026 |
| Meaningful benefits standard | Effective January 1, 2026 |
| Prohibition on discriminatory factors | Effective January 1, 2026 |
| Outcomes data evaluation requirement | Effective January 1, 2026 |
| Non-enforcement policy | In effect for challenged 2024 rule provisions; 2013 rule and CAA requirements remain enforceable |
| Connecticut enforcement action | All five major insurers fined; penalties up to $625,000 annually |
| Nevada enforcement | Violations identified across 9 insurers; market conduct exams and fines possible |
Parity is only useful if someone in your revenue cycle operationalizes it. Mental Health Billing Services (MHBS) builds parity into the billing workflow for behavioral health practices and facilities in all 50 states: our denial management team tracks denial rates, denial reasons, and prior-authorization frequency by payer to build the parity audit trail regulators and appeals both require; our credentialing team closes the network-participation gap the new demand environment is creating; and every appeal we file names the comparable medical/surgical benefit and requests the NQTL comparative analysis.
Start with a free parity-focused denial review we analyze your last 90 days of behavioral health denials for parity-violation appeal grounds and show you exactly which ones to fight. Call (860) 500-1471 or contact us online.
No. Federal agencies paused enforcement of the 2024 Final Rule’s new provisions, but the 2008 statute, the 2013 final rule, and the CAA 2021 comparative-analysis requirement remain fully enforceable — and state regulators in Connecticut and Nevada are actively pursuing insurers for parity violations.
Yes as the patient’s authorized representative in an appeal. Obtain a signed designation, then send a written request to the plan citing the CAA 2021 requirement and naming the specific NQTL. Non-production is itself evidence for a regulator complaint.
QTLs are numerical limits, visit caps, day limits, copays. NQTLs are non-numerical restrictions: prior authorization, medical-necessity criteria, step therapy, network admission standards, and reimbursement methodologies. Most appealable behavioral health denials involve an NQTL.
Connecticut fined all five of its major insurers in April 2026 under SB 10, which authorizes penalties up to $625,000 per insurer per year. Nevada flagged at least 16 carriers in its December 2025 report, with examinations to follow, and Georgia has ordered roughly $25 million in parity-related penalties and payments.
Yes. The 2016 Medicaid parity rule applies MHPAEA standards to Medicaid MCOs, CHIP, and Alternative Benefit Plans, enforced by CMS and state Medicaid agencies. Traditional Medicaid fee-for-service is generally outside MHPAEA’s scope.
In parity appeals, intensive outpatient programs compare to outpatient cardiac or pulmonary rehabilitation; residential SUD treatment compares to skilled nursing facility care; and inpatient psychiatric care compares to inpatient medical/surgical care. Anchoring the analog is step one of every parity argument.
Mental health billing and coding isn’t just about getting paid it’s about translating the work you do every day into standardized language insurers understand. Unlike general medical billing, mental health services involve unique codes, session durations, therapy types, and even time-based reporting.
Whether you’re a solo psychiatrist or managing a multi-provider behavioral health clinic, understanding how to bill accurately can make or break your revenue cycle.
Let’s dive deep and make mental health billing feel less like decoding hieroglyphs and more like second nature.
Who This Guide is for:
The key components of mental billing and coding include:
Let’s break down Current Procedural Terminology (CPT) codes commonly used in mental health. These are the codes that tell the insurer what you did.
For example:
If you’re a psychiatrist managing medications, you’re often using these alongside psychotherapy codes.
A 30-minute follow-up with med management = 99213 + 90833 (30-min therapy add-on)
Psychotherapy Codes – Time-Based and Provider-Specific
The psychotherapy codes include:
| CPT Code | Description | Time Duration |
| 90832 | Individual therapy | 16–37 mins |
| 90834 | Individual therapy | 38–52 mins |
| 90837 | Individual therapy | 53+ mins |
| 90846 | Family therapy (without patient) | Unspecified |
| 90847 | Family therapy (with the patient) | Unspecified |
| 90853 | Group therapy | 1 unit |
Example: A 60-minute therapy session = 90837
Psychiatric Diagnostic Evaluation
These are often used for intake sessions or when a patient is new to your clinic.
Add-on Codes for Medication Management
These are used when therapy is combined with medical checks.
ICD-10 Codes for Mental Health Diagnoses
CPT tells payers what you did, and ICD-10 tells them why. Without the correct ICD-10 codes, you won’t receive payment.
Common ICD-10 Codes
| Diagnosis | ICD-10 Code |
| Major Depressive Disorder, single, moderate | F32.1 |
| Generalized Anxiety Disorder | F41.1 |
| PTSD | F43.10 |
| ADHD, Combined Type | F90.2 |
| Bipolar Disorder I, current episode manic | F31.1 |
| Autism Spectrum Disorder | F84.0 |
| Schizophrenia | F20.9 |
| Substance Use Disorder | F10.20 to F19.20 |
Time matters—a lot. The billing rules for time-based services:
Psychotherapy codes are strictly time-based
Document the exact start and stop times in your notes.
Psychotherapy Billing Chart
| Duration | Billable Code |
| 16–37 mins | 90832 |
| 38–52 mins | 90834 |
| 53+ mins | 90837 |
Scenario: You meet a patient from 3:02 PM to 3:56 PM = 54 mins → Bill 90837
Telehealth in Mental Health Billing
Telehealth isn’t just a pandemic trend—it’s now a permanent part of mental health care. In fact, over 38% of mental health visits are now delivered remotely, according to recent CMS data. Whether you’re a solo therapist or part of a behavioral health group, knowing how to bill telepsychiatry and teletherapy services correctly is key to getting paid.
| CPT Code | Description | Time |
| 90832 | Individual therapy | 16–37 min |
| 90834 | Individual therapy | 38–52 min |
| 90837 | Individual therapy | 53+ min |
| 90846 | Family therapy (w/o patient) | 50 min |
| 90847 | Family therapy (with the patient) | 50 min |
| 90853 | Group therapy | 1 unit |
Example: A psychiatrist sees a patient for 45 minutes of therapy plus med management = 99213 + 90836
Modifiers are how you tell the payer, “This service was done via telehealth.”
Use:
Example: 90834-95 (Psychotherapy, 45 min, audio/video telehealth)
This indicates to the payer the location where the patient received care.
| POS Code | Description |
| 10 | Patient’s home (most common for mental health telehealth) |
| 02 | Anywhere else via telehealth (e.g., clinic, school, assisted living) |
Example: Psychotherapy via Zoom while the patient is at home → POS 10 + Modifier 95
Credentialing & Insurance Paneling
You can’t bill insurance until you’re credentialed.
What You Need:
Mental Health Credentialing takes 60–120 days on average per payer. Medicare and Medicaid are often slower.
Documentation for Mental Billing Services
Your notes should match your codes. It’s that simple—and that crucial.
A Few Must-Haves:
Insurance audits are on the rise. Proper documentation can save you from clawbacks or fines.
Denials, Appeals & Common Mistakes
Denials occur due to incorrect codes or inaccurate documentation.
Billing Software & Outsourcing
Whether you’re billing in-house or outsourcing, using the right tools is key.
Popular Behavioral Health Billing Platforms:
If your practice is growing, consider outsourcing to a company that specializes in mental health billing, not just general medical billing.
According to APA, behavioral practices that outsource billing reduce denials by up to 30%.
Use Time Wisely—Bill the Right Code
Psychotherapy codes are strictly time-based. Track session duration precisely and never round up to the nearest minute. Insurers can audit your notes.
Always document exact start and end times in your clinical notes.
Verify Insurance Benefits Before First Visit
Many plans carve out behavioral health to separate payers like Optum or Magellan. Don’t assume mental health is included under standard medical benefits.
Always verify a patient’s coverage, copay, deductible, and mental health benefits before the first session.
Combine E/M and Therapy Codes for Higher Reimbursement
If you’re providing both medication management and therapy in the same session, bill an E/M code + add-on psychotherapy code.
Example: 99214 + 90836
Don’t leave money on the table by only billing one.
Document “Medical Necessity” Clearly
Most denials occur because documentation doesn’t justify the code.
Include language like:
“Patient exhibits symptoms of GAD (F41.1), including excessive worry, poor sleep, and restlessness. Treatment continues to be medically necessary to prevent clinical deterioration.”
Be Careful with Telehealth Coding
Use the correct modifier (95 or GT) and POS code (10 or 02), depending on the patient’s location and payer rules.
Medicare now requires POS 10 when services are provided at the patient’s home.
90791 and 90792 Can Only Be Billed Once Per Episode
These psychiatric evaluation codes are used once per provider per new treatment episode, not per visit.
If the patient returns after six months or more, document it as a new episode and justify the use of 90791/90792 again.
Stay on Top of Credentialing
Don’t let expired credentials or CAQH lapses delay your payments.
Create a calendar with renewal reminders for:
Avoid Common Billing Mistakes
Top reasons for denial:
Audit 10 claims/month to catch recurring mistakes.
Track Your Denials and Appeals
Keep a spreadsheet or use your EHR to track denied claims, reasons, and outcomes.
Stats show that up to 35% of denied claims are never reworked. That’s lost revenue. Fight for your reimbursements.
Use Superbills for Out-of-Network Clients
If you’re not in-network, provide clients with clean, itemized superbills for insurance reimbursement.
Include:
Outsource Billing If You’re Drowning
If you’re seeing 15–20+ patients per week and billing yourself, you may be losing revenue.
Hiring a mental billing services provider that specializes in mental health can:
Stay Updated Every January
Billing codes and telehealth policies are subject to annual changes.
Sign up for updates from:
Use Modifiers Correctly
Modifiers like 95, 25, and GT are not optional—they’re required for correct reimbursement.
Example: 99214 + 90836 + 25 modifier if both med check and therapy are performed on the same day.
Batch Claims Every 2–3 Days
Waiting to submit claims weekly can delay your revenue cycle. Get paid faster by batching claims regularly.
Most electronic claims are paid within 10–14 days if submitted cleanly.
Know Your Numbers
Track key metrics:
Use dashboards in software like TheraNest, SimplePractice, or Kareo to visualize trends.
Conclusion
Mental health professionals do essential, life-saving work. But without proper billing and coding, even the most impactful therapy sessions can go unpaid. This guide is your foundation—combine it with strong administrative systems, clear documentation, and up-to-date training, and you’ll be in great shape.
Let us handle the paperwork so you can focus on your patients.
Our specialized mental billing team understands the unique needs of psychiatrists, therapists, psychologists, and mental health clinics. We ensure accurate coding, fast claims processing, and fewer denials.
Schedule your free consultation today.
Simplifying mental health billing with accurate claims, faster reimbursements, and seamless revenue cycle management.
info@mentalhealthbillingservice.com
Phone(860) 500-1471
Location403, Port Washington Road
Copyright © MHBS. All Rights Reserved. Terms & Condition Privacy Policy Contact Us