info@mentalhealthbillingservice.com
The counseling profession became eligible to submit Medicare bills on January 1, 2024. The process is strict, and one mistake in any field can stop the whole procedure for months. Your license can be LPC, LMHC, LCPC or LPCC, but Medicare sees all these initials as one single code: Mental Health Counselor. We sign you up under that name, link your taxonomy within the different systems, and bill all your sessions smoothly.
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It is a coding and billing for licensed professional and mental health counselors. Counselors bill 90791 for the diagnostic interview. They bill 90832, 90834, and 90837 for individual psychotherapy. They do not bill E/M, psychological testing, and other procedures related to prescriptions. Medicare granted counselors the status of independent provider on January 1, 2024. Counselors are signed up as Mental Health Counselors and get 75% of the clinical psychologists’ rate.
Before 2024, counselors did not have the option to bill Medicare directly. Most practices are still not enrolled and refuse Medicare patients. Some of them enrolled incorrectly and lost their claims on the spot.
There are five state titles for one Medicare specialty: LPC, LMHC, LCPC, and LPCC. Taxonomy is 101YM0800X. Mismatch of code cannot pass verification before claim payment.
Private and Medicaid coverages of counselors change from state to state. Some Medicaid programs cover counselors only when working through an agency. We verify all prior to bill submission.
Mental Health Counselors received Medicare rights in 2024, however, only upon correct enrollment under the name of a Mental Health Counselor. Paper CMS-855I has no check-box for MHCs yet. Select "Undefined Non-Physician Practitioner Specialty" and enter "MHC". Failure to do so will lead to wrong specialist group routing of the file. The enrollment process takes 60 to 120 days. Any mismatch in your NPPES and CAQH profiles adds 30 to 75 days.
Our credentialing staff will enroll you as an MHC under taxonomy 101YM0800X. We check for an active effective date prior to your first Medicare claim submission. Check the credentialing and enrollment page for the detailed process.
LCPC in Illinois and LPCC in California hold separate license titles. However, both licensees bill Medicare as MHC. An inexperienced biller fails to recognize the difference and codes the title differently than what should be. As a result, NPPES, CAQH, and the claim show the mismatched code. This error leads to credentialing denial and presents itself as a CO-16 denial on the claim.
We always use MHC with taxonomy 101YM0800X for each counselor. Before submission, we make sure that the code is consistent across NPPES, CAQH, and the W-9. Statute defines MHC as a provider that includes the counselor and clinical professional counselor.
Several Medicaid programs of different states require the HO modifier on every master's-level claim. It notifies the payer that the master's-level clinician has provided the service. It is required by the California, Texas, Florida, New York, and Illinois Medicaid programs. Leave it out and your claim will be immediately rejected. Add the doctoral modifier like AJ to the counselor’s bill and your claim will be automatically rejected due to CO-4 error in credentialing information.
We attach HO automatically whenever a counselor files a claim for Medicaid in the state requiring it. We sequence the modifiers in Box 24D such that the pricing is done first followed by informational modifiers. We never add doctoral modifiers to master's-level practitioners.
Medicare now covers counselors across the board. Coverage from commercial and Medicaid payers does not follow any one pattern. A plan that accepts counselors in one state may refuse them in another. Some Medicaid plans only allow counseling to be paid when rendered in the agency environment. Submit a claim to a plan that does not cover counselors in your state, and it will be automatically denied.
We check counselor coverage on a payer-by-payer and state-by-state basis. We submit only to plans that pay for counselors in the specific states. When appropriate, we negotiate a single-case agreement instead of simply writing the visit off.
Fill The Gap Before It Costs You
Forward a recently rejected or unpaid counseling claim to us. It gets analyzed for any rule from 2024 and your payer panel. Our team will get back to you within 48 hours.
These tasks are based on the counseling scope and the Medicare rules for 2024. Each one is done to cover the area where a counseling claim fails.
Position yourself as a Mental Health Counselor in accordance with the 2024 expansion program. Enroll you in the Medicare plan with taxonomy 101YM0800X via our credentialing team. Reconcile each Medicare payment with 75% of clinical psychologist payment. The underpayment goes unnoticed.
Map your state license, LPC to LPCC, to the MHC specialty. Validate it by matching it in NPPES, CAQH ProView and the W-9 form. Maintain attestation at CAQH within its 120-day validity period. A single specialty takes care of the most frequent verification problem.
We code 90791 intakes and the time-based psychotherapy codes from the counseling scope. Each claim goes through a scrubbing process before its submission. We verify the diagnosis, because the combination of a Z-code and 90837 does not satisfy medical necessity. The principles of time-band calculation we have on our clinical social work billing page.
The behavioral health telehealth services become permanent after the adoption of the 2023 law. We pair the place-of-service code with the patient’s location, POS 10 for telehealth delivered from a patient’s residence and POS 02 for other telehealth visits. We apply modifier 95, if it is needed by the payer. We never submit a telehealth visit as an office visit – this is the reason of most telehealth denials.
We verify coverage by payer and state before you can submit the claim. We check if a plan puts a cap on the psychotherapy visits and defines the limit number. We track it in your EHR. Your staff gets information about it, when there is still time to extend the limit.
We track aging ARs and handle denials, including coverage and parity requests. We analyze the EOB, as a CO-16 and a CO-197 require different approaches. We track the timely filing period for every payer, varying from 90 to 365 days. The entire procedure can be found on our denial management webpage.
Counselors use a small range of psychotherapy codes. They are listed in the table below. The time-band rules can be reviewed on our clinical social work page.
| Code | Description |
|---|---|
|
90791 |
Diagnostic evaluation without medical services, the counselor intake. Not 90792. |
|
90832 / 90834 / 90837 |
Individual psychotherapy at 16 to 37, 38 to 52, and 53+ minutes. Document start and stop times. |
|
90853 |
Group psychotherapy. Some state Medicaid plans want the HQ modifier here. |
|
90839 / +90840 |
Crisis psychotherapy, first 60 minutes (30 to 74), then each added 30 minutes. |
Counselors use a small range of psychotherapy codes. They are listed in the table below. The time-band rules can be reviewed on our clinical social work page.
Onboarding a counseling practice is a process that includes 5 main stages. In most cases, clients make their first clean claim within the Medicare enrollment period.
We look through several claims you sent recently and all your payers list, and provide our insights on what we found.
We check your Medicare MHC eligibility and your taxonomy code across all systems.
We validate which payers certify counselors in your state and at what frequency.
We log in into your EHR system and configure all modifiers and limits.
We manage all claims, work all A/R, and report on collections monthly.
Yes. Counselors are allowed to bill Medicare individually starting from January 1, 2024. The benefit is established by section 4121 of the Consolidated Appropriations Act, 2023. They are enrolled as Mental Health Counselors, taxonomy code 101YM0800X. Medicare reimburses them at 75% of the rate of clinical psychologists, subject to the 20% coinsurance of patients. Counselors and marriage and family therapists are the most recently included provider types.
Section 4121 adds counselors and marriage and family therapists to Medicare Part B. It is the first new behavioral health provider category that Medicare added in years. Previously, it included psychiatrists, psychologists, clinical social workers, and psychiatric nurses. Now, counselors bill Medicare individually for diagnosing and treating mental disorders. This benefit does not cover treatment of an inpatient of the hospital.
Counselors must register with Medicare using PECOS or CMS-855I paper form under taxonomy 101YM0800X. The paper application still includes no option for MHC specialty. One needs to choose “Undefined Non-Physician Practitioner Specialty” in 2H and enter MHC there. Enrollments began in late 2023, but no claim made before January 1, 2024, is payable.
MHCs should have a master’s or doctoral degree qualifying them for licensure as counselors in the state in which they work. The counselor is also supposed to have a current state license. Medicare requires two years or 3,000 hours of clinical experience post-degree. Should the state already require such experience for the issuance of licenses, the MAC confirms its validity in the process.
A Mental Health Counselor gets 75% of the charge of a clinical psychologist for delivering the same service. This percentage applies to clinical social workers and marriage and family therapists who fall at this level. Clients owe 20% coinsurance. Reconciliation is performed for each remittance on the allowed amount and an appeal is filed for underpayment instead of taking a loss.
They cannot bill 90792 since this code contains medical services and belongs to prescribers. They cannot bill E/M codes such as 99214. They cannot bill codes for psychological testing since 96130 can be billed only by psychologists and physicians. We keep your claims within the counseling scope of practice.
Our counseling billings cover all 50 states in the US. The licensing title varies from state to state, as does the important list of payers in each state. Below, each state lists its title and the payers we work with.
California
Texas
Florida
New York
Pennsylvania
Ohio
Georgia
North Carolina
Michigan
New Jersey
Washington
Arizona
Massachusetts
Virginia
Colorado
Tennessee
Counseling practice in a metro and searching nearby? We bill for practices in New York City, Los Angeles, Chicago, Houston, Dallas, Phoenix, Philadelphia, San Diego, Miami, Atlanta, Boston, Seattle, Denver, Washington DC, the Bay Area, Minneapolis, Charlotte, Nashville, Austin, Detroit, Tampa, and Columbus. Our coverage is nationwide, so your state never limits us.
Coverage of counselors depends on the payer, state and title used for licensure. Behavioral health counseling should be billed through a carve-out, not through the regular medical plan. We check the rules and regulations for each payer before the billing process starts.
Since January 1, 2024 Medicare covers counselors under Mental Health Counselors at 75% of the clinical psychologist payment rate. There is no definite outpatient psychotherapy cap set. Before the first claim we verify the MHC enrollment. We reconcile each payment with 75% allowed amount.
Aetna is credentialed in most states. Behavioral health services will be submitted through Aetna’s behavioral health unit. Benefits and visit limitations vary per state and plan. We verify the counselor panel for the particular state first. The claims are filed under the behavioral route, not the medical.
Cigna diverts behavioral health to Evernorth. Coverage for counselors varies by plan and state. Cigna reduces telehealth payment on some plans. We confirm the panel for the particular title and state first. Then, we direct the claim to the correct reviewer at Evernorth.
UnitedHealthcare diverts behavioral health to Optum. Optum has its own counselor panels, and they generally have tiering based on credentials. We verify the panel for the particular state and title first. We keep track of visit limitations for Optum plans. We then divert through carve-out.
Anthem diverts behavioral health to Carelon. Counselor coverage and authorization requirements vary among Anthem’s plans per state. We confirm the Carelon panel for the particular state first. We file the required prior authorizations for the particular plan first.
Medicaid coverage of counselors varies among states and is generally administered through managed care organizations. Some states cover counselors only within agency limits. Some require the HO modifier on each claim submitted. We check the state law and MCO panel before billing.
Newly eligible counselors miss out on potential revenue due to enrollment errors, taxonomy issues, Medicaid modifier issues, and excluded payers by state for counselors. We find it within 48 hours, no commitment required.
Yes. Counselors will start billing Medicare independently starting January 1, 2024. The provider type to enroll is federal Mental Health Counselor, and the taxonomy is 101YM0800X. Medicare pays such providers 75% of the clinical psychologist rate, subject to 20% patient coinsurance. Your Medicare enrollment will look the same irrespective of the title you have on your license.
January 1, 2024. The Consolidated Appropriations Act, 2023 created the benefit under section 4121. Marriage and family therapists and counselors were the most recent addition as provider types by Medicare. Although enrollment was open since late 2023, claims prior to January 1, 2024, are not payable.
Mental Health Counselor is the category, which has the code 101YM0800X. Counselors pick this code when registering with NPPES and enrolling under MHC specialty. This Medicare category and taxonomy code do not change regardless of the title used in your state.
The Medicare pays Mental Health Counselors at 75% of the clinical psychologist rate for the identical service. Clinical social workers and marriage and family therapists fall into the same tier. Patients pay the normal 20% coinsurance. The exact payment figure is based on the service and the area.
For Medicare, no. They all have the same classification, Mental Health Counselor, in the taxonomy 101YM0800X. According to 4121, MHC encompasses the counselor, the clinical professional counselor, and the professional counselor. However, the commercial and Medicaid insurers consider these titles differently, hence we check each of them.
Counselors bill 90791 which is a diagnostic evaluation but not medical service. 90792 includes medical services and is used by prescribers only, and counselors do not bill it ever. If 90792 is wrongfully coded with the counselor intake then that will result in denial of payment. Mechanics of intake and psychotherapy are located on our clinical social work billing page.
Counselors bill 90791 for the initial assessment or evaluation. They bill 90832, 90834, and 90837 for individual psychotherapy. They bill 90853 for group and 90839 with 90840 for crisis counseling. They don’t bill E/M, psychological testing or prescribing codes.
No. Counselors’ coverage varies depending on the carrier, plan and the title they hold. If the carrier accepts counselors in one state, they might deny coverage in another. It might accept counselors who hold one title but not the other one. Counselors’ coverage is verified with every payer before billing.
Counselors need to register in PECOS or complete the paper CMS-855I form, taxonomy 101YM0800X. When completing the paper form, you choose “Undefined Non-Physician Practitioner Specialty” and write MHC in the field for specialty. Enrollment requires qualified education, licensure and two years or 3,000 hours of supervised experience.
HO is an indicator of the clinician holding a master's degree in a claim. HO is required by several states' Medicaid programs for all counselor claims, namely California, Texas, Florida, New York, and Illinois. Without HO, the claim will be automatically denied. HO is added to the claim where needed and modifiers are ordered appropriately in the claim.
Yes. Telehealth flexibility for mental health services is permanent under Medicare and includes even audio-only calls. POS 10 is used for home visits, while POS 02 is used for other locations. Modifier 95 is added if payer requests it. Claiming a telehealth visit as an office visit, POS 11, is one of the frequent denials that we avoid.
No. Counselors charge evaluation, psychotherapy, group, and crisis codes only. No E/M codes can be charged by counselors. Psychological testing codes such as 96130 cannot be billed by counselors since those codes require psychologists or physicians.
We charge a percentage of collections, so you pay us once we collect. There is no charge for setup, and there is no charge for software. We start with a free counseling billing audit. The percentage will vary depending on your volume and payer mix. [VERIFY pricing terms with client before publishing.]
Yes. We can bill within TherapyNotes, SimplePractice, Valant, Kareo or Tebra, among other systems. You just need to track session numbers and authorizations in your documentation process. The setup will be HIPAA and 42 CFR Part 2 compliant where applicable.
Simplifying mental health billing with accurate claims, faster reimbursements, and seamless revenue cycle management.
info@mentalhealthbillingservice.com
(860) 500-1471
403, Port Washington Road
