What is Mental Health Billing? Complete Guide

META-4-1024x538 What is Mental Health Billing? Complete Guide

Mental health issues have started occurring on a large scale. In such scenarios, mental health services are crucial in providing services. It is essential to maintain high patient care. It will help to achieve customer satisfaction for the service provided.

Providing high-quality service starts with seamless patient registration and ends with an effortless reimbursement process. Filling out all claim information without a single error can cause a burnout experience for providers. Incomplete documentation and pre-authorization can cause difficulties in reimbursement for claims. Medical health billing is quite a critical process. Even Small errors in documentation can cause hindrances in the billing process. To avoid such circumstances, Custom mental health EMR software can be helpful.

What are the Types of Mental Health Services Covered by Insurance

Various treatments and components are considered to ensure the smooth processing of both patient care and billing. It mainly depends on medical coverage, insurance type and benefits, and insurance eligibility. It also depends on the type of provider who is providing service to the patient. Type of providers like physicians, psychiatrists, clinical psychologists, and clinical social workers.

What-are-the-Types-of-Mental-Health-Services-Covered-by-Insurance-1024x576 What is Mental Health Billing? Complete Guide

1. Family Medical Psychotherapy

Family medical psychotherapy service is beneficial for family members of insurance holders. If any family member of the insurance holder starts facing any mental health issue or condition, then the immediate family member can connect with the providers. In this scenario, a Mental health counselor connects with immediate family members/caregivers to provide therapy sessions. It helps to understand the mental condition of patients and how to take care of them. This process can be carried out without the actual patient, for such a service claim gets reimbursed occasionally. Sometimes, it is chargeable.

2. Group Psychotherapy

In-group psychotherapy is beneficial for all patients who are generally suffering from anxiety, depression, and any kind of addiction. In this group therapy session, all patients who are facing mental health issues come together. As per the research, it is proven that group therapy sessions are beneficial in terms of issues like anxiety and addiction. In these sessions, patients discuss their issues and give support.

Most insurance facilities suggest group psychotherapy because it is cost-effective than individual. If this group therapy is not beneficial for any individual, then it will be the responsibility of healthcare to provide medication support for that patient. For that treatment, the required cost gets reimbursement from the insurance service.

3. Psychotherapy Service

Psychiatric therapeutic services are nothing but individual services. This type of Psychiatric therapy is beneficial for those patients who are suffering from severe type of mental health issues. It is useful when mental health issues require personalized care with medication. In this, the patient gets individual care from health care providers.

Insurance services make sure that the patient is getting therapy from qualified providers. Insurance claims for psychiatric therapeutic services are pretty critical. To avoid the worst results from critical mental health issues, it is crucial to provide therapy as soon as possible. Insurance facilities also suggest the same to provide for effortless reimbursement for claims.

4. Psychiatric Diagnostic Review

After completing the patient’s assessment test, a psychiatric diagnosis review occurs. This mental health service collects a patient’s medical and mental health history. Psychiatric Diagnostic Review also helps to make a therapeutic plan for the patient. This Psychiatric Diagnostic Review depends on the assessment carried out by licensed healthcare providers.

To provide better service to patients, it is essential to pay more attention to treatment; a Psychiatric Diagnostic Review helps to create that therapeutic plan effectively. To provide quality-based treatment for any mental health issue, it is essential to have a solid foundation of diagnosis.

Why Mental Health Billing Can Be Complicated?

Most of the providers find mental health billing complicated because of several issues. One of the issues providers face the most is the difference in billing for regular health checkups and mental health issues. Billig of regular health checkups is based on mostly commonly provided services like blood reports, sugar level reports, and other provided services. For these repeatedly provided services, CPT codes are pre-defined.

In the case of mental health, billing scenarios get changed. In mental health billing, several factors come into the picture. Some of the primary factors are the willingness of participants, Age factors, session length, and therapeutic approach. All of these factors can be the reason for making mental health billing complicated.

In mental health care, it is always challenging to provide standardized treatment for patients. Another reason is filling all claim information and insurance details with zero errors. While filling out the claim details, the provider must fill in all columns mentioned on the form. Filling out all this information can result in an exhausting experience for providers. This process consumes the maximum time of the provider. Hence, providers can’t focus on delivering quality patient care with the required attention. If any documentation and pre-authorization is found incomplete or inaccurate, it can cause hindrances in medical billing.

Tips for Mental Health Billing

Tips-for-Mental-Health-Billing-1024x576 What is Mental Health Billing? Complete Guide

When it comes to the billing part of the process, it is essential to focus on some critical factors that must be followed. Errors in billing can directly affect reimbursement rates. So it is necessary to have a complete idea before billing is processed. Some tips include checking insurance eligibility, performing verification processes, and accurately using the UB-04 form. Below are some additional tips:-

1. Consistently review and confirm the insurance information

The provider is responsible for checking patient insurance before appointments, which will help to reduce loss of charges. Double checking with patient insurance details is always beneficial for the provider. It might take more time than required, but it provides long-term benefits. One of the benefits is nothing but a smaller number of insurance voids. It helps patients get the maximum benefit from insurance.

Double checking with patient insurance helps to cut down on upcoming difficulties for claim reimbursement. Double-checking with patient insurance is helpful for providers to know about more benefits and coverage. This practice can provide knowledge about insurance coverage. It helps in providing service according to insurance coverage and benefits.

Verification of benefits (VOB) is a process that helps providers to know better about insurance coverage. After complete knowledge of each patient’s coverage, providers can process reimbursement more effectively. Double-checking with patient insurance assists in identifying authorization requirements and any changes in the patient’s coverage. Sometimes, patients need to remember to mention changes in coverage. That may lead to difficulties in the claim. To avoid such difficulties, a double check with insurance is essential.

2. Conduct a comprehensive verification of benefits for every patient

Verification of benefits (VOB) is nothing but a process for insurance verification. With the help of this process, providers determine coverage and benefits of patient insurance. All insurance information should be detailed on the patient’s insurance card. To learn about complete insurance coverage, providers can follow VOB. VOB helps to know details not mentioned on the patient’s insurance card.

VOB helps to make the mental health billing process more straightforward. VOB assists in knowing that the patient is covered under insurance for the services provided.

Verification of Benefits also helps to know the approximate amount that the patient’s insurance service will pay for the care taken by the patient. In Verification of Benefits (VOB), the provider can follow three techniques to get complete information about the patient’s insurance. The first one is via contact details, which are available on an insurance card. Provider can easily connect with insurance service to get details about total coverage and benefits on insurance.

The second way is to connect via port details. Connecting with insurance services for mandatory information and verification is also easy. If your questions are not resolved with the above techniques, you can pull the required insurance data from EHR (Electronic Health Record). VOB helps avoid unnecessary claim voids and increases reimbursement rates.

3. Submit claims accurately to ensure seamless processing

Provider mainly faced issues while submitting claims. To avoid unwanted situations, providers can follow simple tips for submitting claims correctly. Prepare bills with zero errors. Providers must pay more attention to generating bills with complete and correct information. Most of the claims get denied because of errors in billing.

Another method is to ask the insurance company for their preferences. Insurance companies generally offer two ways. Either fill out the claim form within a given time window or take a prolonged time to fill that claim form. The provider can directly ask the insurance company for their preferred way by following the VOB process. The provider can research to gain knowledge about most insurance companies’ repeated use of claim forms. It can reduce time and increase accuracy for submitting claim forms. While submitting a claim, use the proper or correct claim format.

Familiarizing oneself with common claims forms such as UB-04, which most insurance companies use, will help to get good reimbursement rates. This form is usually reserved for mental health clinics and specialized health centers for medical billing

4. Acquire a comprehensive understanding of relevant CPT codes

CPT codes are necessary for medical billing. We know about ICD codes that are generally used for diagnosis purposes. Providers need to associate CPT codes with appropriate ICD codes for errorless billing. Provider needs to use the correct CPT code for complete coverage of service taken by the patient. CPT codes are used to provide a base for medication treatment.

CPT code helps to mention the service provided by a provider that the patient has received. CPT codes must be associated with ICD codes for complete documentation. The provider must have complete knowledge of CPT codes to avoid unnecessary issues. Complete and confirmed CPT codes can help get the maximum reimbursement range for the claim.

Following are examples of CPT codes-

90832: Psychotherapy, 30 minutes with the patient

90847: Family or couples psychotherapy, with the patient present

90853: Group Psychotherapy (other than a family group)


In mental healthcare billing, there are several factors to consider. We must pay more attention to those factors for seamless mental health billing. Mental healthcare billing is quite different and critical as compared to physical health. In mental health, billing is complicated because if any documentation and pre-authorization is found incomplete or inaccurate, it can cause hindrances in medical billing.

Firstly, the provider should know about the type of mental health services covered under the insurance. After that, knowing the CPT code for complete and errorless billing is essential. To make it seamless and effortless, we have highlighted some tips that may be beneficial in getting a reasonable reimbursement rate.

Frequently Asked Questions

1. Why is Mental Health Billing Important?

Medical health boilling is quite a critical process. Even Small errors in documentation can cause hindrances in the billing process.

2. What is ICD-10 Coding in Mental Health Billing?

Providers use ICD codes to describe the diagnosis and treatment that is provided to patients As per the new update, F99 is an ICD-10-CM code that can indicate a diagnosis for reimbursement purposes.

3. What Are Common Reimbursement Challenges in Mental Health Billing?

There are several challenges faced by providers for Reimbursement. Correct documentation and medical billing are one of them

Ganesh Varahade

Founder & CEO of Thinkitive Technologies.

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