Behavioral Health & Psychiatry Billing
Specialized revenue cycle management for psychiatric practices, clinical psychologists, therapy groups, and addiction treatment facilities.
Overcoming the Unique Billing Hurdles of Mental Health
Mental and behavioral health practices navigate some of the most frustrating administrative obstacles in US healthcare. Payers frequently "carve out" mental health benefits to third-party managed behavioral healthcare organizations (MBHOs), enforce tight session-count limits, and trigger automated audits over time-based psychotherapy coding.
Ecardius provides revenue cycle workflows fully compatible with behavioral health and psychiatry practices, ensuring insurance benefits are accurately routed, authorizations are tracked proactively, and clinical claims are filed on time.
Common Behavioral Health Revenue Leaks We Solve
1. Misrouted Carve-Out Payer Claims
Commercial health plans frequently outsource behavioral benefits to third-party administrators (such as Optum Behavioral, Carelon/Beacon, or Magellan). Submitting claims to the medical payer listed on the front of the insurance card results in instant claim rejections. We verify benefit carve-outs before the patient's first session.
2. Time-Based Coding Audits (90837 vs. 90834)
Payer algorithms aggressively audit 60-minute individual psychotherapy (90837, requiring 53+ minutes) when billed consistently. Payers demand clinical documentation of exact start and stop times, session summaries, and therapeutic modalities. We ensure chart compliance before claims are released.
3. Psychiatric E/M with Add-On Therapy (+90833 / +90836)
When psychiatrists or psychiatric nurse practitioners combine medical evaluation and management (99212–99215) with concurrent psychotherapy add-ons (+90833/+90836), payers frequently bundle or downcode the encounter. We verify distinct medical vs. psychotherapeutic documentation in the record.
4. Clinician Credentialing & Incident-To Traps
Billing for Licensed Clinical Social Workers (LCSW), Licensed Marriage and Family Therapists (LMFT), and Licensed Professional Counselors (LPC) requires payer-specific credentialing. Billing under a supervising psychiatrist without fulfilling direct supervision rules leads to major takebacks. We keep enrollment records current.
Behavioral Health Code Families & Services Supported
| Service Domain | Core CPT / HCPCS Codes | Compliance & Billing Nuances |
|---|---|---|
| Diagnostic Evaluations | 90791 (Psych Diagnostic Eval); 90792 (Psych Diagnostic with Medical Exam) | Annual frequency limits; comprehensive biopsychosocial assessment requirements. |
| Individual Psychotherapy | 90832 (30 min / 16–37 min), 90834 (45 min / 38–52 min), 90837 (60 min / 53+ min) | Exact time documentation; progress note linking; treatment plan updates. |
| Psychiatric Add-On Therapy | +90833 (30 min Add-On), +90836 (45 min Add-On), +90838 (60 min Add-On) | Separate time documentation for therapy vs medical decision-making E/M. |
| Family & Group Psychotherapy | 90846 (Family w/o Patient), 90847 (Family with Patient), 90853 (Group Psychotherapy) | Multiple family member billing rules; distinct patient-centered treatment goals. |
| Telehealth Modifiers & POS | Modifiers -95 (Synchronous Video), -FQ (Audio-Only); POS 02 / POS 10 | Correct place-of-service selection based on patient location (home vs facility). |
Integration with Behavioral Health EHR Platforms
We work directly within leading behavioral health and therapy EHRs including SimplePractice, TherapyNotes, Valant, Kareo/Tebra, AdvancedMD, athenahealth, and Qualifacts. We track pre-authorizations, verify active coverage, and automate patient statement distribution.
Eliminate billing stress in your mental health practice
Focus on patient care while our team eliminates denied claims and tracks your authorizations. Request a complimentary 10-point behavioral health billing audit under a signed BAA. We analyze your aging reports, identify uncollected cash, and quote a performance-based fee with $0 upfront.