Mental health care is one of the most important — and rapidly growing — areas in healthcare. Therapists, psychologists, psychiatrists, and counselors work tirelessly to treat conditions like depression, anxiety, PTSD, ADHD, substance abuse, and bipolar disorder. Yet while mental health services are essential, billing for them is anything but simple.
Mental health billing involves varying session lengths, telehealth visits, non-standard CPT codes, and payer-specific limitations. There are strict rules for authorization, documentation, and visit caps, and improper coding can lead to claim denials, delayed reimbursements, or compliance risks.
At Progressive RCM, we understand the complexities of mental health billing. Our team ensures each claim is accurate, compliant, and reimbursed as quickly as possible — so mental health providers can focus on helping people heal, not chasing payments.
Common Challenges in Mental Health Billing
1. Session Duration and Coding
Mental health services vary widely in duration — 30, 45, 60, or even 90-minute sessions. Each session length corresponds with a different CPT code and must be precisely documented. For example:
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90834 for 45 minutes
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90837 for 60 minutes
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99354 for prolonged services
Incorrect documentation can result in underpayment or audits.
2. Limited Covered Visits
Many insurance plans place limits on the number of therapy visits per year or require pre-authorization. Not tracking this can result in unpaid sessions or rejected claims.
3. Telehealth Services
Mental health is one of the most-used specialties for telehealth. To bill correctly, providers must apply:
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Modifier 95 or GT
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POS 10 (home) or 02 (telehealth)
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Meet state parity laws and payer-specific policies
4. Multiple Licensure Levels
Mental health services are delivered by:
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Licensed Professional Counselors (LPC)
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Licensed Clinical Social Workers (LCSW)
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Psychologists (PhD, PsyD)
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Psychiatrists (MD, DO)
Billing requirements and allowed CPT codes vary by provider type and payer, and incorrect submissions can lead to denials.
5. Substance Abuse and Dual Diagnosis
Providers treating both mental illness and substance abuse (dual diagnosis) must link correct ICD-10 codes to each service and follow complex billing structures for group vs. individual sessions.
Common CPT, HCPCS, and ICD-10 Codes in Mental Health Billing
✅ CPT Codes:
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90791 – Psychiatric diagnostic evaluation (no medical services)
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90792 – Psychiatric diagnostic evaluation (with medical services)
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90832 – Psychotherapy, 30 minutes
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90834 – Psychotherapy, 45 minutes
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90837 – Psychotherapy, 60 minutes
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90846/90847 – Family therapy (without/with patient present)
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96101 – Psychological testing
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99417 – Prolonged services (after 60-minute sessions)
✅ HCPCS Codes:
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H0001 – Alcohol and drug assessment
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H0031 – Mental health evaluation
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G0444 – Depression screening
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G2012 – Brief check-in (virtual)
✅ ICD-10 Codes:
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F32.9 – Major depressive disorder
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F41.1 – Generalized anxiety disorder
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F90.0 – ADHD, predominantly inattentive
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F31.9 – Bipolar disorder, unspecified
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F43.10 – PTSD, unspecified
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F11.20 – Opioid dependence
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Z63.5 – Disruption in family
Our Mental Health Billing Services
At Progressive RCM, we handle the full billing lifecycle for mental health practices — from claim creation to denial follow-up, helping therapists and behavioral health providers stay compliant and financially healthy.
✅ Insurance Verification & Authorization
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Confirm benefit eligibility and coverage limits
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Obtain pre-authorization for therapy and psychiatry services
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Notify providers of copays, deductibles, and visit caps
✅ Accurate Coding & Modifier Use
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Match session time with correct CPT code
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Apply proper modifiers for telehealth and extended services
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Link accurate ICD-10 codes to justify medical necessity
✅ Telehealth Billing Support
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Ensure claims include modifier 95 and POS 10/02
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Stay current with telebehavioral health regulations
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Submit compliant claims to Medicare, Medicaid, and private payers
✅ Claim Submission & Payment Posting
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Clean claim submission within 24–48 hours
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Integration with EHRs or therapy platforms (e.g., SimplePractice, TherapyNotes, TheraNest)
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Track EOBs, denials, and reimbursement timelines
✅ Denial Management & Appeals
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Identify denial causes: unauthorized visits, incorrect coding, session limits
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Appeal with documentation (progress notes, treatment plans)
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Prevent future denials through data analysis and workflow improvement
✅ Patient Statements & Collections
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Generate clear, timely statements
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Educate patients on balances, benefits, and mental health parity laws
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Offer payment plans for out-of-pocket expenses
✅ Monthly Performance Reports
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Revenue by provider
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Denials by payer or CPT code
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Sessions per patient
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AR aging and collections trends
Why Choose Progressive RCM for Mental Health Billing?
✅ Behavioral Health Billing Experts
We’re trained in mental health CPT/ICD coding, psych evaluation billing, telehealth billing, and substance abuse billing.
✅ All Licensure Types Supported
We bill for LPCs, LCSWs, psychologists, and psychiatrists, ensuring accurate credentialing and payer recognition.
✅ Integrated with EHRs
We work with all major therapy software platforms and EHRs — or your manual process — for flexible and seamless billing.
✅ Focus on Compliance & Confidentiality
We ensure billing practices meet HIPAA, CMS, and payer-specific guidelines — safeguarding both provider and patient interests.
✅ Custom Plans for Group Practices and Solo Providers
Whether you’re a private practice therapist or a mental health group, we tailor services to fit your needs.
KPIs We Monitor for Mental Health Practices
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Average reimbursement per session
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Denial rate by CPT or ICD code
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Days in AR (accounts receivable)
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Missed or unbilled sessions
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First-pass claim acceptance rate
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No-show write-offs and billing follow-ups
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Final Thoughts
Billing for mental health isn’t just about numbers — it’s about supporting the care and compassion therapists bring to their patients. Whether you’re a counselor offering talk therapy or a psychiatrist managing complex medication plans, accurate and timely billing is key to your success.
At Progressive RCM, we help mental health providers get paid fairly and on time, reduce administrative burden, and stay focused on what matters most — healing minds and saving lives.