Time-based session coding
90832 (16-37 min), 90834 (38-52 min), 90837 (53+ min). Picking the wrong code by a few minutes loses meaningful revenue across thousands of sessions per year.
Therapy session codes, time-based billing, telehealth modifiers, parity-law issues, and Medicaid behavioral health carve-outs. Generalist billers miss this every day. We don't.
Time-based session codes, frequency limits, prior auth on diagnostics, and behavioral health carve-outs in Medicaid all combine into a workflow that breaks generalist billers.
90832 (16-37 min), 90834 (38-52 min), 90837 (53+ min). Picking the wrong code by a few minutes loses meaningful revenue across thousands of sessions per year.
Modifier 95 vs FQ vs 93. POS 02 vs POS 10. Audio-only vs video. Each payer interprets these differently. We maintain a payer-specific telehealth grid and apply it accurately.
Medicaid behavioral health carve-outs (Beacon, Magellan, Optum, Carelon) have their own claim forms, prior auth flows, and reimbursement schedules. We bill carve-out plans directly to the carve-out, not the parent payer.
The Mental Health Parity and Addiction Equity Act bars insurers from imposing tougher limits on mental health benefits than medical. Visit caps, prior auth burdens, and reimbursement disparities are appealable. We file the appeal with parity language.
Crisis intervention (90839, 90840), interactive complexity (90785), psychological testing (96130, 96131, 96136, 96137), assessment (90791, 90792). Frequently miscoded, often denied. We get these right.
Mental health records carry stricter confidentiality protections (42 CFR Part 2 for SUD treatment). Encryption, role-based access, BAA, and minimum-necessary handling are non-negotiable. We meet every standard.
Behavioral health billing is its own discipline. Here's why it matters.
Three reasons. Time-based codes (90832/90834/90837) require precise documentation; an under-coded session is an under-paid session. Telehealth rules shifted dramatically post-PHE, with modifier 95 vs FQ vs 93 differing by payer. And behavioral health carve-outs route claims to vendors like Optum/Magellan/Beacon, not the parent insurer. Generalist billers don't get reps on these the way a specialty team does.
Some payers (BCBS plans, Optum, Cigna) flag providers with high 90837 ratios for documentation review. That doesn't mean stop billing 90837; it means document the session length precisely (start and end time) and the medical necessity for an extended session. We help structure note templates so audit-flagged claims survive review intact.
Yes. The federal MHPAEA and state parity laws bar insurers from imposing tougher session limits, higher copays, or stricter prior auth on mental health than on medical/surgical care. When a payer denies for "exceeded session limit" but doesn't apply the same limit to medical visits, that's an appealable parity violation. We cite the relevant law in the appeal.
Most state Medicaid programs route mental and substance use care through a behavioral health carve-out vendor (Beacon Health Options, Magellan, Optum BH, Carelon). Claims must go to the carve-out, not the parent Medicaid plan, with carve-out-specific prior auth and provider IDs. We map the carve-out for every Medicaid plan you accept.
Yes. 99213, 99214, 99215 for E/M visits, with add-on 90833 or 90836 when psychotherapy is performed during the same visit. Time and MDM-based E/M leveling under the 2021 guidelines applies. We also handle 96127 screening codes and G0511 integrated behavioral health where applicable.
Intensive outpatient (IOP, code S9480 or H0015 by payer) and partial hospitalization (PHP, code S0201) billing is high-volume and high-stakes. Per-diem rates, prior auth requirements, and length-of-stay reviews all matter. We work with both freestanding programs and hospital-based IOP/PHPs.
Yes. SUD records have stricter confidentiality protections than general medical records. We follow Part 2 release-of-information rules, segregate SUD claims from general behavioral health where required, and ensure ROIs are on file before disclosing diagnostic information to payers.
30-minute free billing audit. We'll surface the leaks (undercoding, denials never appealed, eligibility errors) and quantify the dollars you can recover this quarter.
