Billing for mental health billing services isn’t as straightforward as many providers expect. From strict documentation requirements to unique CPT codes and changing insurance rules, mental health billing presents challenges that differ significantly from general medical billing. Whether you’re a solo therapist, a practice manager, or just entering the field, understanding the essentials can save you time, stress, and revenue loss.
Here are three important things you should know about mental health billing—and how they can impact your practice.
1. CPT Codes in Mental Health Are Time-Based and Specific
Unlike many general medical services that are billed per procedure, mental health billing relies heavily on time-based CPT codes. Each type of session—individual, group, or family therapy—has its own billing code based on duration and structure.
Common Mental Health CPT Codes:
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90832 – 30-minute individual psychotherapy session
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90834 – 45-minute individual psychotherapy session
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90837 – 60-minute individual psychotherapy session
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90847 – Family therapy with the patient present
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90791 – Initial psychiatric diagnostic evaluation
Using the wrong code or inaccurately estimating session duration can lead to claim denials or reduced reimbursement. It’s crucial to stay up to date with payer-specific requirements, as some insurance companies may restrict the use of longer sessions or require pre-authorization.
Pro Tip:
Document session start and end times clearly and ensure your notes support the length and type of therapy provided.
2. Insurance Verification and Authorization Are Critical
One of the most common pitfalls in mental health billing is failing to verify insurance benefits before beginning treatment. Unlike other areas of healthcare, mental health coverage can vary dramatically from plan to plan, even within the same insurance company.
What You Must Check:
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Coverage for mental health services
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Session limits per year
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Co-pays, deductibles, and out-of-pocket costs
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Authorization requirements before sessions begin
In some cases, insurance plans will only approve a limited number of sessions initially and require ongoing documentation for continued treatment. Failure to obtain proper authorizations can result in non-payment, even if the services were medically necessary.
Pro Tip:
Establish a process for verifying benefits before the first appointment and rechecking periodically throughout the treatment period.
3. Accurate Documentation and Compliance Are Non-Negotiable
Mental health documentation must meet strict legal and ethical standards. Notes need to be detailed enough to justify the treatment provided, support the diagnosis, and satisfy both HIPAA and insurance regulations.
Unlike general medicine, mental health records often involve narrative descriptions of patient behavior, progress, and symptoms, which means documentation must be especially thorough and well-organized.
Important Considerations:
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Keep clinical notes up to date and accurate.
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Store sensitive records securely and in compliance with HIPAA.
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Ensure psychotherapy notes (which are separate from general progress notes) are protected if maintained.
Inadequate documentation can result in delayed payments, rejected claims, or even audits. It can also affect continuity of care if multiple providers are involved.
Pro Tip:
Use electronic health record (EHR) systems designed for behavioral health to streamline note-taking, billing, and compliance in one platform.
Final Thoughts
Mental health billing is more than just submitting a claim—it’s about navigating a complex system that involves time-based codes, frequent authorizations, and rigorous documentation. By understanding these three key elements, you’ll be better prepared to run a compliant and financially healthy practice.
Whether you’re managing billing in-house or outsourcing to a specialist, staying informed helps reduce errors, improve cash flow, and ensure you get paid for the important work you do.
