Complete Guide to Mental Health Billing Updated for 2022

Everything transpiring between a patient and the mental healthcare provider should be in the medical record. A patient’s medical record determines what is billed for the mental health service, which means that all required information must be adequately documented. This medical record will help support the diagnosis and procedure code that is billed to insurance. It’s important to know the types of covered mental health services for your patients who may have varying insurance or medical coverage. For example, some insurance will only cover mental health services by specific providers, such as physicians, psychiatrists, clinical psychologists and clinical social workers.

Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Don’t worry about memorizing all the CPT Codes (there’s alot!) or even all of the mental health ones. Interactive complexity can be used in conjunction with the primary CPT Codes for diagnostics, psychotherapy, or group therapy and cannot be used for couple/family therapy or crisis codes. CPT (Current Procedural Terminology) is a standardized medical codeset maintained by the AMA.

Health Behavior Assessment and Intervention Services

Before sessions with any new or existing patient, ensure that you know their insurance plan and benefits ahead of time. When these services are billed to health insurance, it is often a simple task because routine checkups are frequently under one general charge. For mental and behavioral health services, this is not always the case.

Start your free trial today or request a live demo to see how we can help you get billing right. Another tip for submitting claims properly is to familiarize yourself with common claims forms that many insurance companies use, such as the UB-04 form. This form is usually reserved for mental health clinics and specialized health centers for medical billing. The UB-04 and other mental health forms are uploaded on some compliant software programs, making it easier for you to electronically fill out and file the form. However, regardless of the services you provide, it’s always a good idea to check that your patient is covered for the mental health services they need. Performing a VOB can also help you determine the amount that your patient’s insurance company will pay for the services they are seeking.

Coding Information

To do this, you can call the patient’s insurance company provider using their account number to get a better idea of their benefits. If you know the available coverage for every patient before you provide services, it will be much easier for you to submit proper claims and minimize frustration for you and your patient. This may take mental health billing some additional time on your part, but it will be worthwhile when you can avoid common mistakes. If you want to check your patient’s coverage, you can perform a verification of benefits (VOB). This procedure will give you a better idea of your patient’s insurance plan and provide them with treatment and services accordingly.

CPT codes are five digit numeric codes describing everything from surgery to radiology to psychotherapy. The guidelines for properly reporting interactive complexity have been https://www.bookstime.com/ revised and the new rules became effective on January 1, 2022. Read on for guidance on how to report interactive complexity and some clinical examples of when it applies.

For Clinicians: CPT Codes for Psychotherapy and Other Psychology Services

In simple terms, if the insurance provider rejects your ICD-10 code, they wont cover the services you provided to your patient, and you wont get paid. While each state is different, many have expanded coverage for telebehavioral and telemental health during the COVID-19 public health emergency. Many states currently match Medicare’s telebehavioral and telemental health coverage. Medicare and some Medicaid programs will continue to cover telebehavioral health through December 31, 2024. Information on Medicaid reimbursement for telehealth by state is available at the Center for Connected Health Policy with live policy trend maps. Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the psychiatric procedure.

• If their diagnosis changes, you need to update it on your claims forms.
• Payments for the CoCM codes go entirely to the primary care physician who bills for the service, Dr. Ratzliff told webinar viewers.
• Ensuring that all components of mental health billing are accurate and on time can be challenging.
• At least one of the four complicating factors identified in the CPT manual must pertain in order for providers to report the interactive complexity code as an add-on to the principal psychiatric procedure.
• Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server.
• Double-checking patient insurance can also help you identify authorization requirements or any changes in their plan or coverage — as many patients may forget to inform you of changes.
• Clinicians use these codes to bill clients and file health insurance claims to private insurance providers and government insurance providers such as Medicare and Medicaid.