Behavioral & Mental Health Billing

Behavior & Mental health billing can get complicated due to the various type of services offered to patients and the insurance plans, deductibles and other variations by state, payer and plan. Our behavioral health billers & medical coders   have been trained specifically for mental health. Apart from our years of experience in Behavioral & Mental health billing we can offer analytics and automation based services to increase revenue, reduce denials and insurance AR. We have a client base that extends over 10 states covering a wide range of mental health providers. Our certified coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).

We support mental health billing for services offered by

• Psychiatrists
• Psychologists
• Counselors
• Clinicians
• Therapists
• Social workers
• Primary care physicians

We also support Behavioral health billing for

• Psychotherapy billing
• Psychologist billing
• Psychiatric billing
• Therapy billing

Some of the Mental Health CPT Codes we bill include :

• 90785 - Add-on code for interactive complexity
• 90791 – Psychiatry / Psychology intake secession – Without Medical secession
• 90792 - Psychiatry / Psychology intake secession – With Medical secession
• 90832 to 90837- Psychotherapy established secessions
• 90846 to 90847- Family psychotherapy
• 90853 – Group Therapy
• 96127 - Brief emotional/behavioral assessment
• 96130 - Psychological testing evaluation
• 96131 - Psychological and Neuropsychological Testing Evaluation Services
• 96136 – 96137 - Psychological or neuropsychological test administration/scoring
• 99051 – Add on for Psychiatry secession
• 99404 – New / Established EAP code

Key challenges in Mental Health billing include

Claims are processed and paid based on the provider type and fee schedules vary for each type of providers.

Solution: Plutus team will verify the provider type during the eligibility verification and exact provider information will be added.

Patient benefits need to be verified before submitting the claims, most of the patient might not have Mental health benefits they might have only Health benefit coverage.

Solution: Eligibility verification is done to determine whether the services will be covered by payer for the appointment date or not, if not covered same will be updated to client.

Usual commercial payers will be completely different, for instance, Instead of Aetna we need to bill the claims to Aetna Behavioral health. (Exact payers need to be verified before claim submission)

Solution: Proper payer ID#, Address will be verified before claims submission and same will be documents in PM software.

For Medicaid CO and few other commercial payers require Authorization number In-order to process the claims.

Solution: Based on client SOW, Plutus will be sending notification for obtaining prior Authorization or Plutus team will obtain Authorization and update them in PM.