Psychiatry Billing Services

E/M with psychotherapy add-ons, medication management, telepsychiatry coding and prior authorization.

Psychiatry is billed on a combination no other specialty uses. You bill an E/M service for the medical work, plus a psychotherapy add-on for the therapy in the same session. Each needs its own time documented separately. Two things cause most psychiatric denials we unpick. Billing the add-on without that separate time. Or billing a standalone therapy code when an E/M was done. Our psychiatry billing services code both halves from the note.

Practices comparing psychiatric billing services should also ask about the behavioral carve-out. For many plans the claim and the authorization go to Optum or Evernorth. Not to the carrier whose name is on the card.

Our Services

What Our Psychiatry Billing Covers

Our psychiatry billing services are handled by mental health billing specialists. They code psychotherapy, diagnostic assessment, neuropsychological assessment and the reporting of findings.

Key Attributes of Our Medical Billing Services:

  • Charge Entry

    Your claims come to us and go into our billing software. We hold accuracy above 98% within 24 hours. We get there by automating the routine steps, handling patient data carefully, checking eligibility and chasing insurers quickly.

    Claim Scrubbing

  • Claim Scrubbing

    Sessions that combine an E/M service with psychotherapy are checked for two separately documented times before they go out. The add-on without its own recorded time is the most common psychiatric denial there is.

    Insurance and Rejection

  • Insurance and Rejection

    Most psychiatric rejections are carve-out rejections. The claim or the authorisation went to the carrier when Optum or Evernorth actually administers the behavioral benefit. We route by product, not by what is on the card.

    Payment Posting

  • Payment Posting

    Payments are posted against the behavioral fee schedule, not the medical one. For the same code under the same carrier, those two are often different.

    Patient Statements

  • Patient Statements

    Statements are written to protect confidentiality. They show service dates and balances, with no diagnostic detail. That matters more in psychiatry than anywhere else we bill.

    Illustration of a doctor writing a prescription for a patient

  • Optimize Efficiency

    We track authorisation counts against sessions delivered every week. A block that is about to run out gets renewed before the last covered session, not after it.

    Timely Claim Submission

  • Timely Claim Submission

    Claims go out within 48 hours. Telepsychiatry claims are checked for the right place of service and modifier for that payer before release.

    Reporting icon

  • Reporting

    Reporting separates medication management from psychotherapy, and shows denial reasons by carve-out. That tells a practice which network is costing it money.

    Procedures icon

Procedures

We bill this work every day. That includes, but is not limited to:

  • Forensic (legal) psychiatry
  • Addiction Psychiatry
  • Pain medicine
  • Sleep medicine
  • Psychotherapy
  • Geriatric Psychiatry
  • Child and adolescent psychiatry
  • Psychosocial interventions
  • Electroconvulsive therapy or ECT
  • Psychosomatic (mind and body) medicine

How psychiatric services are actually coded

Psychiatry has a small code set with strict time rules, and most of its denials come from time and from documentation rather than from diagnosis.

Medication management with therapy

When a psychiatrist provides both an evaluation and management service and psychotherapy in the same session, they are billed together: the office visit code plus a psychotherapy add-on code chosen by time.

Two rules decide whether it survives review. The time counted for the add-on is psychotherapy time only, separate from the time spent on medication management. And the note has to describe the psychotherapy itself, with the modality and what was addressed, not simply state that therapy was provided.

The time thresholds are real

The psychotherapy add-on codes have defined time bands, and the midpoint rule decides which one applies. A session documented as forty five minutes with no start and stop time is a weak record. Times in the note remove the argument entirely.

Interactive complexity

There is an add-on for sessions complicated by specific factors: a third party who has to be involved, a court report, a patient who cannot communicate typically, or high emotional reactivity that interferes with the work. It is billed alongside the primary service and it is under-used.

It is not a code for a difficult patient. The note has to name which factor applied and how it changed the session.

Initial evaluations

There are separate codes for a psychiatric diagnostic evaluation with and without medical services. Which one applies depends on whether medical services were part of the evaluation, not on the clinician's licence alone.

Telehealth

Psychiatry runs more of its work by video than most specialties, and the rules attached to it have changed repeatedly. What matters on every claim is the place of service, the modifier, and whether that payer covers audio only contact for that service. These three vary by payer and by plan, and a setting that was correct last year is worth re-checking rather than assuming.

Psychiatry Credentialing and Behavioral Carve-Outs

If you are looking to outsource psychiatric billing services, the credentialing usually needs a look at the same time. Psychiatrists and psychiatric nurse practitioners are normally credentialed twice: once on the medical panel, and once with the behavioral health network. For many plans that network is run by a separate company, such as Optum for UnitedHealthcare or Evernorth for Cigna. Send the application to the medical plan when a carve-out owns the behavioral network and it is never processed. That one mistake causes most of the delay we see.

Credentialing and claims are one job here. Our psychiatric billing services team bills the same panels this page gets you onto. Prescribers also need DEA and state controlled substance registration checked at credentialing, and the address has to match the practice exactly. See insurance credentialing for therapists and mental health providers for the carve-out map, and nurse practitioner credentialing for PMHNPs.