Complete Guide to Mental Health Billing Updated for 2022

This website and its contents are for informational purposes only and should not be a substitute for experienced medical advice. We recommend consulting with your medical provider regarding diagnosis or treatment, including choices about changes to medication, treatments, diets, daily routines, or exercise. Certain aspects of mental health treatment are covered by Original Medicare (Parts A & B), while others are covered by Medicare Advantage (Part C) and Medicare prescription drug coverage (Part D). The coding system for insurance claim modifiers can be complex and difficult to learn.

Modifiers can describe the license level of provider, when services were provided, and how the services were provided, among other things. While it is very rare to require HE for routine behavioral health claims, a service like TheraThink can call ahead to make sure it is being properly billed with HE or any other modifier. A billing service such as TheraThink can help to determine by asking the insurance company if HE is required when you file a claim.

Telehealth codes for Medicare reimbursement for telebehavioral health

In mental health billing, modifiers help to specify unique circumstances, exceptions, or special considerations related to the service rendered. These modifiers are essential for accurate and appropriate reimbursement, reducing claim denials, and ensuring effective communication between providers and payers. Common Procedural Technology (CPT) codes are also necessary for billing for therapists and other mental health providers. Now that you know how ICD codes are relevant to insurance billing, CPT codes have a similar role. ICD codes are used primarily for diagnosing a patient, whereas CPT codes are used to support the diagnosis with the necessary medical treatment. 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.

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. While there are many codes that may be applicable to mental health services more broadly, in a therapy setting, you’ll probably find yourself using only a relatively small subset of these codes. Learning the most common CPT codes for mental health will help you choose the best code for each service you provide.

Beginner’s Guide to Mental Health Billing Video

Most payers will request that you use modifer 95 on your telehealth sessions. However, a smaller number of payers will expect you to use the GT modifier. In addition, there are other rarely used modifiers that can indicate some type of remote service was provided. While modifier 95 is your mental health billing safest bet, if there’s any question about how to code for the particular type of telehealth service you provide, you may want to ask a coding specialist in order to be certain. However, because the procedure codes are the same, the fee schedule reimbursement should remain the same.

• Psychiatric Diagnostic Procedures may be covered once, at the outset of an illness or suspected illness.
• CPT codes also contain E/M codes — Evaluation and Management codes — which are also often used.
• During these difficult and uncertain times, psychotherapy and mental health services are more important and more in-demand than ever.
• Medicare only provides mental health insurance for therapy provided by a licensed psychiatrist, clinical psychologist, or other health professionals who accept Medicare assignment.
• For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Behavioral health billing modifiers are necessary to indicate the specific type of services provided, such as those that are extended, unique, or exceptional. This information helps the insurance companies determine the reimbursement amount for the services provided and helps in proper claim processing and payment. The UD modifier is specific to Missouri and is used to identify mental health services provided by Licensed Professional Counselors (LPCs). It is a state-specific modifier required for billing purposes in Missouri.

Make and store copies of insurance cards.

If you’ve mailed in claims, wait 4 weeks to call and verify claims are received. If they haven’t been received, verify their claims address and submit again. However you end up doing them, you need to transcribe this information onto a CMS1500 form and send it electronically or physically to the insurance company. Like other HCPCS, HE should be used under the 24d field on the CMS 1500. Your MCD session is currently set to expire in 5 minutes due to inactivity. If your session expires, you will lose all items in your basket and any active searches.

Part B will also cover family counseling if its goal is to help your condition improve. Additionally, Medicare Part B may cover up to four sessions of alcohol abuse counseling. Using modifiers on insurance claims helps to ensure that providers are being reimbursed accurately for the https://www.bookstime.com/ services they provided. This helps to reduce the risk of fraud and abuse by ensuring that the services provided are accurately reported and billed. To see which telebehavioral and telemental health services Medicaid covers, check your state’s current laws and reimbursement policies.