Difference Between Mental Health Billing & Medical Billing! A Complete Guide

Recent times have helped people understand that their mental health is as significant as their physical strength to lead a healthy life. However, the sudden increased demand for mental health care services has provoked some challenges for mental health practitioners as well. Now, practitioners are more over-whelmed and under-supported in many areas and mental health billing is one of them. 

Generally, medical billing is a complicated task for healthcare providers and they need the full support of their administrative staff to comply with the ever-changing medical billing and coding rules. On the contrary, many healthcare practices are not working at a very large scale and some don’t even have sufficient resources to proceed with mental health billing services. It makes their claims process slow and frustrating which makes it difficult for practitioners to collect their reimbursements on time. 

Therefore, a study establishes that mental health providers are often paid lower than other specialty practitioners. According to a Milliman study, primary care was more than 23% higher than behavioral and mental health reimbursements. Combined with complex billing rules, it’s no wonder that therapists and psychiatrists are often out-of-network, therefore, most patients become reluctant to visit a therapist due to financial problems. 

If you’re navigating the tricky waters of behavioral and mental health billing services, don’t give up! This article features the key information that highlights the difference between mental health and behavioral billing and the right way to execute the billing tasks. 

Let’s understand the fundamental significance of mental health and behavioral billing services and how it differs from medical billing; 

How Is Mental Health Billing Different From Medical Billing?

The primary difference between mental health billing and medical billing are the limits and restrictions applied by the insurance companies for behavioral health claims. 

Moreover, behavioral health therapies are delivered in non-clinical settings as well e.g. schools, corporate companies, and other institutes. Therefore, they are billed and reimbursed according to different standards. 

Since behavioral health includes more nuanced treatment plans, therefore, insurance companies reimburse therapy sessions of the same patient differently. 

For example, billing for a 45-minute-long session would be different from a yearly wellness check or lab test. 

Different Billing For Different Session Lengths

In medical billing, CPT codes are assigned to different procedures according to the nature of service. For example, CPT code 36415 is used for a blood draw or code 99385 for a well-woman visit for a new patient ages 18-39.

On the other hand, mental health billing depends upon the time of the session. This means that a patient will be billed using a CPT code that is closest to the amount of time of the patient-therapist encounter. 

For example

90832: 30 minutes of individual psychotherapy (fits for sessions 16-37 minutes)

90834: 45 minutes of individual psychotherapy (fits for sessions 38-52 minutes)

90837: 60 minutes of individual psychotherapy (fits for sessions 53+ minutes)

90846: 50 minutes of family psychotherapy without the patient/client (fits for sessions 26+ minutes)

90847: 50 minutes of family psychotherapy with the patient/client (fits for sessions 26+ minutes)


Appointment Limits For Mental Health & Behavioral Therapy Sessions

For most health insurance companies, there are limits on how many mental health sessions or services you can deliver to your patient in a certain time. For example, an insurance company allows you one session per day or week. 

Therefore, it’s important to understand the appointment limits of each insurance company to charge them for reimbursement. Otherwise, if you have delivered more sessions to a patient than the appointment limits of his/her coverage plan then you’ll face claim denials and you won’t get your reimbursements. 

Customized Treatment Plans For Different Services

There is a one-size-fits-all coverage plan for mental health coverage plans. Therefore the insurance plan of each patient varies from another. It is the responsibility of mental health coding and coding specialists to go through the customized insurance plan of each patient at the beginning of mental health revenue cycle management (RCM) 

Prior Authorizations For A Certain Number Of Visits

More often, insurance companies require prior authorization (pre-authorization) before approving a medical claim for mental health care and behavioral therapy services. However, this requirement varies from payer to payer or service to service for mental health care. 

Therefore, mental health billing specialists should verify the insurance eligibility criteria of each patient and proceed with prior authorization as needed. Even though, some insurance companies require prior authorization for not only an initial visit but also for additional care after a certain number of p[atient visits. 

Service Location (Telehealth)

Since, the COVID-19 pandemic, clinicians tend to provide mental health care and behavioral therapy via telehealth. In some cases, CPT codes for physical care services are similar to telehealthcare services, however, in some cases, you have to add modifiers along with the CPT codes. 


95 modifier: This modifier is used with a medical code if the interaction is real-time (but not recorded) and it is done virtually via a telecommunication system (such as video chat).  

02 modifier: This code shows that the point-of-service (POS) for the interaction was a telecommunication system. On the other hand, you would use the 11 POS modifier for an office-based visit. 


Moreover, there are some modifiers for behavioral health telemedicine billing codes that are introduced by the Healthcare Common Procedural Coding System (HCPCS). Usually, these codes start with the letter “G”. For example, 


G2010: Remote evaluation of an established patient’s recorded video

G2012: Virtual check-in or short, patient-initiated visit


Other HCPCS telehealth codes can include:


99421: Online evaluation and management with an established patient; five to 10 cumulative minutes over seven days

99422: Online evaluation and management with an established patient; 11-20 cumulative minutes over seven days

99423: Online evaluation and management with an established patient; 21+ cumulative minutes over seven days


Use Superbills More Frequently

Mostly, patients’ insurance plan doesn’t cover mental health services which makes therapists out-of-network. Therefore, mental health practitioners use superbills to collect reimbursements. On the other hand, physical therapy practitioners are usually in-network and they don’t need to charge superbills more often. 


Mental health care providers can file and submit superbills to speed up their reimbursement process because superbills are a great alternative to joining an insurance panel and becoming in-network. 


Changing Regulations For Mental Health Practitioners

With mental health becoming a major concern for everyone around the globe, it has become a significant field of the healthcare industry. Just like other areas in the medical field, mental health practice also features complex billing rules and coding standards that keep changing regularly. 


Institutes are introducing several new medical codes for mental health practice, especially after the COVID-19 pandemic.  The Centers for Medicare and Medicaid Services (CMS) are still working to update its telehealth fee schedules. 


Therefore mental health billing specialists should stay in the know about the changing billing standards and new medical codes. So they don’t miss out on any essential information and stay stuck to obsolete practices. Because using outdated medical codes causes claim denials and significant revenue loss to a mental health care practice. 


You can stay on top of these challenges with the help of hyperactive mental health billing and coding staff. If you don’t have any then partner with CureCloudMD. We are a US-based medical billing company offering HIPAA-compliant, cost-effective, and reliable mental health and behavioral therapy billing outsourcing services. Book a free demo of our medical billing solutions. 

Leave a Reply

Your email address will not be published. Required fields are marked *