Mental health billing has its own ruleset: time-based psychotherapy codes, E/M plus add-on therapy, and payer policies that still under-enforce parity. We bill to session detail and push back when payers underpay.
We see the same patterns across mental & behavioral health groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.
Not a complete list. A representative slice of the codes that drive revenue and denials for mental & behavioral health practices.
| Code | Description | Profile |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | High volume |
| 90832 | Psychotherapy, 30 minutes | Modifier-sensitive |
| 90834 | Psychotherapy, 45 minutes | Denial-prone |
| 90837 | Psychotherapy, 60 minutes | High volume |
| 90833 | Psychotherapy add-on, 30 min with E/M | Modifier-sensitive |
| 90846 | Family therapy without patient | Denial-prone |
| 90847 | Family therapy with patient | High volume |
| 90853 | Group psychotherapy | Modifier-sensitive |
Time documented and coded to the closest psychotherapy CPT. E/M plus therapy add-on billed when medication management and therapy occur in same encounter. Telehealth POS (02 for non-home, 10 for home) and modifier 95 applied per payer rule.
Pattern we see. Psychotherapy time not documented, E/M plus therapy add-on denied without separate E/M documentation, and telehealth denied for wrong POS or missing modifier 95.
How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable mental & behavioral health denials averages above 60 percent.
A written 30-day diagnostic. Dollar figures against every finding. No obligation.