This beginner's guide to mental health billing is for the brand new and having-no-clue outpatient therapist looking to learn how to bill insurance companies. You will learn what client information you need, how to verify mental health benefits, create and submit claims, and account for EOBs.
Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated.
Our beginner’s guide to mental health billing will first discus your client information, then the most frequently used CPT codes, how to verify eligibility and benefits, and finally how to submit claims.
Otherwise, let’s start with information about your patients.
Minimum Required Patient Information
Required Demographic Information:
- Your patient’s full legal name
- Your patient’s date of birth
- Your patient’s address
- Your patient’s gender (male or female, not the most progressive)
- Their Social Security Number (almost never required)
- Case Notes (keep them, however, if you need to provide evidence of medical necessity)
- Their Phone Number (good idea to collect this, though)
- Their Email Address (also a good idea to collect this)
Required Insurance Information:
- Their Subscriber ID with the Alpha Prefix (always record letters and numbers in their subscriber ID, not just numbers)
- Group Number
That being said, we recommend snapping a front and back photo of their insurance card for your records.
Having the customer service phone number isn’t essential for submitting claims, but is necessary to gather eligibility and benefits information and to verify claim status and payment amounts.
Time to move onto CPT codes.
The Three Most Often Used CPT Codes
- 90791 – Intake session — to be billed for your first appointment with that patient exclusively
- 90834 – 45-55 Minute Individual Therapy Session
- 90837 – 56+ Minute Individual Therapy Session
It’s as straight forward as it seems: bill the intake code for their first session, and bill either a 45 minute or 60 minute session for the rest, depending on the length of their sessions.
Dealing with family therapy, therapy with a family member with the patient not present, group therapy, or other cases? Review our definitive guide to CPT codes to get sorted!
Which Diagnosis To Use
We cannot and will not advice you to use a single diagnosis code, even though it is a very common practice for therapists to use one code for all of their patients (e.g. anxiety or depression).
It is your duty, as demanded by submitting any insurance claim, to submit the most accurate diagnosis you possibly can for each session. If their diagnosis changes, you need to update it on your claims forms.
A few tips: always use a specified diagnosis. Since the ICD10 / DSM-5 change, unspecified diagnoses are being rejected by Medicare.
Otherwise, just use the most accurate diagnosis code. FOr a simple tool to quickly look up which diagnosis to use, check out our “Mental Health Diagnosis Finder Tool“, it’s free!
Okay! You have all the necessary patient and session information to file claims. Now it’s time to check eligibility and benefits to ensure they have coverage that will reimburse you.
How to Check Eligibility and Benefits
We have a guide called “How to Check Mental Health Eligibility and Benefits” at this link which contains a script and thorough questions to ask so you gather all necessary information.
If you want the quick and dirty version, you’ll need to:
- Call the insurance card via the customer service phone number on the back of the card
- Ask to verify mental health outpatient provider eligibility and benefits
- Give them your NPI and Tax ID and ask if you are in-network
- Give them the patient’s name, date of birth, and subscriber ID
- Ask them for the patient’s deductible, copay, and coinsurance. Record them all
- Ask for the claims addresess
- Try not to pull out all of your hair while you do the whole thing
- Consider reaching out if you want us to handle any or all of this for you, if the above already sounds too pain-inducing
Okay! You now have all the necessary information to file claims, you know what to charge the patient in person, and you know where to file the claims.
How to Submit Claims
Unfortunately, this is the extremely annoying, hard part. There is no “quick guide” way of handling this process.
The cheapest option is to learn how to use “PracticeMate” by OfficeAlly to submit claims, even though it is made for hospitals.
You can try to use a purely software solution to input the data and create the forms. You can reach out to us for help: we do every part of the billing process for you. (Not free but you may live longer without that stress).
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.
Once you’ve done that..
Call and Verify Receipt of Claims & Payment Information
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.
It’s critical to submit them within the 90 day timely filing window most insurance companies hold you to (not all, but most).
Once claims are verified as received, it’s time to hurry up and wait until payment. Often processing takes two to three weeks after receipt of the claims, plus the time to mail checks.
You will received EOBs in the mail along with a check for those dates of service.
Finish with EOB Accounting
Finally, add them to your appointment list spreadsheet or tracker, including check number, patient responsibility, amount reimbursed by insurance, and perhaps the amount you collected in session.
Our Beginner’s Guide to Mental Health Billing in Summary
- Collect Client Demographic and Insurance Information
- Verify Mental Health Eligibility and Benefits
- Verify Claims Submission Requirements
- Create and File Claims Coded with the correct Mental Health CPT Codes
- Follow Up With Your Pending Claims
- Account For Your Payments via EOB Reconcillation
And each of those steps aren’t exactly one step, unfortunately.
But at least you now have a comprehensive idea of how to bill mental health insurance.
It’s a damn shame that submitting insurance claims is such a pain.
We wish it were easier, as the whole process causes revenue loss, frustration, and inefficiency in our health care system.
That being said, if you just want to gather up your new patient’s demographic info and their subscriber ID, we can take care of the rest.
Hopefully this guide was a helpful introduction to mental health billing claims.
Please let us know in the comments how we can improve it, answer your questions, and simplify the process.