Why credentialing comes first
In behavioral health billing, the first question isn't "what code do I use?" It's "am I in-network with this patient's insurance?" An insurance company will only pay you at in-network rates after you've been credentialed and contracted with it. Until then, claims are processed as out-of-network or denied outright.
That makes mental health credentialing the foundation of mental health billing. The provider details on every claim (your name, NPI, tax ID, and service location) need to match what each insurer has on file from credentialing.
Your effective date
When an insurance company approves you, it assigns an effective date, the first date you're considered in-network. Services before that date generally can't be billed in-network. Know your effective date for every payer before scheduling that insurer's members, and don't assume approval with one plan means approval with its affiliates.
Eligibility and benefits verification
Before a patient's first visit, and periodically after that, verify:
- The patient's coverage is active
- Whether behavioral health benefits are managed by the medical plan or a separate behavioral health organization
- You're in-network for that specific plan
- Copay, coinsurance, and deductible
- Any visit limits or prior authorization requirements (common for TMS)
Common behavioral health billing codes
Behavioral health uses a specific set of CPT codes. Some of the most common:
| Service | CPT codes |
|---|---|
| Psychiatric diagnostic evaluation (without / with medical services) | 90791 / 90792 |
| Psychotherapy, 30 / 45 / 60 minutes | 90832 / 90834 / 90837 |
| Psychotherapy add-on with an E/M visit (medication management plus therapy) | 90833 / 90836 / 90838 |
| Family psychotherapy (without / with patient) | 90846 / 90847 |
| Group psychotherapy | 90853 |
| TMS: initial treatment and mapping / subsequent delivery / re-determination of motor threshold | 90867 / 90868 / 90869 |
Medication management visits are typically billed with evaluation and management (E/M) codes, with a psychotherapy add-on when therapy is also provided. Each insurer has its own rules for which license types can bill which codes, so the codes you can use depend on your credentials as well as the service.
Billing for telehealth
Telehealth claims usually need a telehealth place-of-service code (such as POS 02 or 10) and, for some insurers, a modifier such as 95. Requirements differ by insurance company and change over time, so check each payer's current telehealth policy. Remember that you must be licensed in, and credentialed for, the state where the patient is located.
Claims, payment posting, and reporting
Once services are coded, claims are created and submitted (usually electronically through a clearinghouse), then tracked until the insurer processes them. When payments arrive, they're posted against each claim and reconciled with the insurer's explanation of benefits, so underpayments and patient balances are caught. Monthly reporting on collections, outstanding claims, and trends shows how the practice is actually doing.
Why behavioral health claims get denied
- Not credentialed, or billed before the effective date. The most avoidable denial there is.
- Provider information mismatch between the claim and the insurer's credentialing records.
- Eligibility issues: inactive coverage, or benefits carved out to a different behavioral health organization.
- Coding errors: wrong time-based psychotherapy code, missing add-on pairing, or a code your license type can't bill.
- Missing authorization where the plan requires it.
- Telehealth errors: wrong place-of-service code or modifier.
Billing readiness checklist
Before you bill a new insurance company, confirm:
- Credentialing and contracting are complete with that insurer
- You know your effective date and provider ID
- Your NPI, tax ID, and service locations match the insurer's records
- You have a process to verify each patient's eligibility and benefits
- You know the codes your license type can bill with that insurer
- You know the insurer's telehealth and authorization requirements
- You have a plan for claim tracking, payment posting, and reporting
How Becker Credentialing can help
Becker Credentialing Services handles both sides for mental and behavioral health practices in any state, including telehealth practices. We credential you with commercial insurance companies and confirm your effective dates, then our behavioral health billing team handles eligibility verification, claim submission and tracking, payment posting, patient statements, and monthly reporting, for psychiatry, medication management, therapy, counseling, and TMS.
FAQs
What is the difference between behavioral health billing and general medical billing?
Behavioral health billing uses its own set of time-based psychotherapy and psychiatric codes, often involves separate behavioral health organizations managing benefits, and has license-specific rules about who can bill which services. Telehealth is also far more common in behavioral health.
Can a billing company fix claims denied because I wasn't credentialed?
Usually not in-network. If services were provided before your effective date with an insurer, they generally can't be billed in-network. That's why billing and credentialing need to be coordinated from the start.
Does TMS require prior authorization?
Many insurance plans require prior authorization for TMS, along with documentation of previous treatment. Requirements vary by plan, so verify benefits before starting treatment.