Behavioral Health Billing That Understands the Complexity
E&M + psychotherapy add-ons, mental health parity, telehealth rules, prior auth for medications, patient collections — our behavioral health billing team resolves the issues that cost psychiatric practices the most.
96.1%
Clean Claim Rate
4.3%
Average Denial Rate
22 Days
Average AR Days
+340%
Average Patient Collections Improvement
BILLING CHALLENGES WE SOLVE
Why Behavioral Health Billing Is Uniquely Complex
Six specific billing challenges that cost psychiatry and behavioral health practices the most — and how we address each.
E&M + Psychotherapy Bundling
Billing E&M and psychotherapy on the same day requires careful use of add-on codes (90833, 90836, 90838). Most payers require specific time documentation and separate medical decision-making support. Incorrect bundling is the #1 denial reason in psychiatry.
Mental Health Parity Compliance
MHPAEA requires payers to cover behavioral health at parity with medical benefits. When payers apply more restrictive limits to psychiatric services, there are appeal and legal remedies available. We identify parity violations and escalate appropriately.
Prior Auth for Psychiatric Medications
Prior authorization for newer antipsychotics, LAIs, and branded formulations is among the most time-intensive processes in any specialty. Our prior auth team maintains formulary-specific approval workflows for every major payer.
Telehealth Billing for Behavioral Health
Post-pandemic telehealth rules for behavioral health remain in flux. Audio-only visit billing, place of service modifiers (95, GT), originating site requirements, and state-specific telehealth mandates all affect how claims are submitted.
Patient Collections Strategy
Behavioral health practices have historically low patient collection rates due to sensitivity around balances. Our approach uses a professional, staged statement series with soft-touch follow-up that collects without damaging the therapeutic relationship.
Group Therapy Billing
Group psychotherapy (90853) has specific group size requirements, separate session documentation for each participant, and payer-specific approval criteria. Our coders verify compliance for every group therapy submission.
How Aethera Handles Behavioral Health Billing
Behavioral health billing occupies a unique intersection of psychiatric coding complexity, parity law compliance, and patient sensitivity. Our team is trained to handle all three dimensions simultaneously — submitting claims correctly while protecting the therapeutic environment your practice depends on.
We work with psychiatric practices of all sizes and compositions, from solo psychiatrists to multi-provider behavioral health groups including prescribers, therapists, and social workers all billing under the same TIN.
Our behavioral health billing covers:
E&M + psychotherapy add-on code management (90833, 90836, 90838)
Standalone psychotherapy (90832, 90834, 90837)
Psychiatric diagnostic evaluations (90791, 90792)
Group psychotherapy (90853) documentation compliance
Telehealth billing — video and audio-only
Collaborative care model codes (99492–99494)
Crisis psychotherapy (90839, 90840)
Prior auth for psychiatric medications and LAIs
Mental health parity appeals
Patient statement series and soft-touch collections
All behavioral health provider types (MD, PhD, LCSW, LPC, MFT)
Substance use disorder billing (H-codes, HCPCS)
PROCEDURE CODES
Common Psychiatry CPT Codes We Bill
Behavioral health procedure codes our team handles daily — each with specific documentation and payer rules.
| CPT Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
| 90792 | Psychiatric diagnostic evaluation with medical services |
| 90832 | Psychotherapy, 30 minutes |
| 90833 | Psychotherapy add-on, 30 min (with E&M) |
| 90834 | Psychotherapy, 45 minutes |
| 90836 | Psychotherapy add-on, 45 min (with E&M) |
| 90837 | Psychotherapy, 60 minutes |
| 90838 | Psychotherapy add-on, 60 min (with E&M) |
| 90853 | Group psychotherapy |
| 90839 | Psychotherapy for crisis, first 60 minutes |
| 99214 | Office visit, established, moderate MDM |
| 99215 | Office visit, established, high MDM |
Behavioral Health Group
Bundling edits on E&M + therapy claims, 34% prior auth denial rate on new medications, and essentially zero patient collections — balances were being written off entirely.
Bundling Denials
Frequent
Eliminated
Prior Auth Approvals
66%
89%
Patient Collections
Baseline
+340%
Net Revenue
Baseline
+$31K/mo
FAQ
Psychiatry Billing Questions
Common questions from psychiatrists, psychologists, and behavioral health practice managers.
How do you handle E&M + psychotherapy billing on the same day?
We apply the correct add-on codes (90833, 90836, 90838) when your provider performs both medication management and psychotherapy in the same visit. We review your session documentation to confirm that both services are independently documented and meet payer requirements before submitting.
Our telehealth volume is high. Do you handle audio-only visits?
Yes. Audio-only behavioral health billing has specific modifiers and place of service rules that vary by payer. We track the current telehealth rules for each of your payers and apply the correct POS codes (02, 10), modifiers (95, GT), and audio-only-specific codes where applicable.
We write off a lot of patient balances. Can you improve our patient collections?
This is one of the most common issues in behavioral health. We implement a professional, staged collection process: first statement with clear balance explanation, follow-up call at 30 days, second statement, final notice. Most practices see 200–400% improvement in patient collections without a single difficult conversation for the clinical staff.
How do you handle prior auth for psychiatric medications that require step therapy?
Our prior auth team maintains step therapy protocols for the top 20 psychiatric medications by payer. We document step therapy failure, submit appeals with clinical notes, and escalate to peer-to-peer reviews when appropriate — all without requiring physician time on phone holds.
Do you work with therapists and psychologists in addition to psychiatrists?
Yes. We bill for all behavioral health provider types: psychiatrists (MDs/DOs), psychologists (PhDs/PsyDs), licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), and marriage and family therapists (MFTs) — each with the correct rendering provider credentials and taxonomy codes.
Ready to Maximize Your Behavioral Health Revenue?
Start with a free psychiatry billing assessment. We'll audit your E&M + therapy bundling, prior auth denials, and patient collection patterns.
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