Specialty Behavioral Health Billing Services | Olympus

The Beginner’s Guide to Behavioral Health Billing

You need behavioral health billing solutions because the billing feels like reading a foreign language textbook, it’s complex and confusing! We don’t blame you for feeling totally lost here. But at the same time, billing done right is crucial for getting paid for your hard work in helping people. You got into this field to change lives, not become an expert coder and biller overnight! So where do even start for behavioral health billing solutions? We’ll tackle this step-by-step so you can bill correctly and get the reimbursement you deserve for the life-changing services you provide.

What is Behavioral Health Billing?

Behavioral health billing refers to the processes and systems for submitting insurance claims and getting reimbursed for mental health or substance use disorder treatment services. It includes sending claims to private insurers, Medicaid, Medicare, etc. to get payment for the care you provide. The types of treatment and care that fall under the behavioral health billing umbrella includes:
  • Mental health counseling or psychotherapy – both individual and group sessions
  • Family therapy or counseling when working with clients and their families
  • Evaluation and assessment appointments to diagnose conditions and develop treatment plans
  • Medication management for psychiatric medications
  • Intensive outpatient programs for mental health or addictions
  • Partial hospitalization programs as an alternative to inpatient care
  • Residential treatment programs when clients stay onsite during treatment
  • Crisis intervention for clients experiencing urgent mental health needs
So in simple terms, any services that help assess, diagnose, treat, and support individuals dealing with mental health or substance abuse issues. The billing process is what allows you to obtain payment for providing these incredibly needed services. Make sense so far?

Why Behavioral Health Billing is Different

You might be wondering – how does behavioral health billing differ from medical billing for physical health services? There are a few key differences:
  • It uses very specific procedural and diagnostic codes to denote the services delivered – more on those coming up later!
  • There are special rules and policies set by Medicaid, Medicare, and private insurance companies that behavioral services need to follow.
  • The overall claims process, paperwork, and systems tend to be more extensive and complex compared to medical billing.
  • Documentation and confidentiality requirements have unique aspects for mental health services.
But the overall purpose is fundamentally the same – to obtain reimbursement for caring for people in need and helping them get healthier!

Key Billing Codes Used for Behavioral Health Claims

Now we’re going to dive into the billing codes themselves. We’ll go through the main ones you need to know:

CPT Codes for Counseling and Therapy Services

CPT stands for Current Procedural Terminology, and these codes represent specific medical services like office visits, procedures, and therapy. They are numbers between 10000 and 99999. Some examples for behavioral health are:
  • 90832 – 30 minute psychotherapy or counseling session
  • 90834 – 45 minute psychotherapy or counseling session
  • 90837 – 60 minute psychotherapy or counseling session
  • 90846 – Family therapy or counseling without the client/patient present
  • 90847 – Family therapy or counseling with the client/patient present
So you’ll use these sorts of CPT codes anytime you bill for individual, family, or group therapy sessions.

HCPCS Codes for Other Behavioral Health Services

HCPCS stands for Healthcare Common Procedure Coding System. These are alphanumeric codes that represent things like medical supplies, equipment, drugs, and also services not covered by the CPT codes above. Some examples:
  • H0004 – General behavioral health counseling
  • H0031 – Mental health assessment like psychosocial evaluation
  • H0046 – Mental health services not classified elsewhere
So HCPCS tends to capture other care beyond just the therapy session codes.

Codes for Higher Levels of Care

There are specific codes that represent intensive mental health services for clients who need more support:
  • H0017-H0019 – Residential treatment programs at different intensity levels
  • H2001 – Partial hospitalization for mental health treatment for less than 24 hours
  • H2011 – Partial hospitalization for 24 hours or more
These codes are used for clients in higher levels of care like partial or residential treatment programs. The specific codes may vary over time, but this framework helps understand the structure. 

Modifiers – Not As Scary As They Sound!

Along with the CPT and HCPCS billing codes, you’ll also see 2-digit modifiers used on claims. These provide additional details about the service or care delivered to help the insurance companies process the claim accurately. Some examples of modifiers commonly used in behavioral health billing solutions include:
  • GT – Indicates the service was delivered via telehealth video or audio
  • HE – Signals the service was performed in a non-typical mental health setting like a school or home
  • HO – Clarifies the therapy was performed in a group setting
  • HW – Specifies the therapy was family therapy with the client present
  • HX – Identifies the therapy was family therapy without the client present
  • SA – Notes the service was provided by a nurse practitioner rather than MD
  • UA – Indicates the service was medically necessary
  • UB – Means the insurer must “use it or lose it” – like granting more therapy sessions
  • UC – Shows the patient’s cost sharing amount for Medicaid
These 2-digit codes may seem odd, but they play an important role in giving insurers all the details needed to process claims and reimburse you accurately. Modifiers provide that extra context so your hard work translates into fair payment!

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Billing Services for Mental Health Providers

Follow The Rules To Stay Out of Trouble!

Billing correctly goes beyond getting claims paid – it’s also about staying compliant with umpteen regulations. Some key areas to keep straight:
  • Only use valid codes active for the date the service was delivered. Keep them codes current!
  • Get proper consent, disclosure, and authorization forms signed by each client. Don’t cut corners!
  • Make certain all clinical and medical staff have current licenses, credentials, and malpractice insurance on file. Dot those i’s and cross those t’s!
  • Document medical necessity and treatment goals so insurers know care is appropriate. Don’t let ’em second guess you!
  • Follow all privacy and confidentiality laws about protecting health info and sharing only with those authorized. Lock it down tight!
  • Set up systems to catch issues before they become big problems down the line. An ounce of prevention is worth a pound of cure!
  • Consult compliance experts when guidance is needed in gray areas. Two minds are better than one!
Having an experienced billing partner helps stay current on the seemingly ever-changing regulations while you focus on client care.  Their expertise keeps you compliant and out of hot water! But you’ve still got to do your part too.

Should I Just Outsource This Billing Madness?

If you’re trying to handle billing in-house, outsourcing to a pro may be the self-care you need! Here’s some food for thoughts if you do it alone:
  • Ever-evolving codes, rules, and laws are complex and time consuming to keep up with. Can you commit to ongoing training and education?
  • Hiring the right billing and coding staff requires paying competitive salaries and benefits. Can you afford it in your budget?
  • Denials inevitably happen and appeal processes to get claims reprocessed take days of work. Do you have ample time for appeals?
  • Specialized behavioral health billing solutions and tools are pricey. Is that IT investment feasible right now?
Of course you can choose to build an internal team. But also know that outsourcing to an experienced billing company offers some nice perks:
  • Access the latest expertise for maximizing revenue and streamlining workflows
  • Leverage economies of scale and proven practices that improve efficiency
  • Avoid the high fixed costs of salaries and overhead needed in-house
  • Minimize compliance risks and centralize needed auditing processes
  • Stay focused on client outcomes and program quality instead of billing busywork
Essentially, the right billing partner serves as an extension of your team – their specialized skills complement yours. 

Final Thoughts

Ready to optimize your revenue cycle or still have more questions? Reach out anytime – We are here to help you!