Whether you're a solo psychiatrist, a group practice owner, or managing billing operations for a growing behavioral health clinic, the struggle is real: billing for psychiatric services is often a frustrating maze of evolving codes, payer quirks, and rejected claims. But with a proactive approach and a few strategic upgrades, you can dramatically improve claim acceptance, cash flow, and overall sanity.
Here are detailed strategies to get your claims clean, accurate, and reimbursed—on time.
1. Choose the Right CPT Codes—Down to the Minute
Coding errors are one of the most common causes of claim denials and underpayments.
Psychiatric billing relies heavily on time-based CPT codes, which must accurately reflect the services provided. Misusing or misinterpreting these codes—especially when combining E/M (Evaluation & Management) and psychotherapy—is a common trap.
Common CPT Codes for Psychiatrists:
- 90792 – Psychiatric diagnostic evaluation with medical services
- 99214 / 99215 – E/M codes for follow-up visits (used with psychotherapy add-on codes if applicable)
- 90833 / 90836 / 90838 – Psychotherapy add-ons (30/45/60 mins) used in conjunction with E/M
- 90832 / 90834 / 90837 – Standalone psychotherapy sessions
Tip: Know when to use E/M + psychotherapy vs. psychotherapy-only codes. If the visit involves med management plus therapy, you may need both sets—with appropriate documentation justifying each component.
Here's a glossary of popular CPT codes.
2. Verify Insurance Before Every Visit—No Exceptions
You may be seeing a patient weekly, but their insurance plan could change at any time. Eligibility lapses or missing prior authorizations can lead to 100% write-offs.
What to check:
- Plan status (active or inactive)
- Mental/behavioral health coverage specifics (some insurers carve out to a different payer)
- Copay, deductible, and co-insurance
- Authorization/referral requirements
- Telehealth or out-of-network restrictions
Tip: Use an EMR with eligibility checks to verify active coverage before the patient even arrives.
3. Write Notes That Defend Your Codes
Insurance audits are on the rise, especially for high-frequency services and outlier codes like 90837 (60-minute psychotherapy). Your documentation must justify:
- Time spent
- Medical necessity
- Content of the session (including symptoms, interventions, progress)
Template Tip:
Avoid overly generic or copy-pasted notes. Instead, use structured templates with customizable fields. Ensure you document:
- Start and end time
- Mental status exam
- Medication changes
- Psychotherapy techniques used
- Patient response and progress toward goals
Tip: Include clinical rationale for longer sessions (e.g., trauma processing, suicidality) when billing 90837.
4. Keep Up with Telehealth Billing Nuances
Telehealth rules continue to shift post-COVID, and different payers have different policies.
Key things to know:
- Place of Service (POS) codes matter:
- POS 10 = Telehealth at home
- POS 02 = Telehealth elsewhere
- Modifier 95 is often required to denote telehealth services
- Some payers do not cover audio-only sessions
- Some states mandate in-state licensure for reimbursement
Tip: Maintain a cheat sheet for your top payers' telehealth rules and update it quarterly. Denials from incorrect modifiers or POS codes are easy to prevent.
5. Submit Claims Daily and Track Rejections
Why it matters: Delayed submissions and untracked rejections are silent revenue killers. Submitting claims in real time:
- Improves cash flow
- Reduces aging AR (accounts receivable)
- Allows faster follow-up on denials
Your EMR should flag:
- Missing diagnosis codes
- Incompatible code combinations
- Missing authorization fields
Set up a weekly workflow:
- Track denials by payer, code, and reason
- Create a playbook for common denial types
- Train staff to correct and resubmit quickly
Tip: Use your built-in EMR tools to catch errors before submission.
6. Minimize Front Desk Data Errors
Simple typos cause a shocking number of denied claims.
Train staff to double-check:
- Patient name spelling (must match insurance card)
- Date of birth
- Insurance ID number
- Address and phone (used for portal logins or mailed EOBs)
Tip: Collect a photo of the front and back of the insurance card at every visit. Patients often carry old or secondary cards by mistake.
7. Use an EMR That Works for Psychiatry (Not Against It)
Many generic EMRs don’t support behavioral health billing rules. You need:
- Integrated E/M + psychotherapy coding
- Modifiers and POS options
- Preloaded behavioral health CPT/ICD-10 libraries
- Easy documentation of time-based sessions
- Eligibility checks and ERA (Electronic Remittance Advice) posting
Tip: Avoid “Frankenstein” setups where scheduling, charting, and billing are in different systems—it increases human error and slows down claim flow.
8. Know When to Outsource
If billing is draining time and revenue, it may be time to get outside help. A professional psychiatric billing service can:
- Improve clean claim rates
- Follow up on aged AR
- Navigate payer appeals and authorizations
- Monitor underpayment trends
Tip: When outsourcing, choose a biller who specializes in psychiatry and is familiar with your state’s parity laws and telehealth coverage.
Billing Doesn’t Have to Be the Bane of Your Practice
You trained to treat people, not chase payers. But clean billing is essential for your practice’s health and sustainability. With the right systems, a supportive EMR, and a trained team (or expert billing partner), you can make billing efficient, accurate, and—dare we say—manageable.
You deserve to focus on what matters: providing excellent care.
Why OptiMantra Is a Smart Choice for Behavioral Health Billing
OptiMantra was built for behavioral health and integrative practices. Its robust psychiatry features include:
- Integrated E/M + psychotherapy coding
- Built-in telehealth compliance tools
- Real-time eligibility checks and automated claim scrubbing
- Customizable note templates for psychotherapy, medication management, and time tracking
- ERA posting and financial reporting for clean, fast reimbursements
Whether you're submitting your own claims or working with a billing partner, OptiMantra streamlines every step of the process—so you can get paid on time, every time.
Try OptiMantra for 15 days for FREE.
