Psychiatry Practices
Clean Claim Rate
Revenue Recovered
Claim Submission
A psychiatry practice in Phoenix watched $180,000 in annual revenue disappear over two years. Not from lost patients, but from systematic miscoding of E/M with psychotherapy add-on combinations. The billing team had been selecting standalone therapy codes when the visits clearly warranted both components.
We see patterns like this across psychiatry practices of every size. The billing rules for psychiatric services create traps that general billers walk into repeatedly: incorrect add-on code pairing, missed medication management charges, and claims routed to the wrong behavioral health carve-out. Our team handles psychiatry billing with the specificity this specialty requires.
Every Psychiatry billing team deals with payer delays, coding nuance, and collection leakage. We tighten those weak points before they turn into write-offs.
Psychiatrists frequently provide both medication management (E/M) and therapy in a single visit. Billing requires the base E/M code plus the appropriate add-on (90833, 90836, 90838). Most billing errors occur when staff select standalone therapy codes instead.
Many commercial plans separate psychiatric benefits from medical benefits. Claims sent to the medical administrator instead of the behavioral health carve-out (Optum, Magellan, Beacon) are denied automatically.
Payers scrutinize psychiatric E/M claims for documented medication changes, side effect reviews, and treatment response assessments. Insufficient documentation triggers downcoding or denial.
Telepsychiatry has specific place-of-service requirements, modifier rules, and state-based licensure restrictions that affect billing eligibility. Incorrect POS codes cause systematic denials across entire patient panels.
Support spans the full revenue cycle, from front-end verification to denial recovery and reporting.
E/M with psychotherapy add-on code optimization (90833/90836/90838)
Behavioral health carve-out identification and claim routing
Medication management documentation review
Telehealth billing with correct POS and modifier assignment
Prior authorization for psychiatric medications and services
Denial management focused on medical necessity appeals
We support independent practices, multisite groups, and growing provider organizations with flexible workflows.
Independent physician groups
Multi-location practices
Private equity backed platforms
Hospital-owned outpatient groups
A psychiatry practice in Phoenix watched $180,000 in annual revenue disappear over two years. Not from lost patients, but from systematic miscoding of E/M with psychotherapy add-on combinations. The billing team had been selecting standalone therapy codes when the visits clearly warranted both components.
We see patterns like this across psychiatry practices of every size. The billing rules for psychiatric services create traps that general billers walk into repeatedly: incorrect add-on code pairing, missed medication management charges, and claims routed to the wrong behavioral health carve-out. Our team handles psychiatry billing with the specificity this specialty requires.
Answers to the questions practice owners and managers ask most often before switching billing partners.
Bill the appropriate E/M code (99213-99215) as the base, then add the psychotherapy add-on code based on therapy duration: 90833 (16-37 minutes), 90836 (38-52 minutes), or 90838 (53+ minutes). Never use standalone therapy codes (90834, 90837) when medication management is also provided.
When a patient's plan carves out behavioral health benefits, psychiatric claims must go to the carve-out administrator, not the primary insurance company. We verify carve-out status during eligibility checks and route claims to the correct entity, preventing the most common source of psychiatry denials.
Yes. CPT 90791 (without medical services) and 90792 (with medical services) cover initial psychiatric evaluations. We select the correct code based on whether the psychiatrist performed a medical evaluation and prescribed medication during the initial visit.
Psychiatric E/M documentation must include the chief complaint, medication review (current medications, changes, side effects), mental status examination, and the treatment plan. Medical decision-making complexity determines the E/M level, following the same 2021 MDM framework used across medicine.
Psychiatric NPs bill under their own NPI using the same CPT codes as psychiatrists in most states. Some payers reimburse NPs at 85% of the physician rate. We apply the correct fee schedule and ensure proper credentialing with each payer.
A typical psychiatry visit billed as 99214 plus 90836 (38-52 minutes of therapy) reimburses $180 to $260 depending on the payer and geographic region. The E/M component typically covers $80 to $130, and the add-on covers $60 to $100.
The difference is operational discipline. We focus on clean submissions, fast follow-up, and transparency.
Get a revenue review and a clear action plan tailored to your practice, payers, and claim mix.