Mental health billing, done by specialists
The full evaluation-to-cash cycle for psychiatry and outpatient mental health, where revenue is won or lost at verification, benefit routing, and documentation, long before a claim goes out.
Revenue is lost before the claim, not after.
Mental health billing runs on episodes, level of care, and authorization, not “visit, code, submit.” Miss one step upstream and delivered care becomes uncollectible.
- 01
The payer on the card isn’t the payer you bill
Mental health benefits are carved out to Optum/UBH, Carelon, Evernorth, or Magellan. We verify the carve-out, not just the medical plan, so claims reach the right entity the first time.
- 02
Accuracy in documentation protects your codes
Evaluations, psychotherapy time bands, and E/M add-ons each carry their own documentation burden. We audit time and medical necessity so your highest-value codes survive audit.
- 03
Prior authorization is a revenue asset
Timely authorizations and renewals keep claims payable. We make sure deadlines are met, preventing denials and protecting your revenue.
- 04
Out-of-network & single-case agreements
We verify out-of-network benefits and track every step of the single-case agreement process to support timely approvals and reimbursement.
We bill by the time band, not the method.
There is no code for every therapeutic approach, only a code for documented time. We map each evaluation and session to what the note supports, so the claim survives review.
| CPT code | Time band | Description |
|---|---|---|
| 90791 | Evaluation | Psychiatric diagnostic evaluation, without medical services |
| 90792 | Evaluation | Psychiatric diagnostic evaluation, with medical services |
| 90832 | 16–37 min | Psychotherapy, patient and/or family member |
| 90834 | 38–52 min | Psychotherapy: the routine session standard |
| 90837 | 53+ min | Extended psychotherapy: documented time required |
| 90833 / 90836 / 90838 | Add-on | Psychotherapy performed with an E/M service |
| 90785 | Add-on | Interactive complexity, billed with the primary service |
| 90853 | Group | Group psychotherapy (other than family) |
We speak every mental health carve-out.
Each managed-behavioral org has its own auth rules, forms, and timelines. We maintain a live payer matrix so nothing slips.
- Optum / UBHProvider Express · concurrent review
- CarelonBehavioral Health · auth portal
- EvernorthCigna behavioral · SCA forms
- MagellanMedicaid & commercial carve-outs
See what your mental health claims are leaving behind.
A no-obligation review of your denials, benefit routing, and authorization workflow, with a recovery estimate.