Psychiatric Billing Service Checklist: 5 Checks That Matter
A psychiatric billing service checklist helps you judge whether a billing partner truly understands prescriber claims. Psychiatrists and psychiatric nurse practitioners bill differently from therapists, mainly because an E/M (evaluation and management) visit and psychotherapy often share one appointment. For the basics, start with our psychiatry billing guide.
What should a psychiatric billing service check on every claim?
A good service checks five things before submitting: the E/M code, the psychotherapy add-on, authorization, the telehealth details, and the documentation. It also tracks what comes back. Use this psychiatric billing service checklist when you review a vendor, or your own in-house process.
- E/M level supported by the note
- Add-on code paired correctly, with separate time
- Prior Authorization verified where the payer requires it
- Place of service and telehealth details match the visit
- Denials worked, not just resubmitted
How should the E/M and psychotherapy add-on be paired?
The psychotherapy add-on rides on top of an E/M visit. It is never billed alone, and the two services must be separate and identifiable in the record. The add-ons are 90833, 90836, and 90838, and our psychotherapy add-on code guide explains the time ranges. A Psychotherapy Add-On Code depends on that documentation.
A Medicare contractor billing and coding article from WPS (A57480, revised 1/1/26, checked 10/23/26) adds several points. Both services should be significant and separately identifiable. The E/M level is chosen by medical decision making, not by time. Time spent on E/M work does not count toward the psychotherapy minutes. Prolonged service codes are not reported with these add-ons. That article applies to WPS jurisdictions, so check your own contractor’s version.
Watch for the most common failures. Our 90833 billing errors guide shows the fixes, and the interactive complexity post covers that separate add-on.
Who counts as a prescriber on the claim?
Physicians and nurse practitioners both appear in CMS’s list of Medicare-eligible mental health professionals (MLN1986542, revised March 2026, checked 10/23/26). A Psychiatric Nurse Practitioner (PMHNP) should bill under their own enrollment where the payer allows it. Rules differ by payer and by state, so confirm each plan’s policy for rendering and supervising providers.
How do you handle prior authorization?
Treat authorization as a payer-by-payer task, not a rule you can memorize. Some plans want approval for certain services, and others do not. Verify before the visit, record the reference number, and keep it with the claim. Read our posts on telehealth prior authorization rules and denials from missing prior authorization for the prevention steps.
What telehealth details belong on the claim?
Medicare uses place of service 10 when the patient is at home and 02 when the patient is somewhere other than home, per CMS’s telehealth booklet (MLN901705, revised December 2025, checked 10/23/26). CMS also says audio-only is allowed for behavioral and mental health telehealth when the patient is at home. Modifier requirements vary by payer, so a good service keeps a payer-by-payer sheet instead of one default. Rules change often, so recheck them at the start of each year.
How should a service work denials?
It should find the root cause, fix it, and prevent repeats. Resubmitting the same claim wastes time. The best checklist item is a monthly review of denial reasons. Our denied claims follow-up and appeals service works this way.
What does a psychiatric billing service checklist look like for outsourcing?
Ask the vendor to walk through every line of this psychiatric billing service checklist, and ask to see a sample report. If you are comparing options, our post on when to outsource psychiatric billing covers the decision, and the psychiatry billing services comparison lists the options.
How MCM South helps
MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices, including psychiatrists and psychiatric nurse practitioners. We bill out-of-network claims for clients and review each claim against this kind of checklist. If you are weighing options, we are happy to walk through your current process.
Psychiatric billing service checklist: the short version
Print this psychiatric billing service checklist and keep it near your desk. Run every claim through the psychiatric billing service checklist before it goes out, and review the list each quarter with your biller or vendor. A good vendor will welcome a psychiatric billing service checklist like this one.
Keep going
Related reading
Frequently asked questions
Can I bill a psychotherapy add-on without an E/M visit?
No. The add-ons 90833, 90836, and 90838 are reported with an E/M service, not alone. See our [[/cpt-codes/psychotherapy-add-on-codes/|add-on code guide]].
Is the E/M level based on time when I add psychotherapy?
Per a WPS Medicare article (checked 10/23/26), the E/M level follows medical decision making, and E/M time does not count toward psychotherapy time. Confirm your own payer’s rule.
What place of service goes on a telehealth claim?
For Medicare, CMS says POS 10 when the patient is at home and POS 02 otherwise (checked 10/23/26). Other payers may differ.
How is this different from outsourcing psychiatric billing?
This checklist covers what to verify on claims. Our [[/outsource-psychiatric-billing/|outsourcing guide]] covers whether and when to hand billing off.
Where MCM South works
MCM South works only in mental and behavioral health. We serve psychotherapists and psychiatrists in solo and medium-size practices across ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Need a payer contact? Use our insurance companies contact directory.
