EAP Billing at Year End: A Checklist for Therapists
EAP billing year end is the set of tasks you finish before December 31 so your employee assistance program claims are paid and your January starts clean. An EAP (employee assistance program) is an employer-funded benefit that covers a small number of short-term counseling sessions. This post gives you a plain checklist for EAP billing year end, whether you see clients in person or by telehealth.
What EAP billing is
EAP billing is the process of billing an employee assistance program vendor, not the client’s health plan, for covered counseling sessions. The employer pays the vendor in advance, so the client usually owes you nothing for the visit. Each vendor sets its own rules for sign-up, claims and codes.
For example, the Evernorth Behavioral Health Administrative Guidelines (September 2026 edition) say EAP is prepaid, so providers collect no copay. The same guide says every EAP claim must carry CPT code 99404, or it will be denied or not processed. Another vendor may ask for something different. Read the contract you signed. For more terms, see our EAP billing terms page.
Why EAP billing year end matters
Year end matters because EAP session counts, authorizations and filing windows come from each vendor contract, and a gap can leave sessions unpaid. We cannot give one universal number, because the rules vary by vendor and by employer group. What stays the same is the risk. Sessions delivered late in the year are easy to forget, and a claim filed after a vendor’s window closes may be denied.
Think of it as the same cleanup you do for every payer, only with tighter, less familiar rules. Our year-end billing checklist for therapists covers your whole caseload. This post covers the EAP part.
The EAP billing year end checklist
The checklist is a short list of actions that turns open EAP sessions into paid claims before the calendar flips. Work through it in order.
- Run an aging report for EAP claims and look for anything unpaid or never sent.
- Confirm every open authorization. Some vendors give clients an EAP code before the first session, so check that each active client has one on file. See prior authorization for the basics.
- Send final claims for all December sessions as soon as notes are signed. A clean submission is a clean claim, so check the vendor’s required code and client details first.
- Check each vendor’s timely filing window in your contract. Write down the date for each open claim.
- Note how many sessions each EAP client has left, and what the client plans next.
- Collect the new EAP details you need for January, such as employer, vendor and any fresh authorization.
What do I do with EAP clients who need more care in January?
When an EAP client needs more care than the benefit covers, the usual next step is to move them to their health plan or another resource. Do not assume you can keep seeing them under the EAP. For example, the Evernorth guide says that if Evernorth provides only the EAP, the provider coordinates referrals for ongoing care. If Evernorth also provides the behavioral health benefit, continued care is allowed only when specific conditions are met.
Before you move a client, check their health plan. Verify that you are in network, or confirm out-of-network benefits. If the client has more than one plan, review coordination of benefits. Do this in December so January visits are not delayed.
How EAP billing differs from insurance billing
EAP billing differs from insurance billing mainly in who pays and how many visits are covered. The table below is general. Your vendor contract controls the details.
| Topic | EAP | Health insurance |
|---|---|---|
| Who pays | The employer, through the EAP vendor | The client’s health plan, plus client cost-share |
| Client cost-share | Often none, because the benefit is prepaid | Copay, coinsurance or deductible |
| Authorization | Often an EAP code or referral first | Depends on the plan and service |
| Session limits | A small, fixed number set by the employer | Based on medical necessity and plan terms |
| When sessions run out | Referral to ongoing care | Authorization for more sessions, if required |
For example, the Evernorth guide describes short-term counseling as more than three sessions, sometimes up to ten, with five to eight most common. That is one vendor’s description. Other vendors and employers differ.
What to do Monday morning
Start with one task: list every EAP client you saw this year and what each still needs. Then do these steps.
- Pull the EAP aging report and send any unsent claims.
- Open each EAP contract or provider manual and write down its filing window and billing code.
- Flag clients who will need care after the EAP ends, and verify their health plan benefits.
- Set a reminder for the first week of January to check for EAP payments and denials.
Questions to verify with the payer
Before year end, ask each EAP vendor these questions, and write the answers in your billing notes.
- What code and claim format does this vendor require?
- What is the filing deadline for claims, and does it differ for the end of the year?
- Do unused sessions expire on December 31, or does the benefit renew on a different date?
- Does the client need a new EAP code or authorization in January?
- Can I continue to see the client after the EAP sessions end, and under which benefit?
The short version: eap billing year end
The short version of EAP billing year end is this: audit open claims, confirm authorizations, send final claims, track remaining sessions and gather new details for January. Always check each vendor’s own rules, since EAP billing year end deadlines are not the same everywhere. This is operational guidance, not legal advice.
How MCM South helps with eap billing year end
MCM South bills for psychotherapists and psychiatrists, including out-of-network claims for clients. We help with the billing side, such as tracking claim status and working denials, so EAP claims do not sit unpaid. We do not give legal advice. Learn more about our behavioral health billing services.
Where MCM South works
MCM South works with psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. See insurance company contacts by state, who we serve and the state billing guides. This post is operational guidance for billing, not legal advice.
The short version: eap billing year end
The short version: eap billing year end means auditing open claims, confirming authorizations, sending final claims and gathering new details for January. Check each vendor’s own rules, because eap billing year end deadlines vary. More guides are in Resources.
Sources checked (November 2, 2026)
Keep going
Related reading
Frequently asked questions
Do EAP claims have different filing deadlines than insurance claims?
They can. Each EAP vendor sets its own filing window in your contract or provider manual, and it may differ from your health plans. The Evernorth guide I read did not state an EAP-specific deadline in the sections reviewed, so ask your vendor and write the date down.
What happens to unused EAP sessions on December 31?
It depends on the employer and the vendor. Some benefits renew on a calendar year and some on another date. Ask the vendor whether unused sessions expire and when the client’s benefit resets, then tell the client.
Can I bill insurance after EAP sessions run out?
Often yes, if you are in network or the client has out-of-network benefits, but you must verify first. Do not bill the same session to both the EAP and the health plan. Some vendors have rules about continuing care, so check the vendor guide before you move a client.
How do I find an EAP’s billing rules?
Start with your signed provider agreement, then the vendor’s provider manual or provider portal. These documents list the required codes, claim format and authorization steps. If something is unclear, call the vendor’s provider line and note the date and name of the person you spoke with.
