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Mental Health Billing FAQ for Therapists and Psychiatrists
This mental health billing FAQ answers the questions practice owners ask most about codes, claims, credentialing and payer rules. Every answer covers both psychotherapists and psychiatrists, and we say so when a rule changes by payer or state. Checked October 2, 2026.
Operational guidance only, not legal or clinical advice. Confirm anything with real financial or legal exposure with the payer, your attorney or a compliance officer.
Start here: a claim did not get paid. What do I check first?
Check the claim status first. A rejected claim never entered the payer system, so you fix the error and resubmit. A denied claim was processed and refused, so you read the reason, then correct the claim or appeal. After that, check the filing deadline and the payer appeal window.
Who sets the rule in mental health billing?
Read this table before the answers below. These four often disagree. A Medicare rule does not make a private payer follow it, and one state Medicaid rule does not carry over to the next state.
| Rule type | Who sets it | Where to confirm |
|---|---|---|
| Private payer rules | The payer and your contract | Provider manual, payer portal, your contract |
| Medicare | CMS (Centers for Medicare & Medicaid Services) | CMS.gov |
| Medicaid | Each state, and often its managed care plans | Your state Medicaid agency |
| State law | Each state | Your state licensing board or an attorney |
Mental health billing FAQ: codes and claims
What is the difference between CPT 90834 and 90837?
CPT 90834 is individual psychotherapy for 38 to 52 minutes. CPT 90837 is individual psychotherapy for 53 minutes or more. Record start and stop times in every note, because payers check the time against the code. See the full guide to psychotherapy codes 90832, 90834 and 90837.
Source: CMS.gov, as checked on our code page 9/29/26.
Do psychiatrists bill differently than therapists?
Yes. Psychotherapists bill the psychotherapy code that matches the session time. Psychiatrists and other prescribers who do medication management and psychotherapy in the same visit bill an E/M (evaluation and management) code plus a psychotherapy add-on code: 90833, 90836 or 90838. The E/M and the psychotherapy must each be significant and separately identifiable, and the add-on goes on the same date. See add-on codes 90833, 90836 and 90838.
What is the difference between a denied claim and a rejected claim?
A rejected claim failed the payer or clearinghouse front-end checks and never entered processing, usually because of an error in the data. You correct it and resubmit. A denied claim was processed and the payer refused to pay, for reasons such as medical necessity, eligibility or coding. You investigate, then correct it or appeal within the deadline. Definitions are in our claim denial glossary.
How long do I have to file a claim?
It depends on who the payer is.
- Medicare: claims must reach the right MAC (Medicare Administrative Contractor) within one calendar year after the date of service, or Medicare denies them.
- Private payers: each payer sets its own limit in your contract or provider manual. It varies, so read yours.
- Medicaid: each state sets its own limit, and managed care plans may set another. Check your state manual.
Source: CMS Timely Filing training, checked 10/2/26.
What CPT code and place of service do I use for a therapy session in a patient's home?
There is no special home psychotherapy code. You bill the service you delivered, such as 90834, and put place of service 12 (home) on the claim. Prescribers who bill E/M pair POS 12 with the home visit codes 99341 to 99350. See our guide to place of service codes.
What are the CMS-1500 and 837P, and do I need a clearinghouse?
The CMS-1500 is the standard paper claim form. The 837P is the standard electronic version that professionals use. Medicare requires initial claims to be sent electronically unless you qualify for an exception, such as a small provider with fewer than 10 full-time equivalent employees. A clearinghouse is the service that checks electronic claims and routes them to payers, and it is where many rejections happen. Private payers set their own rules. See clearinghouse terms.
Source: CMS MLN, Medicare Billing: CMS-1500 and 837P, December 2025.
Do I need prior authorization for therapy or psychiatry visits?
It depends on the payer and the plan. Some plans require authorization after a set number of visits or for certain services, and others do not. Check eligibility and benefits before the first visit, ask about authorization, and write down who you spoke to and when. If a service needs authorization and you skip it, expect a denial.
Can I bill more than one session in a day?
Payers decide this, so check each policy. Many limit how often the same service can be billed per day, and a second same-day service may need documentation showing why it was medically necessary. Do not assume that a code that pays on one plan will pay on another.
Insurance, EAP and networks
What is an EAP claim, and how is it billed?
An EAP (Employee Assistance Program) is an employer-paid benefit run by a vendor that handles authorization and pays network clinicians. Each EAP vendor has its own credentialing, claims process and eligible clinician rules, and you usually join an EAP panel separately from health plan networks. Check each vendor process before you see the first client. See EAP and behavioral health terms.
What is credentialing, and do I need it to bill insurance?
Credentialing is the payer review of your license, education and history before it lets you join its network. To bill a payer as an in-network provider, you need to be credentialed and contracted with it. Our credentialing page walks through the process.
How long does insurance credentialing take?
It varies by payer and by state, so we do not give a number. The steps are the same: complete the application, the payer verifies your information, then it issues a contract with an effective date. Ask each payer in writing for the effective date and keep the confirmation.
Can I bill a payer before I am credentialed?
Do not assume you can. Whether a payer pays for services before your effective date depends on that payer and your contract. Ask for the rule in writing before you see that payer's members.
What is the difference between in-network and out-of-network for my practice?
In-network means you signed a contract with the payer and accept its allowed amount. Out-of-network means you have no contract, so the payer out-of-network benefits and your own fee policy apply. Both still need clean claims. Read the full comparison: in-network vs out-of-network.
Does MCM South bill out-of-network claims?
Yes. MCM South bills out-of-network claims for clients, alongside in-network claims.
Telehealth, Medicare and parity
Is telehealth reimbursed by insurance?
It depends on the payer and the state, so check each one. For Medicare, CMS has permanently removed the geographic and originating-site limits for behavioral health telehealth, which lets patients receive it at home. CMS also schedules in-person visit requirements for mental health telehealth later, so check the current CMS telehealth FAQ. Use the right modifier and place of service: see modifiers 93 and 95.
Source: CMS Telehealth FAQ, updated 2/26/26, current as of last search (10/2/26).
What is mental health parity, and does it affect my reimbursement?
Parity (MHPAEA, the Mental Health Parity and Addiction Equity Act) requires many group health plans to treat mental health benefits no more strictly than medical benefits. It limits how a plan applies things like visit limits and prior authorization. It does not set your fee schedule. As of the last search, the federal departments announced on May 15, 2025 that they will not enforce the new provisions of the 2024 final rule while they reconsider it. The statute itself still applies. Rules in this area are changing, so confirm the current status, and ask counsel if you have real exposure.
Source: U.S. Department of Labor enforcement statement, current as of last search (10/2/26).
Mental health billing FAQ: working with MCM South
Who does MCM South bill for?
MCM South bills only for mental and behavioral health practices: psychotherapists and psychiatrists, solo and medium-size groups. We do not work with hospital systems. See who we serve.
Which states does MCM South bill in today?
MCM South currently bills in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. MCM South has worked in all 50 states at some point.
What does MCM South do?
MCM South handles insurance verification, electronic claims submission, EAP claims, denied and rejected claim follow-up and appeals, secondary claims and insurance credentialing. See the services overview.
Does MCM South have Spanish-speaking staff?
Some MCM South staff are bilingual in Spanish.
How do I get a quote?
Use the free quote or consultation form. Please do not include patient names or health information in the form. Get a Free Quote.
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