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Billing Terms Glossary

Behavioral Health Billing Terms: Definitions for Therapists and Psychiatrists

These behavioral health billing terms are defined in plain English for therapists and psychiatrists. Behavioral health billing terms describe the services, codes, and programs that are specific to mental health and substance use care. These definitions serve both psychotherapists and psychiatrists.

In this section

44 terms defined
Written for psychotherapists and psychiatrists
Source organization linked on every entry

Back to the full billing terms glossary

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988 Suicide and Crisis Lifeline

General (all payers)

Also called: 988; national suicide prevention lifeline; crisis line

Definition: The 988 Suicide and Crisis Lifeline is the national three-digit number for people in suicidal crisis or emotional distress. SAMHSA, part of HHS, oversees it. People can call, text, or chat.
Why it matters: Crisis services often connect to billing through mobile crisis and crisis codes. Practices should know the number for their crisis plan.
Illustrative example: A therapist gives a client the 988 number as part of a safety plan.

Reference source SAMHSA · HHS (U.S. Department of Health and Human Services)

Categories Behavioral Health Specific Terms

American Psychiatric Association (APA)

General (all payers)

Also called: APA (Psychiatric); psychiatry.org; American Psychiatric Association

Definition: The professional medical association of psychiatrists in the United States, publisher of the DSM. Not to be confused with the American Psychological Association, which also uses the acronym APA.
Why it matters: Its practice guidelines and DSM inform clinical documentation and diagnosis.
Illustrative example: A practice cites the DSM when documenting a diagnosis.

Related terms DSM-5-TR Psychiatrist

Reference source American Psychiatric Association

Categories Behavioral Health Specific TermsQuality & Risk Adjustment Terms

Applied Behavior Analysis (ABA)

General (all payers)

Also called: ABA; ABA billing

Definition: A therapy approach often used for autism, billed with specific CPT codes and requiring authorization and specific credentials in many plans.
Why it matters: Distinct coverage, authorization, and credential rules apply.
Illustrative example: A payer authorizes ABA hours with a treatment plan.

Verify: payer- and state-specific.

Related terms Prior Authorization Treatment Plan

Reference source American Psychiatric Association

Categories Behavioral Health Specific Terms

Behavioral Health Billing

General (all payers)

Also called: mental health billing; psychotherapy billing; behavioral health revenue cycle

Definition: The specialized process of coding, submitting, and collecting claims for mental health and substance use disorder services, with time-based codes, authorization rules, and carve-out networks.
Why it matters: Differs from general medical billing because of session-time codes, carve-outs, and documentation standards.
Illustrative example: A billing team confirms session times, diagnosis, and carve-out payer before submitting a therapy claim.

Reference source American Psychiatric Association

Categories Behavioral Health Specific Terms

Behavioral Health Integration (BHI)

General (all payers)

Also called: BHI; general BHI; 99484

Definition: Services that integrate behavioral health care with primary care, including general BHI care management and the collaborative care model.
Why it matters: Growth area with specific codes and consent requirements.
Illustrative example: A practice bills general BHI for a monthly care management service.

Verify: confirm current codes and requirements.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories Behavioral Health Specific TermsValue-Based Care Terminology

Brief Emotional or Behavioral Assessment (96127)

General (all payers)

Also called: 96127; depression screening instrument; PHQ-9 billing; GAD-7 billing

Definition: A CPT code for brief emotional or behavioral assessment with a scored, standardized instrument.
Why it matters: Payer policies on units and diagnosis linkage vary.
Illustrative example: A clinician bills 96127 for a scored PHQ-9 where the payer allows.

Verify: payer-specific.

Related terms CPT Code Screening Medical Necessity

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Certified Community Behavioral Health Clinic (CCBHC)

General (all payers)

Also called: CCBHC

Definition: A clinic model certified under federal criteria that offers a defined set of behavioral health services and is paid through special payment methods in participating states.
Why it matters: Payment and billing differ from standard outpatient clinics.
Illustrative example: A CCBHC in a participating state is paid under a state-defined payment method.

Verify: state-specific.

Reference source SAMHSA

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms

Collaborative Care Model (CoCM)

General (all payers)

Also called: CoCM; collaborative care; psychiatric collaborative care; 99492; 99493; 99494

Definition: A team-based approach that integrates behavioral health into primary care with a care manager and psychiatric consultant, billed with monthly codes.
Why it matters: Requires specific staffing, documentation, and consent, and payer coverage varies.
Illustrative example: A primary care practice bills CoCM codes monthly with time tracking.

Verify: confirm current codes and requirements.

Reference source CMS (Centers for Medicare & Medicaid Services) · CMS Medicare Learning Network (MLN)

Categories Behavioral Health Specific TermsValue-Based Care Terminology

Community Mental Health Center (CMHC)

General (all payers)

Also called: CMHC

Definition: A community-based provider of mental health services, with special rules under Medicare and Medicaid.
Why it matters: Payment and enrollment rules differ from private practice.
Illustrative example: A CMHC bills Medicaid under its state program.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms

DSM-5-TR

General (all payers)

Also called: DSM; Diagnostic and Statistical Manual of Mental Disorders

Definition: The American Psychiatric Association's manual for diagnosing mental disorders. Clinicians diagnose with the DSM, and claims carry the matching ICD-10-CM code.
Why it matters: Clinical diagnoses must be translatable to billable ICD-10-CM codes.
Illustrative example: A therapist documents a DSM-5-TR diagnosis and codes it on the claim in ICD-10-CM.

Reference source American Psychiatric Association

Categories Behavioral Health Specific TermsClaims Processing

EAP Authorization

Private payer

Also called: EAP authorization letter; EAP referral

Definition: A vendor's approval for a set number of EAP sessions with a named provider, usually required before the first session.
Why it matters: Sessions without an authorization are commonly denied or unpaid.
Illustrative example: A therapist confirms an authorization number and session count before scheduling.

Verify: EAP rules are vendor-specific.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsPrior Authorization Terminology EAP

EAP Vendor

Private payer

Also called: EAP network; EAP administrator

Definition: A company that administers EAP benefits for employers, including authorization and payment to network clinicians.
Why it matters: Each vendor has its own credentialing, claims process, and eligible clinician rules.
Illustrative example: A clinician joins an EAP vendor's panel separately from health plan networks.

Verify: never describe any vendor as a partner.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsBCBS, UHC & Commercial Payer Terms EAP

Electroconvulsive Therapy (ECT)

General (all payers)

Also called: ECT; 90870

Definition: A psychiatric treatment delivered under anesthesia, billed with specific codes and often involving facility and professional claims.
Why it matters: Requires authorization and coordination of professional and facility billing.
Illustrative example: A hospital bills facility fees while the psychiatrist bills professional fees.

Related terms CPT Code Prior Authorization

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Employee Assistance Program (EAP)

Private payer

Also called: EAP; EAP benefit; EAP sessions

Definition: An employer-sponsored program offering short-term counseling and referrals, usually with a set number of sessions at no cost to the employee.
Why it matters: EAP billing differs from standard insurance: separate networks, authorization letters, and payers.
Illustrative example: An EAP authorizes six sessions and the therapist bills the EAP vendor, not the health plan.

Verify: each EAP vendor sets its own eligibility, authorization, and clinician rules.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsBCBS, UHC & Commercial Payer Terms EAP

Evidence-Based Practice in Psychology (EBPP)

General (all payers)

Also called: EBPP; evidence-based practice; evidence-based treatment

Definition: Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics and preferences.
Why it matters: Payers, accreditors, and value-based programs increasingly ask for evidence-based treatments. Document the approach and why it fits the patient.
Illustrative example: A therapist notes that a client's plan uses a research-supported treatment for the diagnosis and records progress with a standard measure.

Verify: Confirm the definition against the source.

Reference source Society of Clinical Psychology (Division 12, American Psychological Association)

Categories Behavioral Health Specific TermsQuality & Risk Adjustment Terms

GAD-7

General (all payers)

Also called: Generalized Anxiety Disorder 7-item scale; anxiety screening questionnaire

Definition: The GAD-7 is a seven-item questionnaire used to screen for and measure the severity of generalized anxiety.
Why it matters: Practices use it for measurement-based care and for billing CPT 96127 per instrument, where the payer allows it.
Illustrative example: A clinician gives the GAD-7 and PHQ-9 at intake and reports two units of 96127.

Verify: Confirm payer policy on which instruments are covered.

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsQuality & Risk Adjustment Terms

In-Home Therapy

General (all payers)

Also called: home-based therapy; in-home behavioral health; community-based therapy

Definition: Behavioral health services delivered in a patient's home or community, often under Medicaid programs, with distinct codes, authorization, and documentation.
Why it matters: Rules on codes and place of service vary by state and plan.
Illustrative example: A state program authorizes in-home therapy for children.

Verify: state-specific.

Reference source Medicaid.gov

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms

Intensive Outpatient Program (IOP)

General (all payers)

Also called: IOP; intensive outpatient

Definition: A structured behavioral health program that provides several hours of treatment per week without an overnight stay.
Why it matters: Billed with specific codes and authorization, often by revenue code or HCPCS, and payer rules differ.
Illustrative example: A payer authorizes IOP for three days a week.

Verify: coding is payer-specific.

Reference source SAMHSA

Categories Behavioral Health Specific Terms

Long-Acting Injectable (LAI) Administration

General (all payers)

Also called: LAI; long-acting injectable; injection administration; 96372

Definition: A long-acting injectable is a psychiatric medication given by injection at intervals of weeks or months. A practice bills the drug and the administration separately, with the injection administration code and the drug's HCPCS code.
Why it matters: Payers have specific rules on drug codes, units, buy-and-bill versus pharmacy benefit, and prior authorization. Check them before you stock the drug.
Illustrative example: A psychiatry practice confirms coverage and prior authorization before giving a patient a monthly injection.

Verify: Confirm codes and payer rules.

Reference source American Psychiatric Association · American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Managed Behavioral Health Organization (MBHO)

General (all payers)

Also called: MBHO; behavioral health administrator; BHO

Definition: A company that administers behavioral health benefits for health plans, including networks, utilization review, and claims.
Why it matters: Explains why some behavioral health claims go to a different company than the medical plan.
Illustrative example: A therapist is credentialed with the MBHO, not with the medical plan.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsBCBS, UHC & Commercial Payer Terms

Medicaid Rehabilitation Option

Medicaid (state-specific)

Also called: rehab option; Medicaid rehabilitative services; mental health rehabilitation

Definition: The Medicaid rehabilitation option is a state plan benefit that lets a state cover rehabilitative services, which many states use for community-based mental health services.
Why it matters: The services and provider types differ by state. Check the state manual for codes and rules.
Illustrative example: A community provider bills a state's rehabilitation benefit for skill-building services.

Verify: State-specific.

Reference source Medicaid.gov · CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms Medicaid

Medication Management

General (all payers)

Also called: pharmacologic management; med management; medication management visit

Definition: Medication management is a psychiatric visit that focuses on monitoring and adjusting psychiatric medication. It is usually billed with an E/M code, sometimes with a psychotherapy add-on.
Why it matters: Choose the E/M level by MDM or total time. Add a psychotherapy code only if psychotherapy was done and documented separately.
Illustrative example: A psychiatrist reviews response and side effects and bills 99214.

Related terms E/M Code CPT 99214 CPT 90833 Psychiatrist

Reference source American Psychiatric Association · American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Medication-Assisted Treatment (MAT)

General (all payers)

Also called: MAT; medications for opioid use disorder; MOUD

Definition: Treatment for substance use disorders that combines FDA-approved medication with counseling and behavioral therapy.
Why it matters: Has specific coding, coverage, and Medicaid rules.
Illustrative example: A prescriber bills an E/M and counseling for MAT.

Reference source SAMHSA

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms

Mobile Crisis Services

Medicaid (state-specific)

Also called: mobile crisis; crisis response team; Medicaid mobile crisis

Definition: Mobile crisis services are crisis response services delivered in the community by a team that goes to the person, rather than requiring a visit to a facility. Some state Medicaid programs cover them.
Why it matters: Coverage, provider types, and codes vary by state. They link to 988 and to crisis codes.
Illustrative example: A state Medicaid program pays a provider for a mobile crisis visit to a patient's home.

Verify: State-specific.

Reference source Medicaid.gov · SAMHSA

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms Medicaid

Neuropsychological Testing

General (all payers)

Also called: neuropsych testing; 96132; 96133; 96137

Definition: Testing that assesses brain-behavior relationships, with separate evaluation and administration codes.
Why it matters: Requires careful time documentation and often authorization.
Illustrative example: A neuropsychologist documents testing hours and interpretation time.

Verify: confirm in current CPT manual.

Related terms Psychological Testing CPT Code

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Opioid Treatment Program (OTP)

General (all payers)

Also called: OTP; methadone clinic

Definition: A federally regulated program that provides medications for opioid use disorder, such as methadone, along with counseling.
Why it matters: Medicare and Medicaid have bundled payment rules for OTPs.
Illustrative example: An OTP bills weekly bundled payments where allowed.

Verify: payer-specific.

Reference source SAMHSA · CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms

Partial Hospitalization Program (PHP)

General (all payers)

Also called: PHP; day treatment

Definition: A more intensive outpatient program, typically several hours a day on multiple days, as an alternative to inpatient care.
Why it matters: Medicare and payers set specific criteria and billing rules.
Illustrative example: A PHP is authorized for a defined number of days.

Verify: payer-specific.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms

Peer Support Services

Medicaid (state-specific)

Also called: peer support; certified peer specialist services; Medicaid peer support

Definition: Peer support services are support services delivered by people with lived experience of a mental health or substance use condition who are trained and often certified. Many state Medicaid programs cover them.
Why it matters: Coverage, provider certification, supervision, and codes vary by state. Check the state Medicaid manual.
Illustrative example: A clinic bills a state Medicaid program for peer support delivered by a certified peer specialist.

Verify: State-specific codes and requirements.

Reference source Medicaid.gov · SAMHSA

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms Medicaid

PHQ-9

General (all payers)

Also called: Patient Health Questionnaire-9; depression screening questionnaire

Definition: The PHQ-9 is a nine-item questionnaire used to screen for and monitor depression severity. It is commonly used with brief assessment billing.
Why it matters: Practices use it for measurement-based care and for billing CPT 96127 per instrument, where the payer allows it.
Illustrative example: A clinician gives the PHQ-9 at intake and bills 96127 with one unit.

Verify: Confirm payer policy on which instruments are covered.

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsQuality & Risk Adjustment Terms

Progress Note

General (all payers)

Also called: session note; clinical note; SOAP note; DAP note

Definition: A record of a session that documents the service, time, interventions, and patient response, and supports the claim.
Why it matters: Payers rely on progress notes to confirm medical necessity and billed time.
Illustrative example: A note shows start and end times, the intervention, and progress toward goals.

Reference source American Psychiatric Association

Categories Behavioral Health Specific TermsAudits & Compliance

Psychiatric Nurse Practitioner (PMHNP)

General (all payers)

Also called: PMHNP; psychiatric mental health nurse practitioner; psychiatric NP

Definition: An advanced practice nurse specializing in psychiatric care who can diagnose, prescribe, and provide therapy in many states.
Why it matters: Payer credentialing, supervision, and incident-to rules for NPs vary widely.
Illustrative example: A payer credentials a PMHNP as an independent provider in one state but requires collaboration in another.

Verify: state and payer rules vary.

Reference source CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsCredentialing & Enrollment

Psychiatrist

General (all payers)

Also called: MD psychiatrist; prescriber; psychiatric provider

Definition: A physician who specializes in mental health and can prescribe medication, and who commonly bills E/M codes with add-on psychotherapy codes.
Why it matters: Prescribers bill differently from therapists: E/M plus add-ons, and prescribing-related requirements.
Illustrative example: A psychiatrist bills an E/M with a psychotherapy add-on.

Reference source American Psychiatric Association

Categories Behavioral Health Specific Terms

Psychological Testing

General (all payers)

Also called: psychological and neuropsychological testing; 96130; 96131; 96136

Definition: Standardized assessment of cognitive, emotional, and behavioral functioning, billed with testing evaluation and administration codes that often require prior authorization.
Why it matters: Testing has time-based codes, authorization needs, and frequent denials for documentation.
Illustrative example: A psychologist bills evaluation and test administration codes with authorization.

Verify: confirm code details in the current CPT manual and payer policy.

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Psychotherapist

General (all payers)

Also called: therapist; counselor; LCSW; LMFT; LPC; psychologist

Definition: A licensed clinician, such as a psychologist, clinical social worker, marriage and family therapist, or professional counselor, who provides psychotherapy.
Why it matters: Payers set separate credentialing and billing rules by license type.
Illustrative example: A licensed clinical social worker bills psychotherapy codes under an individual NPI.

Reference source American Psychiatric Association

Categories Behavioral Health Specific Terms

Research-Supported Psychological Treatment

General (all payers)

Also called: empirically supported treatment; EST; evidence-based psychological treatment; Division 12 list

Definition: A research-supported psychological treatment is a psychological treatment for which studies show benefit for a condition. The Society of Clinical Psychology keeps lists and rates the evidence. Its archived labels are strong, modest, and controversial, and its current labels are very strong, strong, weak, and insufficient evidence.
Why it matters: The rating shows how much research backs a treatment for a condition. It does not decide payer coverage, but it can support a medical necessity argument.
Illustrative example: A psychologist cites the evidence level for a treatment in a medical necessity letter.

Verify: Confirm the current ratings on the Society of Clinical Psychology site.

Reference source Society of Clinical Psychology, Psychological Treatments · Society of Clinical Psychology (Division 12, American Psychological Association)

Categories Behavioral Health Specific TermsQuality & Risk Adjustment Terms

Residential Treatment

General (all payers)

Also called: residential treatment center; RTC

Definition: Live-in behavioral health or substance use treatment in a non-hospital setting.
Why it matters: Billed on institutional claims with authorization and level-of-care review.
Illustrative example: A payer authorizes residential days with concurrent review.

Reference source SAMHSA

Categories Behavioral Health Specific Terms

SBIRT

General (all payers)

Also called: Screening, Brief Intervention, and Referral to Treatment

Definition: A public health approach to identify people with risky substance use, provide a brief intervention, and refer to treatment when needed.
Why it matters: Has specific codes in Medicare and some Medicaid programs.
Illustrative example: A clinic bills SBIRT using payer-recognized codes.

Verify: codes and coverage vary by payer.

Reference source SAMHSA · CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific Terms

Screening

General (all payers)

Also called: behavioral health screening; SBIRT

Definition: A brief standardized check to identify possible conditions, such as depression or substance use, which may be billed with specific codes where covered.
Why it matters: Coverage and codes differ by payer and program.
Illustrative example: A primary care office screens for alcohol use with a standard tool.

Reference source SAMHSA · CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific Terms

Serious Mental Illness (SMI)

Medicaid (state-specific)

Also called: SMI; serious mental illness definition; serious emotional disturbance

Definition: Serious mental illness is a term SAMHSA uses for a mental, behavioral, or emotional disorder in an adult that causes serious functional impairment and substantially limits major life activities.
Why it matters: Programs, Medicaid benefits, and some state laws use the term or a similar one. Definitions differ, so check the payer or statute.
Illustrative example: A community clinic checks a patient's diagnosis and functioning against the state's definition to see if a program applies.

Verify: Definitions differ by program and state.

Reference source SAMHSA

Categories Behavioral Health Specific Terms Medicaid

Substance Use Disorder Treatment

General (all payers)

Also called: SUD treatment; addiction treatment

Definition: Treatment for substance use disorders, including counseling, medication, and programs at various levels of care.
Why it matters: Billing rules, confidentiality, and authorization differ from mental health services.
Illustrative example: A program bills SUD counseling with its own codes and consent rules.

Related terms 42 CFR Part 2 Level of Care

Reference source SAMHSA

Categories Behavioral Health Specific Terms

Suicide Risk Screening

General (all payers)

Also called: suicide screening; C-SSRS; suicide risk assessment tool

Definition: Suicide risk screening is the use of a structured tool or questions to identify a patient's risk of suicide, followed by assessment and a plan when risk is found.
Why it matters: Accrediting bodies and many payers expect it. Document the tool, the result, and the actions taken.
Illustrative example: A clinic screens every new patient and documents a safety plan when the screen is positive.

Verify: Confirm the tools and steps your accreditor or payer requires.

Reference source The Joint Commission · SAMHSA

Categories Behavioral Health Specific TermsQuality & Risk Adjustment Terms

Targeted Case Management (TCM)

Medicaid (state-specific)

Also called: TCM; Medicaid case management; targeted case management

Definition: Targeted case management is a Medicaid service that helps a defined group of people get medical, social, and other services. States can choose which groups to cover.
Why it matters: Coverage, provider rules, and codes vary by state. It is often used for people with serious mental illness.
Illustrative example: A clinic bills targeted case management for a patient who needs help linking to housing and treatment.

Verify: State-specific.

Reference source Medicaid.gov · CMS (Centers for Medicare & Medicaid Services)

Categories Behavioral Health Specific TermsMedicare & Medicaid Terms Medicaid

Transcranial Magnetic Stimulation (TMS)

General (all payers)

Also called: TMS; 90867; 90868; 90869

Definition: A noninvasive treatment for certain depressive conditions using magnetic pulses, billed with specific CPT codes and usually requiring prior authorization.
Why it matters: Has strict payer criteria and documentation.
Illustrative example: A psychiatrist requests authorization for a TMS course.

Verify: payer criteria vary.

Reference source American Medical Association (AMA)

Categories Behavioral Health Specific TermsClaims Processing

Treatment Plan

General (all payers)

Also called: plan of care; individualized treatment plan

Definition: A written plan that lists a patient's goals, interventions, and expected duration, updated as care progresses.
Why it matters: Many payers and Medicaid programs require current plans to support continued care.
Illustrative example: A therapist updates a treatment plan every set period as payer rules require.

Verify: update frequency is payer-specific.

Reference source American Psychiatric Association

Categories Behavioral Health Specific TermsAudits & Compliance