Mental health billing has the highest denial rate of any specialty — 18.1% industry average. Carve-outs, session limits, MBHO rules, and telehealth coding require specialist expertise.
Common Billing Challenges
These are the six billing failure points we see most often — and the ones our team resolves systematically from day one.
Most commercial plans use a separate Managed Behavioral Health Organization (MBHO) to manage mental health benefits. Billing the wrong entity is an automatic denial — we know every payer's carve-out structure.
Payers impose session limits for psychotherapy. Billing beyond authorized sessions without re-authorization results in denials that are extremely difficult to overturn.
Telehealth reimbursement rules for mental health changed significantly after the PHE. State-specific originating site rules and GT/95 modifier requirements vary by payer.
Billing for psychiatrists, psychologists, LCSWs, LPCs, and MFTs under one practice requires correct NPI and taxonomy code for each credential level — incorrect taxonomy causes enrollment-level denials.
The distinction between 90833 (add-on psychotherapy) and 99213/99214 (E/M for med management) is frequently miscoded. We apply the correct code based on documented service time and content.
SUD billing requires ASAM level of care documentation, H-code proficiency, and state Medicaid SUD waiver billing knowledge — a specialized skill set few general billers possess.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in that specialty.
| CPT Code | Description | Common Issue |
|---|---|---|
| 90837 | Psychotherapy, 60 min | MBHO vs. medical benefit routing |
| 90833 | Psychotherapy add-on, 30 min | Session limit tracking per auth |
| 90847 | Family psychotherapy with patient | GT/95 modifier + originating site |
| 99214 | E/M, established, moderate complexity | NPI + taxonomy per credential |
| 90791 | Psychiatric diagnostic evaluation | Time vs. complexity selection |
| H0001 | Alcohol/drug assessment | H-code + ASAM documentation |
Why RCMAXIS
We are not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to your field — not a generic CPC only.
Significantly above the 18.1% industry denial rate for your specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.