Mental Health Billing Errors: Therapy and Psychiatry Billing Issues
Mental health billing errors include wrong session codes, telehealth issues, and E/M vs therapy code confusion. Learn to spot errors and save $100-$3,000.
Potential savings: $100-$3,000
Mental health services, including psychotherapy, psychiatric evaluations, and medication management, are subject to unique billing rules that create frequent opportunities for errors. With the rapid growth of telehealth for mental health services, new billing complexities have emerged. The Mental Health Parity and Addiction Equity Act requires insurers to cover mental health services comparably to medical services, yet billing errors and improper denials remain widespread.
What Is Mental Health Billing Errors?
Mental health billing uses specific CPT codes for different service types. Psychotherapy is coded by duration: 90832 (16-37 minutes), 90834 (38-52 minutes), and 90837 (53+ minutes). Psychiatric evaluations use 90791 (without medical services) or 90792 (with medical services). When a psychiatrist provides both therapy and medication management in the same visit, add-on codes 90833, 90836, or 90838 are used alongside an E/M code. Incorrect code selection is the most common error.
Common Billing Errors
Being billed for a longer therapy session than what was provided. A 30-minute session should be billed as 90832, not 90834 (38-52 minutes) or 90837 (53+ minutes). The difference between a 30-minute and 60-minute session code can be $75-$150.
CPT 90832 (~$80) vs 90837 (~$175)Billing a standard office visit E/M code (99213-99215) for a psychotherapy session instead of the appropriate psychotherapy code. E/M codes may result in different insurance coverage and cost-sharing, potentially costing the patient more.
CPT 99214 (E/M) vs 90834 (psychotherapy)Incorrect or missing telehealth modifiers (modifier 95 or GT) on virtual mental health visits. Without proper telehealth coding, claims may be processed at in-person rates or denied entirely. Some providers also incorrectly add facility fees to telehealth visits.
Modifier 95 or GT for telehealth sessionsWhen a psychiatrist provides both psychotherapy and medication management, add-on therapy codes (90833, 90836, 90838) should be used with an E/M code. Billing both a standalone therapy code (90834) and an E/M code for the same visit is incorrect.
CPT 90834 + 99214 (incorrect) vs 90836 + 99214 (correct add-on)How to Spot These Errors on Your Bill
- 1
Track the actual duration of your therapy sessions (start time to end time) and compare against the CPT code billed.
- 2
Check if your therapist billed an E/M code instead of a psychotherapy code, which could affect your insurance coverage.
- 3
For telehealth visits, verify that appropriate telehealth modifiers are present and no facility fee was charged.
- 4
If you see both a standalone psychotherapy code and an E/M code on the same date, ask the provider to explain the billing.
- 5
Review your insurance EOB to ensure mental health visits are covered at parity with medical visits as required by federal law.
Frequently Asked Questions
What is the Mental Health Parity Act and how does it affect my bills?
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurance plans that cover mental health services to provide coverage that is no more restrictive than coverage for medical and surgical services. This means copays, deductibles, visit limits, and prior authorization requirements for mental health must be comparable to those for medical care. If your plan applies stricter rules to mental health, it may be violating the law.
How do I know which therapy session code should be used?
Therapy session codes are based on the actual time spent in face-to-face psychotherapy: 90832 for 16-37 minutes, 90834 for 38-52 minutes, and 90837 for 53 minutes or more. Note the start and end time of your sessions. If you consistently have 45-minute sessions but are billed 90837 (53+ minutes), the code may be incorrect.
Can my therapist charge for a missed appointment?
Therapists can charge a no-show or late cancellation fee as a business practice, but they cannot bill your insurance for a missed appointment since no service was provided. If you see an insurance claim for a date when you missed your appointment, this is an error or potential fraud that should be reported immediately.
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