Mental health, ABA therapy, psychiatry, and substance use disorder billing requires specialists — not generalists. High-performing billing partners provide behavioral health billing with deep payer knowledge, parity compliance expertise, and authorization management for practices that can't afford generic billing teams.
Behavioral health billing is the process of coding and submitting insurance claims for mental health, ABA therapy, psychiatry, and substance use disorder services. It is significantly more complex than general medical billing due to time-based CPT codes, strict prior authorization requirements, parity compliance obligations, and payer-specific documentation rules. ABA practices that use a specialist billing company collect 12–28% more revenue than those using generalist billers.
HCPCS H-code and T-code billing for ABA providers. BCBA supervision documentation, behavior treatment plan compliance, and Medicaid/commercial auth management. We understand the complexity of 97153, 97155, and H2019 billing.
Outpatient therapy, group therapy, and crisis services billing. CPT 90832–90838 with proper time-based documentation. Parity compliance monitoring and violation appeals included.
E/M and psychotherapy add-on billing. 90833, 90836, 90838 with the appropriate base E/M. Medication management coding and prior authorization for psychiatric medications where applicable.
IOP, PHP, and residential SUD billing. H-code billing for counseling services. SAMHSA compliance and state-specific Medicaid billing for SUD programs.
Multi-clinician group practices with LCSW, LMFT, LPC, PhD, and MD providers. Each clinician billed under the correct NPI with appropriate supervision and incident-to rules applied.
Post-PHE telehealth billing with correct POS codes (02, 10) and GT/95 modifiers. Payer-specific telehealth coverage rules applied. Audio-only billing where covered.
| Metric | Generalist Biller | BH Specialist |
|---|---|---|
| Denial Rate | 15–20% | <5% |
| Auth Management | Reactive | Proactive |
| Revenue Collected | Baseline | +12–28% more |
| Parity Violation Detection | Rarely flagged | Monitored + appealed |
| ABA H-code Accuracy | Inconsistent | 100% compliant |
We track every active authorization — session counts, expiration dates, and payer-specific renewal timelines. Auth renewals submitted 30 days before expiration. No auth lapses.
Session notes reviewed for time documentation, therapist credentials, and medical necessity language before claim creation. Catches documentation gaps before they become denials.
Correct CPT and HCPCS codes applied based on service type, clinician license level, and session length. Supervision ratios and incident-to rules applied accurately.
Every denial reviewed for potential parity violations. When a payer applies stricter limits to behavioral health than comparable medical services, we file parity appeals — recovering revenue generalist billers miss.
Monthly performance reports with denial analysis by payer and code. Credentialing support for new clinicians joining the group.
Most behavioral health practices using generalist billers are under-collecting by 12–28%. A free audit reveals exactly where your revenue is leaking.