Billing for psychiatrists, psychiatric nurse practitioners, TMS and esketamine programs, child and adolescent psychiatry, and integrated behavioral health teams.
A psychiatric practice loses money in places a general biller never looks. A session documented at 51 minutes pays as 90834, not 90837, and that is $53.10 a claim. A visit sent to the payer printed on the card instead of the behavioral health carve-out denies and then ages out. A home telepsychiatry visit coded place of service 02 pays the facility rate. Luxen owns the full cycle inside the system you already run.
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Psychiatry medical billing is the coding, claim submission, and collections work behind psychiatric evaluations, medication management, psychotherapy, and interventional treatment. It covers time-based psychotherapy codes, E/M add-ons, telepsychiatry rules, and behavioral health carve-out routing. Across 38 client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days of onboarding.
We bill for solo psychiatrists and psychiatric nurse practitioners, multi-provider psychiatric groups, child and adolescent psychiatry, geriatric psychiatry, addiction psychiatry, and hospital-affiliated faculty practices. Each bills differently. A solo prescriber lives on 99213 to 99215 with psychotherapy add-ons and carries the enrollment risk alone; new clinicians waited a median 96 days to go in-network with commercial payers, which is why we start credentialing the week a contract is signed. A group runs mixed rosters of physicians, nurse practitioners, psychologists and therapists, so incident-to and split or shared rules decide which NPI goes on the claim.
Most psychiatric practices bill more than one service line: medication management and psychotherapy on one encounter, interventional treatment such as repetitive transcranial magnetic stimulation and esketamine where authorization runs by unit count across dozens of sessions, psychological and neuropsychological testing billed by the hour, collaborative care billed on accumulated minutes across a calendar month, and group, family and crisis work. We bill all of them and reconcile against the schedule instead of waiting for a denial.
The four leaks we find most often when we audit a psychiatric practice. Dollar figures are CY2026 Medicare national non-facility amounts.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Long session documented just under the threshold | 90837 vs 90834 | CPT puts 90837 at 53 minutes and over, so a note reading 51 minutes supports 90834 and the claim downcodes or is recouped. | $53.10 | 18% of 90837 claims had documented session time under 53 minutes |
| Claim sent to the payer printed on the card | Any psychiatric service | The carve-out has its own payer ID and filing window. The medical plan denies while the real clock runs. | $167.00 on a 90837 | Claims sent to the medical plan instead of the behavioral health carve-out caused 12% of behavioral health denials |
| Home telepsychiatry billed with place of service 02 | 90834, 99214 | POS 02 pays the facility rate. A patient at home is POS 10, which pays non-facility. | $22.05 on 90834, $51.11 on 99214 | Telehealth place-of-service and modifier errors caused 15% of behavioral health telehealth denials |
| Psychotherapy during a medication visit, never billed | 99214 plus 90833 | The add-on needs psychotherapy time documented apart from the E/M work. Blended notes lose it. | $81.50 | Coding and modifier errors caused 21% of denials |
The three psychotherapy codes carry descriptors of 30, 45 and 60 minutes, but CPT selects a timed code once the midpoint of the stated time is passed. That produces the thresholds that matter at claim level: 16 to 37 minutes is 90832, 38 to 52 is 90834, 53 and over is 90837. The American Psychiatric Association publishes the same ranges. Round numbers in a template note create downcoding and audit exposure, because the payer reads documented time, not the descriptor.
| Code | Service | Documented time | CY2026 Medicare non-facility |
|---|---|---|---|
| 90791 / 90792 | Psychiatric diagnostic evaluation, without and with medical services | Not time based | $173.35 / $202.08 |
| 90832 / 90834 / 90837 | Psychotherapy with patient | 16 to 37 / 38 to 52 / 53 and over | $85.84 / $113.90 / $167.00 |
| 90833 / 90836 / 90838 | Psychotherapy add-on with E/M | 16 to 37 / 38 to 52 / 53 and over | $81.50 / $103.20 / $136.59 |
| 90785 | Interactive complexity add-on | Not time based | $14.70 |
| 90839 / 90840 | Crisis, first 60 minutes / each additional 30 | Time based | $160.32 / $77.16 |
| 90847 | Family psychotherapy with patient present | 50 minutes | $109.55 |
| 90853 | Group psychotherapy | Not time based | $30.39 |
90833, 90836 and 90838 let a prescriber bill medication management and psychotherapy on one encounter. They are add-on codes, cannot stand alone, and the psychotherapy time has to be documented separately from the work supporting the E/M level. A 99214 with a documented 20 minute psychotherapy component pays $135.61 plus $81.50 instead of $135.61 alone: the most commonly abandoned $81.50 in psychiatry. Our certified coding team checks these pairs before submission.
90785 reports four communication factors that complicate delivery of the primary psychiatric service. It may be reported with 90791, 90792, the psychotherapy codes, the psychotherapy add-ons when reported with an E/M service, and 90853. It may not be reported with crisis codes 90839 and 90840, with family psychotherapy 90846, 90847 or 90849, or with an E/M service carrying no psychotherapy add-on.
The Medicare Claims Processing Manual is explicit. POS 02 is used when the patient is not in their home and pays the facility rate. POS 10 is used when the patient is at home and pays the non-facility rate. The manual adds that the modifier does not change the rate of payment, only the place of service code does. On a mostly at-home telepsychiatry panel, defaulting to POS 02 costs $22.05 on every 90834 and $51.11 on every 99214.
Modifier 95 identifies a synchronous service delivered by real-time interactive audio and video. Modifier 93 identifies audio-only. Modifier FQ identifies a telehealth service furnished using real-time audio-only communication technology. Modifier FR identifies that a supervising practitioner was present through real-time two-way audio and video. Modifier GT was eliminated for all professional claims in the CY2018 Physician Fee Schedule final rule and survives only on Critical Access Hospital Method II institutional claims.
Behavioral health is treated differently from every other specialty here. Under the Consolidated Appropriations Act, 2021, beneficiaries in rural and urban areas alike can receive behavioral health telehealth services in their homes, and that exemption does not expire. The broader geographic and originating site flexibilities run through December 31, 2027, and audio-only telehealth in the home is permitted through the same date. The in-person visit requirement within six months prior to a first mental health telehealth service takes effect after December 31, 2027, with an in-person visit every 12 months after. A great deal of published guidance still describes that requirement as active today. It is not.
Collaborative care is billed by the treating practitioner, not the psychiatric consultant, on accumulated care manager time within a calendar month. The model requires a designated behavioral health care manager working under the billing practitioner and a psychiatric consultant qualified to prescribe. Practices that run the model clinically and never bill it give up a recurring monthly payment.
| Code | Service | Time in a calendar month | CY2026 Medicare non-facility |
|---|---|---|---|
| 99492 | Initial psychiatric collaborative care management | 70 minutes, initial month | $160.32 |
| 99493 | Subsequent psychiatric collaborative care management | 60 minutes | $144.96 |
| 99494 | Collaborative care, each additional 30 minutes | 30 minutes | $61.46 |
| 99484 | General behavioral health integration | At least 20 minutes | $57.45 |
99484 covers general behavioral health integration at 20 minutes or more of care management time in a month, billed by practitioners whose scope includes E/M services. G0323 is the parallel code for clinical psychologists, clinical social workers, marriage and family therapists and mental health counselors performing it personally, and G2214 reports 30 minutes of care manager time. The problem is never the codes, it is the minute log. We reconcile that log against the claim before it goes out, the same way we handle eligibility and prior authorization on interventional treatment.
G2211 is the visit complexity add-on for care that is the continuing focal point for a patient, or part of ongoing care for a single serious or complex condition. Longitudinal psychiatric care is the textbook case, and CMS has confirmed the code is not limited to any specialty. It pays $17.37. The trap is modifier 25: CMS denies G2211 when the office or outpatient E/M on the same date, same patient, same practitioner carries modifier 25, outside a narrow set of preventive exceptions.
The requirement to use GT was eliminated for all professional claims in the CY2018 Physician Fee Schedule final rule and survives only on Critical Access Hospital Method II institutional claims. On a professional telepsychiatry claim it buys a rejection on a claim that would otherwise have paid. CMS MM10583. Telehealth place-of-service and modifier errors caused 15% of behavioral health telehealth denials.
CPT selects a timed code once the midpoint of the stated time is passed, putting 90837 at 53 documented minutes and over. A note reading 50 minutes supports 90834, a $53.10 difference a claim, and on audit the recoupment reaches back across the panel. APA CPT overview. 18% of 90837 claims had documented session time under 53 minutes, across 7,200 behavioral health claims.
Behavioral benefits are frequently administered by a separate carve-out with its own payer ID, rules and filing window. The medical plan denies, the denial is reworked as a coding problem, and the real filing clock runs out. Exposure is the full allowable, $167.00 on a 90837. Claims sent to the medical plan instead of the behavioral health carve-out caused 12% of behavioral health denials.
Per CMS telehealth guidance updated February 26, 2026, that requirement takes effect after December 31, 2027, with an in-person visit every 12 months after. Practices enforcing it early turn away billable visits. CMS telehealth FAQ. Audio-only visits were billed with video modifiers on 6% of telehealth claims.
Direct supervision under 42 CFR 410.32 means the supervising practitioner is in the office suite and immediately available, never in the room, and from January 1, 2026 it can be met virtually for applicable services. On a split or shared visit, 42 CFR 415.140 sets the substantive portion at more than half the total time or a substantive part of the medical decision making, with modifier FS on the claim. 42 CFR 415.140. Credentialing lapses delayed payment for 1 in 12 providers added in the prior year.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Psychiatric practices run on a narrow set of systems and we work inside the one you already have: TherapyNotes, SimplePractice, Valant, ICANotes, Tebra, AdvancedMD, athenahealth, eClinicalWorks, NextGen and Epic on the outpatient side, Qualifacts CareLogic or Netsmart for community mental health. Interventional programs add a separate TMS or infusion log and an authorization tracker that rarely talks to the EHR, which is exactly where treatment units go missing. There is no migration and no new login for your clinicians. We take credentials in your system, bill from your notes, and post payments where your reports already read them. See full service medical billing for the scope.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Psychiatry-specific findings from our own datasets: Luxen claim audit, 61,400 claims audited, January 2025 to June 2026, and Luxen billing reviews, 410 practice billing reviews, same period.
Each TMS course included dozens of sessions, but remaining authorized treatments were tracked manually. Luxen built a patient-level tracker, reducing claims outside the approved range by 84% and lowering held revenue from $59,000 to $8,700.
Operations Director, outpatient psychiatry and TMS clinic
Medication-management visits and psychotherapy add-on services were not consistently supported and billed together. Luxen introduced a documentation review, reduced related denials by 67%, and recovered $36,500.
Practice Administrator, multi-provider psychiatric group
Full engagements are written up in our dental practice case study and our ambulance billing case study.
The CY2026 Physician Fee Schedule final rule was published at 90 FR 49266 on November 5, 2025 and took effect January 1, 2026. For the first time there are two conversion factors: $33.5675 for qualifying APM participants and $33.4009 for everyone else. If your reports still model one national rate, your variance analysis is wrong before it starts. The same rule made virtual direct supervision permanent for applicable incident-to services, using real-time audio and visual interactive telecommunications, excluding audio-only.
The February 16, 2024 final rule on confidentiality of substance use disorder patient records, at 89 FR 12472, carried a compliance date of February 16, 2026. That date has passed. The rule permits a single patient consent covering all future uses and disclosures for treatment, payment and health care operations until the patient revokes it in writing, so addiction psychiatry practices still collecting a consent per disclosure are adding friction the rule no longer requires.
Parity is in an unusual posture. The 2024 MHPAEA final rule was published at 89 FR 77586. On May 15, 2025 the Departments of Labor, Health and Human Services and the Treasury stated they will not enforce the portions of that rule that are new relative to the 2013 rule while litigation proceeds, plus 18 months. The statutory obligations under the Consolidated Appropriations Act, 2021 still apply, including the nonquantitative treatment limitation comparative analysis, so parity remains a usable argument on a psychiatric denial. We use it through denials and AR recovery.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections. Where a psychiatric practice lands depends on volume, payer mix, and whether interventional treatment and testing are in scope. Month to month, 30 days notice, no setup fee and no exit fee.
Two psychiatrists and one psychiatric nurse practitioner collecting $1,650,000 a year, mostly medication management with psychotherapy add-ons plus a small TMS program. At 5% Luxen costs $82,500 a year, or $6,875 a month. Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data, which is $130,350 here. The annual difference is $47,850 before any recovery.
| Cost line | In-house at $1,650,000 collected | Luxen at 5% of collections |
|---|---|---|
| Billing cost | $130,350, at 7.9% of collections | $82,500 |
| Setup or implementation fee | Recruiting, onboarding, training | $0 |
| Coverage during leave or turnover | Practice absorbs it | Included |
| Payer enrollment and credentialing | Separate vendor or staff time | Included |
| Denial reporting by root cause | Rarely produced | Monthly |
| Annual difference | $47,850 lower |
Recovery is separate from cost. Median days in AR dropped from 54 to 33 within 120 days across our client practices, and every 10 days removed from AR released a median $41,000 in cash for practices collecting $1.5M to $3M a year. On a practice this size that is roughly $86,000 released once.
Ask how they route a claim when the behavioral benefit is carved out from the medical plan, and ask them to describe the check that happens before submission, not after the denial. Ask what documented time they require before submitting a 90837. Ask whether they bill collaborative care and general behavioral health integration, and how they capture the monthly minute log. Ask how they track TMS and esketamine authorization units. Ask for their appeal overturn rate and its sample. Ask for the fee basis in writing: 44% of practice managers could not name the fee basis in their current billing contract.
| Partner type | Psychiatric code depth | Carve-out routing and credentialing | Cost |
|---|---|---|---|
| In-house biller | Depends on one person | Learned by trial, staff time | About 7.9% of collections fully loaded |
| Generalist billing company | General medical | Often missed, credentialing extra | 4% to 8% of collections |
| Specialty billing company | Deep | Built in, usually included | 3% to 7% of collections |
| EHR vendor RCM | Tied to the platform | Varies, sometimes included | 4% to 9% of collections |
| Luxen | Certified coders, psychiatry specific | Checked before submission, included | 3% to 6% of collections |
52% of practices that switched billing vendors cited missing denial reporting as the main reason, worth more weight than the headline percentage. If you are running a formal comparison, compare medical billing companies by state and specialty rather than by price alone. State rules move real money here: Minnesota pulled outpatient mental health and substance use treatment out of prior authorization in January 2026, Ohio routes complex child and adolescent behavioral health through OhioRISE, and North Carolina runs psychiatry and substance use services through four Tailored Plans with separate networks and authorization rules.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
It is harder in specific ways. Psychotherapy codes are time based on thresholds CPT sets by midpoint, so 90834 runs 38 to 52 documented minutes and 90837 starts at 53. Behavioral benefits are often carved out to a separate payer with its own ID and filing window: in our audit, that carve-out caused 12% of behavioral health denials.
Luxen charges 3% to 6% of collections, month to month, 30 days notice, no setup fee and no exit fee. For comparison, fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data. Where you land depends on volume, payer mix, and whether interventional treatment and testing are in scope.
About two weeks from signed BAA to working claims, and first recovered payments in about three weeks. We start on the oldest dollars, because claims aged past 180 days were recovered at 23% of dollar value while claims aged 90 to 180 days were recovered at 61%.
No. We work inside the system you already run, including TherapyNotes, SimplePractice, Valant, ICANotes, Tebra, athenahealth, eClinicalWorks, NextGen, Epic, Qualifacts CareLogic and Netsmart. 38% of practice managers had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch. We do not add to that number.
Yes, when the psychotherapy time is documented separately from the work supporting the E/M level. A 99214 pays $135.61 at CY2026 Medicare national non-facility rates and 90833 adds $81.50 for 16 to 37 documented minutes. Use 90836 for 38 to 52 minutes and 90838 for 53 and over. Blended notes are the usual reason the add-on is dropped.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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