Billing for solo psychologists, group psychology practices, psychological and neuropsychological testing practices, and integrated behavioral health teams.
A psychology practice loses money in places a general billing team does not look. A testing battery that runs across two days gets a second first-hour code and denies. A session at 49 minutes goes out as 90837 and comes back on a retro review. A telehealth visit from the client living room carries the wrong place of service and pays the facility rate. None of it looks like a crisis on the bank statement. It shows up as a slow leak of five to nine percent of what the practice earned.
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Psychology billing services handle coding, claim submission, denials and collections for psychologists and psychology groups, covering psychotherapy, psychological testing and health behavior codes. The work spans commercial plans, behavioral health carve-outs, Medicare and self-pay clients. Across 38 Luxen client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days of onboarding.
We bill for solo psychologists in private practice, group psychology practices with employed and contracted clinicians, psychological and neuropsychological testing practices, pediatric and school-referred assessment practices, forensic and disability evaluation practices, and psychology teams embedded in primary care or a hospital outpatient department.
The billing changes shape with each of them. A therapy-only solo practice runs a short code set and lives on eligibility and patient balances. A testing practice runs base codes and add-on units across multi-day episodes, technician time, and payer policies that treat the same battery three different ways. A group practice adds credentialing, rendering provider mapping and supervision rules on top. An embedded psychology team bills health behavior codes against a medical diagnosis, which is a different coverage rule entirely.
Most psychology practices bill more than one service line: individual and group psychotherapy, family sessions with and without the client present, psychological and neuropsychological testing, health behavior assessment and intervention, and crisis sessions. Practices treating co-occurring conditions run a second book alongside this one, which is why we also handle substance abuse billing. All of it sits inside our full-service medical billing.
These are the six leaks we find most often when we run a billing review on a psychology practice. In the average practice we review, 27% of total AR sat past 90 days and 19% of denied claims were never reworked or appealed. Dollar figures below are 2026 national non-facility Medicare amounts, before locality adjustment.
| Scenario | Codes | What goes wrong | Dollars at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Testing evaluation spans two days | 96130, 96131 | 96130 is reported again on the second day instead of 96131, and the duplicate base code denies | $123.92 | 12% of psychological testing claims billed add-on evaluation hours with no first-hour base code |
| A technician administers the battery | 96136, 96137 vs 96138, 96139 | Technician time is reported under the physician or QHP codes, and the payer recoups on audit | $6.02 per 30-minute unit | Units billed as physician administered on 9% of testing episodes |
| Telehealth session from the client home | 90837 | POS 02 is reported instead of POS 10, so the claim pays at the facility rate | $167.00 | Place of service errors caused 11% of psychology telehealth denials |
| A 49-minute session billed as an hour | 90834 vs 90837 | Documented time supports 90834, and the 90837 claim is recouped on review | $53.10 difference | Coding and modifier errors caused 21% of denials |
| Interactive complexity added by habit | 90785 | 90785 is appended with no complicating factor in the note, and the add-on denies | $14.70 | Add-on billed without a documented complicating factor on 7% of psychology claims |
| Carve-out claim sent to the medical plan | 90791 | The claim goes to the card on file instead of the behavioral administrator, and the filing window closes | $173.35 | Timely filing caused 6% of denials, and only 4% of those were recovered |
Psychological testing splits into two families. Evaluation services cover psychologist professional time: integrating patient data, interpreting standardized results, clinical decision making, treatment planning, the report and feedback. Those accumulate in 60-minute increments. Test administration and scoring accumulates in 30-minute increments, and the code changes depending on whether the psychologist or a technician sat with the client.
| Code | What it covers | Increment | 2026 national non-facility |
|---|---|---|---|
| 96130 | Psychological testing evaluation services by physician or QHP, first hour | 60 minutes | $123.92 |
| 96131 | Same, each additional hour | 60 minutes | $86.51 |
| 96132 | Neuropsychological testing evaluation services, first hour | 60 minutes | $122.25 |
| 96133 | Same, each additional hour | 60 minutes | $97.86 |
| 96136 | Test administration and scoring by physician or QHP, first 30 minutes | 30 minutes | $43.76 |
| 96137 | Same, each additional 30 minutes | 30 minutes | $37.07 |
| 96138 | Test administration and scoring by technician, first 30 minutes | 30 minutes | $37.74 |
| 96139 | Same, each additional 30 minutes | 30 minutes | $35.40 |
The first-hour code is used once for the whole assessment episode, even when the assessment spans several days. The same rule applies to the first 30 minutes of administration and scoring: 96136 and 96138 are used once for the complete evaluation regardless of how many sessions it took. Every hour or half hour after that is an add-on unit against the single base code. A per-hour code also needs a minimum of 31 minutes before it can be reported at all. Time under that threshold is not a short unit, it is no unit.
When a technician administers the battery under general supervision, the time is reported with 96138 and 96139, not 96136 and 96137. The difference is $6.02 per 30-minute unit at the national rate, small on one claim and material across a practice running four to six hours of administration per case. It is also the line that draws post-payment review. Our certified coding team builds the episode first, then codes it, so the base and add-on structure is set before anything transmits.
POS 02 is telehealth provided other than in the patient home. POS 10 is telehealth provided in the patient home. Since January 2024, Medicare pays telehealth furnished to a patient at home at the non-facility rate, which is the higher of the two. Most psychology telehealth happens in a client bedroom, kitchen or parked car, which is POS 10. Practices that set POS 02 as the EHR default two years ago and never revisited it have been underpaid on every virtual session since.
Modifier 93 is a synchronous service rendered by telephone or other real-time interactive audio-only system. Modifier 95 is a synchronous service rendered by real-time interactive audio and video. Modifier GT was retired for professional claims in 2018 and still sits in claim templates. Behavioral health is where audio-only matters most, because a client without a working camera is a common Tuesday, not an edge case.
Geographic and originating-site restrictions were permanently removed for behavioral health telehealth by the Consolidated Appropriations Act, 2021, and audio-only is permitted. The in-person visit requirement described as current on most billing sites takes effect after December 31, 2027. Patients who began mental health telehealth on or before that date are treated as established and face only an annual in-person visit, not a six-month lookback. When a payer denies anyway, it goes to denial and AR recovery with the rule citation attached.
CPT assigns 90832 to 16 to 37 minutes, 90834 to 38 to 52 minutes, and 90837 to 53 minutes or more. Psychotherapy under 16 minutes is not reported at all. The code follows the time documented in the note, not the length of the appointment slot. A practice that schedules 60-minute blocks and documents 48 minutes is billing 90834, and a template that auto-fills 90837 is building a recoupment file one session at a time. At 2026 national non-facility rates the gap between 90834 at $113.90 and 90837 at $167.00 is $53.10 per session, which is why payers scrutinize 90837 volume.
Interactive complexity requires at least one of the four complicating factors in the CPT manual to be present and documented. It is not a translation or interpretation code, and it is not billable when the patient cannot communicate by any means. 90839 covers psychotherapy for crisis with a 30-minute floor; 90840 adds each additional 30 minutes once the session passes 75 minutes. Crisis codes are reported by themselves and are not combined with 90791, 90792, or the 90832 to 90838 range.
The card in the client hand often is not where the psychology claim goes. Behavioral benefits are frequently administered by a separate carve-out entity with its own enrollment, portal and filing window. In Maryland the public behavioral system is carved out of HealthChoice managed care entirely, which is one reason Maryland medical billing runs differently from the states around it. Getting this wrong does not produce a denial you fix in a week. It produces a timely filing write-off. That is why the check happens at credentialing and payer enrollment, before the first claim.
The base code is used once for the entire assessment episode, even when testing spans additional days. Each hour after that is an add-on unit. See the CMS article on psychological and neuropsychological testing. Cost: a denied duplicate base code at $123.92 and a pattern that invites post-payment review.
It does not yet. The requirement takes effect after December 31, 2027, and patients established before that date face only an annual visit. See the CMS telehealth FAQ. Cost: sessions declined or converted to in-person that were billable as they stood.
GT was retired for professional claims in 2018. Audio-only is modifier 93 and audio and video is modifier 95. See the CMS Claims Processing transmittal R13088CP. Cost: a front-end rejection on every affected virtual session until someone edits the template.
90837 begins at 53 minutes. 38 to 52 minutes is 90834. See the CMS billing and coding article for psychiatric diagnostic evaluation and psychotherapy. Cost: $53.10 per session recouped on review. Coding and modifier errors caused 21% of denials in our claim audit, and appeals filed by Luxen were overturned 68% of the time.
96156 through 96168 require an underlying physical illness or injury, and Medicare does not cover 96170 or 96171. See the CMS health and behavior assessment and intervention article. Cost: full denial with no appeal path, because the coverage condition is the diagnosis itself.
The statutory obligations under the Mental Health Parity and Addiction Equity Act remain in effect. Only the provisions new to the 2024 final rule sit under an enforcement relief policy while the Departments reconsider them. See the Departments statement on enforcement. Cost: parity appeals abandoned that were still winnable.
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.
Psychology practices run SimplePractice, TherapyNotes, TheraNest, Valant, Tebra, athenahealth, AdvancedMD, NextGen and Epic on the hospital side. Claims and eligibility move through Office Ally, Availity and payer portals, which are clearinghouses and payer portals rather than EHRs, and they carry their own enrollment steps. Testing practices add PARiConnect, Q-global, the MHS Online Assessment Center and WPS Online, where the administration and scoring record that supports 96136 through 96139 actually lives.
We work inside whichever of these you already use. No migration, no new subscription, no second note template for your clinicians. We take login credentials after the BAA is signed and bill in your system, so your schedule, notes and client records stay where they are.
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
Testing administration, scoring, and report-writing time were documented in different places. Luxen reconciled the full assessment, captured 486 missed units, and recovered $53,200.
Clinical Director, psychological assessment practice
Clients often began through an employee assistance program, but the transition to insurance after approved sessions was inconsistent. Luxen built a visit-level tracker, reduced wrong-payer denials by 81%, and recovered $25,700.
Practice Owner, multi-location psychology group
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Medicare does not pay every behavioral clinician the same way, and group practices that mix licenses get this wrong on the enrollment form rather than on the claim. Clinical psychologists who accept assignment are paid at 100% of the physician fee schedule amount. Clinical social workers are paid at 75%. Marriage and family therapists and mental health counselors are paid at 75% of what a clinical psychologist is paid, and they have only been able to enroll and bill Medicare independently since January 1, 2024, under section 4121 of division FF of the Consolidated Appropriations Act, 2023.
| Practitioner type | Medicare specialty code | Share of the fee schedule |
|---|---|---|
| Clinical psychologist, participating | 68 | 100% |
| Independent psychologist, nonparticipating | 62 | 95% |
| Clinical social worker | 80 | 75% |
| Marriage and family therapist | E1 | 75% |
| Mental health counselor | E2 | 75% |
That practitioner reduction is a separate rule from the 80 and 20 coinsurance split, and merging the two is how a practice quotes a client the wrong out-of-pocket number.
Codes 96156 through 96168 cover health behavior assessment and intervention, and they exist for the biopsychosocial factors affecting a physical illness or injury, not a mental health diagnosis. There is no coverage when the patient has no underlying physical condition, and Medicare does not cover 96170 or 96171 at all. State rules move too: Minnesota medical billing changed in January 2026 when outpatient mental health and substance use treatment came out of prior authorization on state-regulated plans.
Psychology carries a heavier self-pay book than most specialties, and the No Surprises Act applies to it. An uninsured or self-pay client, including an insured client who chooses not to submit the claim, is entitled to a Good Faith Estimate: within one business day when the service is scheduled at least three business days out, within three business days when scheduled at least ten business days out or when the client asks. A client whose bill exceeds the estimate by $400 or more can start patient-provider dispute resolution within 120 days of the initial bill. Good Faith Estimates were missing for 47% of self-pay clients in psychology practices we reviewed, and we issue them as part of patient billing. In New Mexico the arithmetic changes again, because cost sharing is off covered behavioral services on state-regulated plans, which New Mexico medical billing has to handle before anything is collected at the desk.
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. Therapy-heavy practices sit at the lower end; testing-heavy practices sit higher, because the episode build, unit math and payer policy work per case is larger.
Take a four-clinician psychology group collecting $960,000 a year, roughly half therapy and half assessment. At 4.5% of collections, Luxen costs $43,200 a year, or $3,600 a month. Across 96 practices under $2M that shared payroll data, fully loaded in-house billing cost 7.9% of collections, which on the same $960,000 is $75,840.
| Annual line item | In-house | Luxen at 4.5% |
|---|---|---|
| Biller salary and benefits, 1.0 FTE | $62,000 | Included |
| Clearinghouse and claim fees | $4,800 | Included |
| Coding review and testing episode audits | $6,000 | Included |
| Coverage during leave and turnover | $3,040 | Included |
| Total annual cost | $75,840 | $43,200 |
| Share of $960,000 collected | 7.9% | 4.5% |
The gap is $32,640 a year before any recovery. Open biller roles took a median 67 days to fill in our practice manager survey, and 42% of practice managers said nobody owns denial follow-up full time.
Month to month, 30 days notice, no setup fee and no exit fee.
Then compare medical billing companies by state before you shortlist.
| Partner type | Knows testing unit rules | Works in your EHR | Denial reporting | Typical cost |
|---|---|---|---|---|
| In-house biller | Depends entirely on the individual | Yes | Usually none | 7.9% of collections fully loaded |
| Generalist billing company | Rarely | Often | Volume reports, not root cause | 4% to 8% |
| Specialty billing company | Yes | Usually | Varies | 4% to 7% |
| EHR vendor RCM | Rarely | Only their own | Tied to their platform | 5% to 8% plus platform fee |
| Luxen | Yes, certified coders | Yes, no migration | Monthly, by root cause | 3% to 6% of collections |
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.
Luxen charges 3% to 6% of collections, with therapy-heavy practices at the lower end and testing-heavy practices higher. For a practice collecting $960,000 a year, 4.5% is $43,200. Across 96 practices under $2M that shared payroll data, fully loaded in-house billing cost 7.9% of collections.
Clinical psychologists who accept assignment are paid at 100% of the physician fee schedule amount. Clinical social workers are paid at 75%, and marriage and family therapists and mental health counselors are paid at 75% of what a clinical psychologist receives. MFTs and MHCs have been able to enroll and bill Medicare independently since January 1, 2024.
About two weeks from a signed BAA to working claims, and first recovered payments in about three weeks. Median time from signed BAA to first claims worked was 9 business days across our client practices. We start with the oldest recoverable money while current claims keep going out.
No. We bill inside the system you already use, including SimplePractice, TherapyNotes, TheraNest, Valant, Tebra and athenahealth, plus Office Ally and Availity for claims and eligibility. There is no migration and no second note template for your clinicians.
No. The first-hour evaluation code is reported once for the entire assessment episode, even when it spans additional days, and every hour after that is 96131. The same rule applies to 96136 and 96138 for the first 30 minutes of administration and scoring. A per-hour code also needs at least 31 minutes before it can be reported.
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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