Mental Health and Behavioral Health Billing Services
Session-based billing, authorisation limits and parity denials, handled by a team that works behavioral health daily.
Behavioral health billing breaks differently from medical billing. Most services are time-based, sessions recur on a schedule, authorisations cap the number of visits, and a large share of claims run through carve-out plans with their own rules and their own portals.
The result is a specialty where the denials are rarely about clinical judgement and almost always about administration: the authorisation ran out, the session length did not match the code, the plan was carved out to a behavioral health vendor nobody checked for.
Those are all preventable at the front end, which is where we put the effort.
The problem
Where this usually goes wrong
Authorisations run out mid-treatment
A patient on a weekly course of therapy hits their authorised visit count and the next session denies. Nobody was tracking the count against the schedule.
Time-based coding mismatches
Psychotherapy codes map to specific time ranges. A session documented at a length that does not match the billed code denies or gets downcoded, and the note is the evidence.
Carve-out plans missed at eligibility
Behavioral health is frequently administered by a separate vendor from the medical plan. Billing the medical payer produces a denial that looks like a coverage issue and is actually a routing issue.
Specialty detail
What we watch in behavioral health billing
- Time-based session coding
- Individual, family and group psychotherapy codes are tied to documented session duration. We code to what the note actually records and query when the documented time will not support the code billed.
- Authorisation tracking
- Visit counts and authorisation expiry tracked per patient per payer, with alerts before the limit is reached so a reauthorisation request goes in ahead of the next session rather than after a denial.
- Carve-out identification
- Eligibility checks confirm whether behavioral health is administered by the medical plan or a separate vendor, before the first session rather than after the first denial.
- Psychiatry E/M plus therapy
- Medication management billed alongside a therapy add-on has specific documentation requirements. Both components need to stand on their own in the note.
- ABA and intensive services
- Applied behavior analysis has its own code set, unit-based billing and authorisation structure, plus state-specific Medicaid rules that differ meaningfully between states.
- Parity appeals
- Federal parity law constrains how behavioral health benefits can be limited relative to medical benefits. Some denials are appealable on that basis and most practices never raise it.
What is included
- Time-based psychotherapy and psychiatry coding
- Authorisation tracking with pre-expiry alerts
- Behavioral health carve-out identification at eligibility
- ABA unit-based billing and authorisation management
- Telehealth place-of-service and modifier handling
- Medicaid billing including state-specific behavioral health rules
- Parity-based appeals where a denial warrants it
- Patient responsibility and sliding-scale balance handling
How it runs
Our process
- 1
Eligibility and carve-out check
Before the first session we confirm behavioral health coverage, which entity administers it, visit limits, and patient responsibility. This single step removes a large share of behavioral health denials.
- 2
Authorisation setup
Initial authorisation requested and logged with its visit count and expiry date, tied to the patient’s scheduled cadence so we know when it will run out.
- 3
Session coding
Sessions coded against documented duration and modality within one business day, with telehealth place of service and modifiers applied correctly.
- 4
Reauthorisation ahead of the limit
Requests submitted before the authorised count is exhausted, so treatment continues without a billing gap.
- 5
Denials and appeals
Denials worked within 48 hours, including parity-based appeals where the limitation applied to behavioral health would not be applied to a comparable medical benefit.
Questions we get asked
Do you bill for solo therapists as well as group practices?
Yes. Solo and small behavioral health practices are a common fit, partly because the authorisation tracking burden is the same regardless of practice size and it is hardest to absorb when you are the clinician and the admin.
How do you handle telehealth sessions?
Telehealth place-of-service codes and modifiers are applied per payer requirement, which still varies. Behavioral health telehealth has broader coverage than most specialties but the billing requirements are not uniform.
Can you track our authorisations?
Yes, and it is one of the highest-value parts of the service here. Visit counts and expiry dates are tracked per patient per payer with alerts before the limit, so reauthorisation goes in ahead of a denial rather than after one.
Do you handle ABA billing?
Yes, including unit-based billing, authorisation management and state-specific Medicaid requirements. ABA has enough structural difference from general behavioral health that it needs to be handled as its own thing.
What about patients on sliding scale or self-pay?
We handle patient statements, sliding-scale balances and payment plans alongside insurance billing. Self-pay is a larger share of revenue in behavioral health than in most specialties.
What is a realistic denial rate for behavioral health?
Low single digits is achievable, and most of the gap between that and where a practice actually sits comes from authorisation lapses and carve-out routing rather than coding. Both are front-end fixes.
Related services
See what your practice is leaving on the table.
We look at 90 days of your claims data and tell you what is recoverable. No cost, no obligation, BAA signed before anything changes hands.
- Recoverable dollars in your aged A/R, as a number
- Denials grouped by root cause, ranked by value
- A written summary you keep either way
Prefer to talk? (301) 786-0552
Or email info@asesormd.com