Mental health billing has the highest denial rate of any specialty — 18.1% industry average. Carve-outs, session limits, MBHO rules, and telehealth coding require specialist expertise.
Common Billing Challenges
These are the six billing failure points we see most often — and the ones our team resolves systematically from day one.
Most commercial plans use a separate Managed Behavioral Health Organization (MBHO) to manage mental health benefits. Billing the wrong entity is an automatic denial — we know every payer's carve-out structure.
Payers impose session limits for psychotherapy. Billing beyond authorized sessions without re-authorization results in denials that are extremely difficult to overturn.
Telehealth reimbursement rules for mental health changed significantly after the PHE. State-specific originating site rules and GT/95 modifier requirements vary by payer.
Billing for psychiatrists, psychologists, LCSWs, LPCs, and MFTs under one practice requires correct NPI and taxonomy code for each credential level — incorrect taxonomy causes enrollment-level denials.
The distinction between 90833 (add-on psychotherapy) and 99213/99214 (E/M for med management) is frequently miscoded. We apply the correct code based on documented service time and content.
SUD billing requires ASAM level of care documentation, H-code proficiency, and state Medicaid SUD waiver billing knowledge — a specialized skill set few general billers possess.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in that specialty.
| CPT Code | Description | Common Issue |
|---|---|---|
| 90837 | Psychotherapy, 60 min | MBHO vs. medical benefit routing |
| 90833 | Psychotherapy add-on, 30 min | Session limit tracking per auth |
| 90847 | Family psychotherapy with patient | GT/95 modifier + originating site |
| 99214 | E/M, established, moderate complexity | NPI + taxonomy per credential |
| 90791 | Psychiatric diagnostic evaluation | Time vs. complexity selection |
| H0001 | Alcohol/drug assessment | H-code + ASAM documentation |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to your field — not a generic CPC only.
Significantly above the 18.1% industry denial rate for your specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.