Insurance Billing for Substance Abuse and Mental Health Cheat Sheet

More insurance billing information and guides are on healthrevenueintelligence.com.

Here’s a cheat sheet for insurance billing related to substance abuse and mental health:

1. Verify insurance coverage: Before treatment begins, the patient’s insurance coverage for substance abuse and mental health services is verified, including whether the plan covers the specific services provided, such as individual therapy, group therapy or medication management.
2. Obtain pre-authorization: Certain types of treatment, such as inpatient hospitalization or intensive outpatient programs, may require pre-authorization, the insurance company’s approval before treatment begins.
3. Check for co-pays and deductibles: The patient’s co-pay and deductible amounts for substance abuse and mental health services are confirmed. They may differ from the amounts for general medical services.
4. Code accurately: Claims carry the correct billing codes for the services provided: diagnosis codes for the patient’s mental health or substance abuse condition and procedural codes for the specific services rendered.
5. Submit claims promptly: Claims are submitted to the insurance company promptly after the services are provided, which supports timely payment.
6. Follow up on unpaid claims: A claim not paid within a reasonable time is followed up with the insurance company to find the reason for the delay. The follow-up may mean resubmitting the claim or providing additional documentation.
7. Document thoroughly: Every service provided, and every communication with the insurance company about billing or reimbursement, is documented. The record supports accurate billing and payer review.

These seven steps support accurate, timely insurance billing for substance abuse and mental health services.

CPT Cheatsheet

Diagnostics:

• 90791 – Psychiatric Diagnostic Evaluation (coverage limits vary by payer)

• 90792 – Psychiatric Diagnostic Evaluation with medical services (coverage limits vary by payer)

Therapy:

• 90832 – Psychotherapy, 30 minutes (16-37 minutes).

• 90834 – Psychotherapy, 45 minutes (38-52 minutes).

• 90837 – Psychotherapy, 60 minutes (53 minutes and over).

• 90846 – Family or couples psychotherapy, without patient present.

• 90847 – Family or couples psychotherapy, with patient present.

• 90853 – Group Psychotherapy (not family).

Crisis:

• 90839 – Psychotherapy for crisis, 60 minutes (30-74 minutes).

• +90840 – Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 90839.

Other:

• +90785 – Interactive Complexity add-on code.

There are also E/M (evaluation & management) services billed in conjunction with psychotherapy, used by authorized prescribers. Coding E/M is trickier, harder to document and more vulnerable to payer scrutiny. There’s also a series of E/M codes that are used without the psychotherapy component. For more in-depth coverage on E/M coding for psychotherapy there are some good free webinars released by AACAP on E/M CPT Codes.

• +90833 – Psychotherapy add-on, 30 minutes, billed with an E/M service (not an E/M code itself).

• +90836 – Psychotherapy add-on, 45 minutes, billed with an E/M service.

• +90838 – Psychotherapy add-on, 60 minutes, billed with an E/M service.

Residential Treatment:

• H0017: Behavioral health; residential (hospital residential treatment program), per diem
• H0018: Behavioral health; short-term residential, per diem
• H0019: Behavioral health; long-term residential (>30 days), without room and board, per diem

Partial Hospitalization:

• H0035: Mental health; partial hospitalization, treatment, per diem

Intensive Outpatient:

• H0015: Alcohol and/or drug services; intensive outpatient (SUD IOP)

Outpatient:

• 90832: Psychotherapy, 30 minutes with patient and/or family member
• 90834: Psychotherapy, 45 minutes with patient and/or family member
• 90837: Psychotherapy, 60 minutes with patient and/or family member
• H0004: Behavioral health; counseling and therapy, per 15 minutes
• H0016: Alcohol and/or drug services; medical/somatic, ambulatory
• H2035: Alcohol and/or drug treatment program, per hour

Other Services:

• 96156: Health behavior assessment or reassessment
• 96158: Health behavior intervention, individual, initial 30 minutes
• +96159: Health behavior intervention, individual, each additional 15 minutes
• 96164: Health behavior intervention, group (2 or more patients), initial 30 minutes
• +96165: Health behavior intervention, group, each additional 15 minutes
• 96167: Health behavior intervention, family (with patient present), initial 30 minutes
• +96168: Health behavior intervention, family (with patient present), each additional 15 minutes

These codes are a starting point. The codes used vary with the patient’s insurance plan and the services provided, and the correct ones are verified with the insurance company.