Verimedix runs behavioral health billing services for therapy groups, psychiatric practices and counseling centers - time-based psychotherapy coding, telehealth POS and modifier control, individual-NPI credentialing, and denial recovery on the claims generalist billers write off. Typical engagements run 5-8% of net collections with no long-term lock-in.
Behavioral health billing services are outsourced revenue cycle management built around the specialty's time-based psychotherapy codes, telehealth rules and individual-NPI credentialing requirements. A behavioral health billing service handles eligibility and benefits, charge capture and code selection (90791/90792, 90832/90834/90837, and the 90833/90836/90838 E/M add-ons), claim submission, denial appeals and A/R follow-up. Pricing is usually 5-8% of net collections for this specialty, $3-$10 per claim, or a flat monthly retainer.
Behavioral health billing is built on time-based psychotherapy codes: 90832 (16–37 minutes), 90834 (38–52 minutes), and 90837 (53+ minutes) for individual therapy without a medical evaluation. These codes are strictly time-dependent—documentation must include start and stop times or total face-to-face time. When a medical professional (MD, DO, NP, PA) also performs a formal evaluation and management service during the same encounter, the standalone psychotherapy codes are replaced by E/M add-on psychotherapy codes: 90833 (30 min), 90836 (45 min), and 90838 (60 min), billed alongside the applicable E/M code. Time spent on E/M activities cannot be counted toward the psychotherapy time, and vice versa—they must be separately documented.
Telehealth has transformed behavioral health delivery. As of 2025, Medicare permanently covers most behavioral health services via telehealth with geographic restrictions largely eliminated. Audio-only services remain billable under Medicare when video is not available. For telehealth claims, providers use modifier -95 (synchronous audio/video) with POS 02 (non-home) or POS 10 (patient home). Commercial payers vary in their telehealth coverage rules—parity laws in most states require commercial insurers to reimburse teletherapy at the same rate as in-person services, but prior authorization requirements and credentialing for telehealth may differ by platform and payer.
Credentialing and 'incident to' billing rules are particularly consequential in behavioral health. Non-physician providers (LCSWs, LPCs, LMFTs, psychologists) bill under their own NPI and are not eligible for 'incident to' billing under Medicare—they must be enrolled and credentialed separately. Group practices that attempt to bill non-physician behavioral health services 'incident to' a physician risk significant compliance exposure. Collaborative care model (CoCM) billing codes 99492 and 99493 are available for practices that implement the structured collaborative care model with psychiatric consultation, offering another revenue stream that many behavioral health and primary care practices overlook. Verimedix navigates these rules to ensure your practice is credentialed, billed, and paid correctly.
Published industry ranges for outsourced billing run 4-10% of net collections across all specialties. Behavioral health sits in the middle-to-upper part of that band - commonly 5-8% - because the specialty pairs high claim counts with low per-claim dollars, and because credentialing, parity disputes and time-based documentation take real analyst hours per account. Larger group practices negotiate toward 5-6%; solo and small practices are usually quoted 7-10%.
The comparison that matters is not the fee against zero, it is the fee against the true cost of billing in-house. Solo practices commonly spend on the order of 10-11% of collections running billing themselves once salary, benefits, clearinghouse fees and clinician time are counted - before any unworked denial is priced in. A therapist at $150 per clinical hour who spends four hours a week on claim follow-up gives up roughly $31,000 a year in billable time.
Verimedix quotes behavioral health engagements at 5-8% of net collections depending on volume, payer mix and whether credentialing is in scope. Credentialing and payer enrollment are priced separately at $200-$500 per provider per payer. There is no setup fee and no multi-year contract.
| Fee model | Typical range | Best fit |
|---|---|---|
| Percentage of collections | 5-8% of net collections | Most therapy and psychiatric practices; the vendor is paid only when you are |
| Per claim | $3-$10 per claim | High-volume group practices with a stable, predominantly in-network payer mix |
| Flat monthly retainer | ~$1,500-$3,000+ per month | Practices that want a fixed line item and have predictable session volume |
| Credentialing (add-on) | $200-$500 per provider per payer | New clinicians, new panels, or practices adding Medicare after the LPC/LMFT expansion |
Ranges are typical US market figures for 2026 and vary by state, payer mix and scope. Ask any vendor to put the fee base in writing - a percentage of net collections and a percentage of billed charges are not the same number.
Below are commonly billed codes our certified coders manage for behavioral health practices. Always confirm payer-specific coverage and current code values.
| Code | Description | Billing note |
|---|---|---|
90837 | Psychotherapy, 60 minutes (53+ minutes) with patient | Highest-reimbursement individual therapy code; document start/stop or total time ≥53 minutes in the clinical note |
90834 | Psychotherapy, 45 minutes (38–52 minutes) with patient | Most commonly billed therapy code; requires documented time in the 38–52 minute range |
90832 | Psychotherapy, 30 minutes (16–37 minutes) with patient | Brief therapy sessions; minimum 16 minutes face-to-face required; do not use for sessions under 16 minutes |
90791 | Psychiatric diagnostic evaluation (without medical services) | Initial intake assessment by psychologists, LCSWs, LPCs; typically billed once per patient per episode of care |
90792 | Psychiatric diagnostic evaluation with medical services | Used by physicians, NPs, PAs who can prescribe; includes medication review; higher reimbursement than 90791 |
90833 | Psychotherapy, 30 min add-on with E/M service (16–37 min therapy component) | Billed in addition to the E/M code when psychiatrist/NP provides both a medical evaluation and psychotherapy |
90838 | Psychotherapy, 60 min add-on with E/M service (53+ min therapy component) | Highest-value add-on psychotherapy code; therapy time must be separately documented from E/M time |
90853 | Group psychotherapy (not family group) | Billed per patient per session; documentation must reflect group dynamics, patient participation, and individualized treatment |
99492 | Initial psychiatric collaborative care management, 70+ minutes in first calendar month | CoCM model: requires care manager, psychiatric consultant, and treating provider; growing Medicare-covered service |
Our standard operating procedures for behavioral health revenue cycle management — the step-by-step workflow we follow on every claim:
These are the issues we see most often in behavioral health billing — and exactly how we resolve them:
Medicare and commercial payers can deny or downcode 90832/90834/90837 claims when the note does not document the session time. Fix: Require start/stop time or total face-to-face time in every psychotherapy note; use EHR templates with time fields as mandatory.
When a prescribing provider performs both an E/M and psychotherapy, billing 90837 instead of E/M + 90838 results in underpayment and potential compliance risk. Fix: Educate prescribing providers on the distinction; implement charge capture logic that flags sessions with both medical evaluation and therapy documentation for add-on code review.
Billing LCSW, LPC, or psychologist services under a supervising physician's NPI as 'incident to' under Medicare is non-compliant; Medicare requires these providers to bill under their own NPI with their own enrollment. Fix: Enroll all non-physician behavioral health providers individually with Medicare and all commercial payers; update billing system to route claims under the rendering provider's NPI.
Telehealth claims are denied or paid at reduced rates when POS 11 (office) is used instead of POS 02 or POS 10. Fix: Automate POS assignment based on visit type at scheduling; train front desk staff to flag telehealth appointments for correct POS coding.
New behavioral health providers begin seeing patients before payer credentialing is complete, resulting in out-of-network denials that cannot be retroactively corrected for most payers. Fix: Begin credentialing applications 90–120 days before a new provider's anticipated start date; track credentialing status in a centralized log and hold claim submission until panel approval is confirmed.
Verimedix works inside the systems behavioral health practices already use, including:
Most behavioral health practices are quoted 5-8% of net collections, with solo and very small practices toward the top of that band and larger groups negotiating to 5-6%. Per-claim pricing of roughly $3-$10 and flat monthly retainers of about $1,500-$3,000 are also common. Credentialing is normally priced separately at $200-$500 per provider per payer.
It depends on your average paid amount per session. Percentage pricing keeps the vendor's incentive aligned with what actually gets collected, which suits practices with denial-prone payer mixes; per-claim pricing can cost less for high-volume in-network groups with clean, predictable claims. Model both against three months of real remittances before signing.
CPT 90837 is standalone psychotherapy of 53 minutes or more with no concurrent E/M service. CPT 90838 is the add-on psychotherapy code reported alongside an E/M code when a prescribing provider delivers both medical management and 53+ minutes of therapy in the same encounter. Never bill 90837 together with an E/M code - use the E/M plus 90833, 90836 or 90838 instead.
Not under Medicare for outpatient behavioral health. Medicare requires licensed clinical social workers, licensed professional counselors, marriage and family therapists and other qualified providers to enroll and bill under their own NPI, so 'incident to' billing does not apply to independently licensed clinicians in the outpatient setting. State Medicaid and commercial rules vary and should be confirmed per payer.
Medicare permanently covers outpatient behavioral health delivered by telehealth, including the psychotherapy codes and psychiatric evaluations, and permits audio-only when video is not feasible. Use modifier 95 for synchronous audio-video and modifier 93 for audio-only, with POS 10 when the patient is at home and POS 02 otherwise. POS 10 generally prices at the higher non-facility rate, so a POS default set to 02 quietly underpays every home-based session.
Yes. Panel enrollment is the single most common reason a new behavioral health clinician's revenue starts late, and the full path from CAQH attestation to a paid claim typically runs 90-150 days. We run credentialing alongside billing so new clinicians are not sitting on unbillable sessions.
Most behavioral health practices are fully live in two to four weeks: access to your EHR, a payer and fee-schedule audit, an A/R aging review, then parallel running on the first claim batch. Your existing aged claims are worked as a separate recovery project so nothing ages past timely filing during the transition.
Verimedix handles the entire behavioral health revenue cycle — coding, submission, denials, and A/R — so your team can focus on patients.