Insurance Billing for Substance Abuse and Mental Health Cheat Sheet

For more insurance billing information and guides, visit axisirg.com.

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

1. Verify insurance coverage: Before beginning treatment, it’s important to verify the patient’s insurance coverage for substance abuse and mental health services. This includes checking if the insurance plan covers the specific services being provided, such as individual therapy, group therapy, or medication management.
2. Obtain pre-authorization: For certain types of treatment, such as inpatient hospitalization or intensive outpatient programs, pre-authorization from the insurance company may be required. Make sure to obtain this authorization before beginning treatment to avoid any billing issues.
3. Check for co-pays and deductibles: Determine the patient’s co-pay and deductible amounts for substance abuse and mental health services. These amounts may be different from those for general medical services, so it’s important to double-check.
4. Code accurately: Use the correct billing codes for the services provided. This includes the diagnosis codes for the patient’s mental health or substance abuse condition, as well as the procedural codes for the specific services rendered.
5. Submit claims promptly: Submit claims to the insurance company promptly after the services are provided. This will help ensure timely payment and prevent any delays or denials.
6. Follow up on unpaid claims: If a claim is not paid within a reasonable amount of time, follow up with the insurance company to determine the reason for the delay. This may require resubmitting the claim or providing additional documentation.
7. Document thoroughly: Document all services provided and any communication with the insurance company related to billing or reimbursement. This will help ensure accurate billing and prevent any potential review issues.

By following these guidelines, you can help ensure accurate and timely insurance billing for substance abuse and mental health services.

CPT Cheatsheet

Diagnostics:

• 90791 – Psychiatric Diagnostic Evaluation (usually just one/client is covered)

• 90792 – Psychiatric Diagnostic Evaluation with medical services (usually just one day per client is covered)

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 but usually results in greater reimbursement. 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 just a starting point, and the specific codes used may vary depending on the patient’s insurance plan and the services provided. It’s important to verify the correct codes with the insurance company and ensure accurate billing to prevent any potential issues with reimbursement.