We see it every week in our work with treatment centers. You provide vital care, your team documents the sessions, and you submit a claim you believe is perfect.
Then, weeks later, the denial arrives. It cites “medical necessity” or “coding errors,” and the money you earned is stuck in a cycle of appeals.
In our experience at Aspen Ridge Billing, the problem usually isn’t the care itself. It is how that care is translated into behavioral health CPT codes.
These codes are the bridge between your clinical work and your facility’s financial health. When that bridge is strong, the money flows. When it is shaky, your team spends hours fixing mistakes instead of helping patients.
Why Mental Health CPT Codes Require a Different Mindset
When a doctor treats a physical injury, the billing is usually very clear. But behavioral health is more complex.
In one therapy session, you might help a patient with a crisis, review their medications, and work on long-term goals. You are doing many things at once. However, a billing code only sees a small part: the time spent and the type of service.
This gap is where denials happen. Payers review mental health CPT codes to determine whether the service was “medically necessary.” They are not just asking what you did. They are asking if that service was right for that specific patient on that day.
The code tells them the “what,” but we always remind our clients that the documentation must tell them the “why.”
If your notes do not back up the code, the payer will deny the claim. This is why some facilities see their claims processed quickly while others struggle with constant rejections.
The Core Behavioral Health CPT Codes We Use Every Day
These codes are the foundation of your revenue. We focus on these because they are most commonly used in residential and outpatient settings.
Evaluation and Assessment
90791 – Psychiatric Diagnostic Evaluation
This is your intake. A common error we see is billing this too often.
Payers expect this when a patient enters treatment. If you bill it multiple times for the same person, we suggest documenting a clear clinical reason in the file.
90792 – Psychiatric Diagnostic Evaluation with Medical Services
This is the same as the code above, but it includes medical work.
We see this used when a psychiatrist or nurse practitioner performs the evaluation and reviews medications. You can read more about how this fits with regular therapy in our breakdown of 90791 and 90834.
Individual Psychotherapy
These codes are based on time. We find that precision is vital here.
- 90832: 16 to 37 minutes
- 90834: 38 to 52 minutes
- 90837: 53 or more minutes
The biggest trap is using 90837 for every session. Payers know that not every session needs to be an hour long. If your billing data only shows 60-minute sessions, you might face an audit. We ensure our notes reflect the actual face-to-face time spent on therapy.
Group Therapy
90853 – Group Psychotherapy
This is billed per patient. In a residential setting, we often see money left on the table here. If you do not track exactly who attended each group, you lose revenue. Each patient needs a unique note about their participation.
Why Notes Fail Even When the Code is Right
We have seen perfect codes rejected because the notes did not demonstrate that the service was needed. In behavioral health, we have to prove medical necessity every time.
Your notes should always answer these four questions:
- What are the current symptoms? Describe what the patient is feeling now.
- How is it affecting them? Explain how these symptoms stop them from performing daily tasks.
- What is the plan? State why this session is the correct response.
- What is the progress? Note what has changed since the last visit.
A note that says “Patient talked about their week” will likely be denied. A note that says “Patient practiced coping skills to manage anxiety that prevents them from working” is a clear story the payer can support.
Common Red Flags That Trigger Audits
Audits are rarely random; patterns in your data often trigger them.
- Consistently using the longest code: If 90837 is your only code, it looks suspicious.
- Unbundling: This happens when you bill for two things that should have been one “add-on” code.
- Missing Modifiers: Modifiers are the fine print. For telehealth, you usually need Modifier 95. Leaving it off can lead to an instant denial.
If you are worried your patterns might invite scrutiny, our consulting services help you find these issues early.
Common Questions About Billing
1. What happens if a session is only 30 minutes?
If your session lasts 16-37 minutes, we recommend using code 90832. You must bill for the time you actually spent with the patient. We advise against “rounding up” to a longer code, as this is considered upcoding.
2. Does 90837 always lead to an audit?
Not always, but it is watched closely. Since it costs more, payers want to be sure the extra time was truly needed. We make sure our notes explain why a shorter session was not enough for the patient’s needs.
3. When should we use “Interactive Complexity” (90785)?
We use this add-on code when a session is much more difficult to conduct. This includes sessions with language barriers, intense family conflict, or a patient in a major crisis. We find this code is often underused by providers.
4. Why was our claim denied for “medical necessity”?
This usually means the notes did not show why the patient needed that level of care. If a patient is getting better, the payer might think they should move to a lower level of care. We document why they still need your specific services to stay healthy.
Moving Toward Efficient Billing
Billing for behavioral health is more than a clerical task. It is where your clinical work meets the business side of your facility. We believe that when clinicians and billers work together, the “denial gap” disappears.
You did not start a treatment facility to spend your days fighting with insurance companies. Our goal at Aspen Ridge Billing is to handle the complexities so you can focus on your patients. We do not just process claims; we help you build a system that works.
Reach out to us to discuss your facility’s needs.
Disclaimer: The content provided by Aspen Ridge Billing is intended for informational purposes only and does not constitute legal, financial, or medical advice. While we strive to ensure the accuracy and reliability of the information, Aspen Ridge Billing does not guarantee its completeness, timeliness, or applicability. Users should seek direct consultation with qualified professionals for specific concerns.
