Behavioral health billing lives or dies on time-based CPT codes, prior authorizations, parity-law carve-outs, and telehealth compliance. We manage all four for Nevada therapists, psychiatrists, psychiatric nurse practitioners, social workers, and group practices — so sessions get paid, not denied.
Mental health billing is part of our behavioral health billing services, covering therapy, psychiatry, ABA and substance use treatment.
Mental and behavioral health claims are audited, capped, and rerouted differently than any other specialty. Here's where Nevada practices lose revenue — and how we close each gap.
Payers audit time-based codes closely, and 90837 draws more scrutiny than 90834. We match documented face-to-face session time to the CPT code billed — 16–37 minutes for 90832, 38–52 for 90834, 53+ for 90837 — before the claim ever leaves our office, so a mismatch never becomes a denial.
Many behavioral health plans cap sessions per authorization and require renewal before the next visit is covered. We track remaining authorized units in real time and request renewals ahead of the cap, so a session is never rendered without active coverage behind it.
Telehealth billing rules — place-of-service codes, modifier 95 for synchronous video, modifier 93 for audio-only — differ by payer and change often. We keep every telebehavioral health claim aligned to current Nevada payer policy so a compliant session doesn't get denied for a modifier mismatch.
Behavioral health benefits are frequently carved out to a separate administrator than medical benefits under the same plan. We verify the correct behavioral health payer before the first session, so claims don't bounce between medical and behavioral networks.
We bill individual, group, and family psychotherapy sessions for licensed clinical social workers, professional counselors, and marriage and family therapists, matching documented session length to the correct 90832/90834/90837 code every time.
We bill outpatient E/M visits (99213–99215) combined with add-on psychotherapy codes (90833 for 30 minutes, 90836 for 45 minutes) when medical necessity supports same-day psychotherapy and medication management.
PMHNPs and behavioral health NPs billing medication management and psychotherapy get the same code-to-documentation matching and payer-specific edits as physician-led practices.
We handle psychiatric diagnostic evaluations (90791) and psychological/neuropsychological testing codes (96130 and above), which carry their own prior-authorization and medical-necessity documentation requirements separate from psychotherapy.
For group practices with mixed provider types — therapists, prescribers, and testing psychologists under one roof — we offer credentialing, claims, and denial management across the full provider mix instead of billing each clinician in isolation.
Session-length codes, add-on psychiatric services, and telehealth modifiers drive most preventable mental health denials. Here's exactly what we code and why each one matters.
| Code | Service | Typical face-to-face time |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | Initial evaluation — must be a distinct assessment, not routine psychotherapy on the same date |
| 90832 | Psychotherapy, 30 minutes | 16–37 minutes |
| 90834 | Psychotherapy, 45 minutes | 38–52 minutes |
| 90837 | Psychotherapy, 60 minutes | 53+ minutes |
| 90853 | Group psychotherapy | Verify payer rules on group size and licensed facilitator requirements |
| Code | Service | Note |
|---|---|---|
| 99213–99215 | Outpatient E/M visit | Billed by medical decision-making or time; documentation must support the level billed |
| 90833 | Add-on psychotherapy with E/M, 30 min | Same-day psychotherapy + medication management |
| 90836 | Add-on psychotherapy with E/M, 45 min | Same-day psychotherapy + medication management |
| Code | Service | Note |
|---|---|---|
| 96127 | Brief emotional/behavioral assessment | Standardized screeners (PHQ-9, GAD-7) when payer policy allows separate reimbursement |
| 96130+ | Psychological/neuropsychological testing | Often requires prior authorization and separate documentation of medical necessity |
| Code/Modifier | Meaning | |
|---|---|---|
| Modifier 95 | Synchronous telehealth (audio + video) | |
| Modifier 93 | Audio-only telehealth | |
| POS 02 / 10 | Telehealth place of service — must match how care was actually delivered |
Coding requirements vary by payer, provider type, and plan. This overview is educational, not billing advice for a specific claim — we verify current payer policy before every submission.
Before the first session, we confirm active mental health coverage, copays, visit limits, and — critically — whether behavioral health is carved out to a separate administrator than the patient's medical plan.
We submit and track authorization requests for ongoing therapy and psychiatric care, and request renewals before existing authorizations run out, so sessions are never delivered without coverage behind them.
Certified coders map documented session time, diagnosis, and service type to the correct psychotherapy, E/M, testing, or telehealth code — not generic claim-scrubbing templates built for procedural specialties.
Every claim is scrubbed against payer-specific edits, modifier logic, time thresholds and same-day billing rules before submission, catching what generic clearinghouse scrubbing misses.
We run root-cause analysis on every mental health denial — documentation gaps, authorization lapses, time-vs-code mismatches, carve-out misrouting — and file appeals with the specific evidence each denial reason requires.
ERA reconciliation, payment posting, and aging A/R follow-up on unpaid behavioral health claims, with reporting your practice can act on.
During onboarding we review panel enrollment status for every provider type on your team, so new clinicians never bill against an inactive or pending contract.
This is where most billing companies stop at “check insurance.” We go a level deeper into the specific mechanics that decide whether a Nevada behavioral health claim gets paid.
The Mental Health Parity and Addiction Equity Act requires that mental health and substance use benefits be no more restrictive than medical/surgical benefits in the same plan — visit limits, copay tiers, and prior-authorization burden included. When a payer applies a stricter standard to behavioral health, that's a parity violation we can use as appeal leverage on a medical-necessity or utilization-management denial, not just a documentation fix.
A carve-out means the payer contracts with a separate behavioral health administrator to manage mental health benefits, even though the patient's ID card shows one medical insurer. Billing the medical payer instead of the carve-out administrator is one of the most common — and most preventable — reasons a clean claim still denies. We identify the correct carve-out administrator during eligibility verification, before the first session is scheduled.
Nevada Medicaid routes behavioral health claims through managed care organizations with their own prior-authorization thresholds, visit caps, and billing manuals that differ from commercial payer rules. We apply Nevada-specific Medicaid edits rather than a generic multi-state template, so claims aren't held up on state-specific formatting or authorization requirements a national billing company might miss.
Before switching, I was spending hours every week dealing with denied 90837 claims and trying to figure out which payer or carve-out to bill. Now I can focus on my patients instead of chasing claims. Our claims are going out cleanly, and I finally have a clear picture of where our A/R stands.
Within the first two months, we noticed a significant improvement in our denial rate for psychiatric E/M and add-on psychotherapy claims. Their team understood the billing requirements for 90833 and 90836 and the nuances of same-day billing far better than our previous billing companies. It has made our revenue cycle much easier to manage.
We support solo therapists and multi-provider psychiatric groups across Las Vegas, handling the mix of commercial carve-outs and Nevada Medicaid managed care common in the metro's behavioral health network.
Henderson group practices and integrated behavioral health clinics get the same authorization-tracking and carve-out routing as our Las Vegas clients.
We bill for Reno-area therapists and psychiatric practices navigating northern Nevada's payer mix, including regional commercial plans with their own behavioral health carve-out administrators.
Solo and small-group behavioral health providers in North Las Vegas make up a large share of our client base — pricing scales with collections, with no large-group minimum.
We support Carson City mental health practices billing both commercial and Nevada Medicaid behavioral health claims.
Sparks-area therapists and psychiatric providers get the same time-based coding accuracy and authorization tracking as practices anywhere else in our Nevada network.
Can't find what you need? Our Nevada team answers every question before you commit.
Most Nevada practices are fully onboarded in 10–14 business days. We map your workflows, connect to your EHR and clearinghouse, migrate open work, and run a parallel period so nothing is dropped during the transition.
We bill 90791, 90832, 90834, 90837, and 90853 for psychotherapy, 99213–99215 plus 90833/90836 for psychiatric E/M with add-on psychotherapy, and 96127/96130+ for screening and psychological testing — matching each to documented time and payer contract.
Yes. Time-based session coding, visit-limit authorizations, and payer carve-outs make behavioral health reimbursement fundamentally different from procedural or E/M-only medical billing — which is why we specialize in it rather than applying a generic billing template.
MHPAEA requires behavioral health benefits to be no more restrictive than medical benefits in the same plan. When a payer's visit limits or authorization burden are stricter for mental health than for medical care, we use that as grounds for appeal on medical-necessity and utilization-management denials.
A carve-out means a separate administrator, not the patient's medical insurer, manages their mental health benefits. We identify the correct carve-out payer during eligibility verification, before the first session, so claims don't route to the wrong network.
Yes. We apply the correct place-of-service code and modifier (95 for synchronous video, 93 for audio-only) for every telebehavioral health claim, matched to current Nevada payer policy.
Often, yes — when documentation supports both services. We bill the outpatient E/M visit (99213–99215) plus add-on psychotherapy (90833 or 90836) and validate the same-day combination against payer rules before submission.
Yes. We review panel enrollment status for every provider on your team during onboarding, so new clinicians are never billing against an inactive or pending payer contract.
Yes. We apply Nevada-specific Medicaid managed care edits — authorization thresholds, visit caps, and billing manual requirements — rather than a generic multi-state template.
Yes. Roughly two-thirds of our clients are solo providers and small groups across Las Vegas, Henderson, Reno, North Las Vegas, Carson City, and Sparks. Pricing scales with collections, with no large-group minimum.
Every workflow is HIPAA-compliant. Access is role-based and logged, staff complete annual HIPAA training, and we sign a Business Associate Agreement before any PHI is exchanged.
Book a free 90-day revenue audit. We review your claims, denials, and aging, then show you exactly where the money is going — no cost, no obligation. We respond within one business day.