Psychiatric Billing for Medication Management and Psychotherapy

When a visit includes an E/M service and psychotherapy, both services must be supported by the documentation and represented correctly on the claim. We review the visit documentation, determine the appropriate E/M level and psychotherapy add-on code, such as 90833, 90836, or 90838, and submit the combined claim according to the payer’s requirements. The psychotherapy service is handled as part of the full encounter, not as an afterthought to medication management.

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A documentation gap or coding mismatch on a psychiatric claim rarely happens once. If a particular add-on code, modifier, or piece of documentation is missing or formatted differently from the way one payer requires, the same issue tends to appear again on the next similar visit, not just the one that was denied. When we work a denial, we look at what caused it, not only the claim in front of us, so a fixable pattern gets corrected once instead of denied on repeat.

Billshrinkers was founded by a practicing psychotherapist. That clinical background informs our familiarity with behavioral-health documentation and how it supports the codes billed.

Psychiatric claims carry requirements that standard psychotherapy billing does not. Our team understands how those requirements affect the way claims must be authorized, documented, and routed. Two examples of what that looks like in practice:

Some payers require authorization for particular psychiatric visits or services before a claim will be paid, and that authorization needs to be in place before the visit is billed, not chased down afterward. We track which visits and services carry authorization requirements and confirm status, so a visit that needed one is not submitted without it.

Some health plans carve out behavioral health benefits to a separate administrator. We have encountered combined claims, where a visit pairs an E/M service with a psychotherapy add-on code, on which the individual claim lines were subject to different carve-out routing requirements. This does not happen with every payer, but when it does, submitting the claim as though the whole visit routes to one place is what produces the denial. We confirm how a psychiatric claim needs to be routed before it is submitted rather than assuming uniform treatment across the visit.

Billshrinkers handles billing. Credentialing, meaning enrollment with insurance panels, is a separate specialty that we refer to an outside credentialing specialist rather than handling in-house. Once you are enrolled with your payers, your billing runs through us.

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Yes. We review the documentation, determine the appropriate E/M and psychotherapy add-on coding, and submit the combined claim the way each payer expects.

Yes. We track which visits and services carry authorization requirements and confirm status, so a visit that needs one is not billed without it. We do not handle prior authorizations for prescription medications.

We confirm how a psychiatric claim needs to be routed before it is submitted. On combined visits, individual claim lines can occasionally be subject to different carve-out routing, and we account for that rather than assuming the whole visit routes to one place.

Yes. Both are a core part of who we bill for. We apply the same documentation review, coding, authorization, and follow-up process while accounting for each payer’s requirements.

Credentialing is handled by an outside specialist we refer you to, so our full focus stays on the billing. Once you’re enrolled with your payers, we take it from there.

Tell us about your billing workflow: the visit types you bill, how you combine evaluation and management with psychotherapy add-on codes, the authorizations your payers require, and how follow-up is handled now. We will tell you plainly how we would handle the coding, authorizations, and follow-up your claims need.

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