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Billing and coding

What you need to know about behavioral health billing

With the right tools and resources, billing can become second nature.

If you bill insurance, you have a few important steps to follow after seeing a client for therapy. Once you document the session, you’ll need to land on an appropriate Current Procedural Technology (CPT) code to describe the session you want to be reimbursed for. Next, you submit the claim — typically through your billing software. Then? Wait to get paid for your hard work. 

Behavioral health billing can be confusing and time-consuming, especially because most therapists don’t learn the business and billing side of things in graduate school. Just like with the therapy modalities you learned, with the right tools and resources, billing can also become second nature. 

“Yes, it can be complex,” says Krista Anderson, Headway’s clinical lead of risk management. “But once you understand CPT codes, you’ll start using the same ones and going through the same motions over and over.”


What types of care are usually covered by insurance?

If you’re credentialed with insurance plans, then you’ll need to figure out which services the payers actually cover. 

As a quick primer, CPT codes describe the service you provide — a particular type of therapy or length of therapy session. In order to bill insurance, you also need to document an ICD-10 code, which represents a diagnosis. Payers will want to ensure that your CPT code is justified based on the diagnosis code, so always prioritize your notes and documentation 

Every payer, plan, and negotiated reimbursement rate is different, but certain CPT codes are more universally covered than others. Some of the most common CPT codes include: 

Verifying benefits

Even if you’re credentialed with a particular insurance company, every provider has different plans. When you take on a new client, you’ll want to verify their benefits with the insurance company (typically, you can do this by calling the number on the back of their insurance card, or by logging into the provider portal for a payer you’re credentialed with). 

But it’s also a good idea to verify your clients’ benefits on a monthly basis. “You don’t want your clients to end up with a big bill,” says Anderson. 

Headway not only assists therapists with the time-consuming credentialing process, we also routinely verify clients’ insurance plans so you can focus on providing the best possible care to your clients (and, of course, get paid in a timely manner).

How to submit claims

Documentation is one of the most important parts of the therapy process. In order to submit a claim to an insurance payer, you’ll need to provide documentation that includes a diagnosis, the service you provided based on the diagnosis. But it’s not as simple as submitting the basic notes you take during a therapy session. “You have to be precise with documentation, which is something providers aren’t trained on in school,” says Jessica Belvin, Headway’s medical coding, auditing, and risk management specialist. “We always say, ‘If it’s not documented, it’s not supported.’”

The American Medical Association (AMA) has CPT guidelines that dictate how to lay out your documentation, and what you need to include. Individual payers also have specific guidelines for compliant documentation. In general, be sure to incorporate a “golden thread,” in your documentation, which means communicating that you’ve incorporated the current diagnosis and treatment plan in every session. 

Headway offers templates to make compliant documentation easier. We designed these templates to integrate multiple payers’ documentation requirements, resulting in a higher likelihood of successful claims and audits across the board.

Documentation

To submit claims to insurers, you need to invest in a billing software (or submit paper claims). Both can be complex and time-consuming. Plus, if there are any issues with submitting a claim, or if your claim gets audited, then you’ll be responsible for following up until you get paid. 

As a Headway provider, you can rest assured in these cases. We promise on-time, consistent payments twice a month for the care you deliver. Our billing specialists handle your claim submissions while going the extra mile to advocate for you when dealing with insurers. Your only responsibility is to provide therapy and choose procedure and diagnosis codes. “If there’s ever an issue, we deal directly with the insurance company, so providers don’t have to interact with them directly,” says Anderson. In some cases, you may need to alter and re-submit your documentation, but you can count on getting paid.

If you need more support, Headway also provides educational resources and one-on-one training in billing for therapists.

How Headway can help your billing process

When it comes to insurance billing, Headway handles all of the busy work for you. Our simplified provider platform saves you time on your entire workflow by allowing you to easily submit, track, and manage multiple claims from one place.

In addition to streamlined billing, Headway helps you add efficiency to your caseload with access to a suite of free EHR features, built-in documentation and assessments — so you can focus less on bookkeeping and more on your clients. 35,000+ providers nationwide already use these features (and more) to save time, stress less, and build their best practice. 

Curious about how Headway can support your mental health practice? Speak with a practice consultant who will walk you through how Headway can help you practice in-network with confidence — at no cost to you.

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.

Headway helps you accept insurance with ease, simplify claims, and run an efficient practice — all from one membership-free platform.

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Billing and coding

ICD-10 codes for PTSD

The ICD-10 includes one general code for PTSD, along with specifier codes that include a greater level of detail.

ICD-10 codes for PTSD