Psychologist Billing Services

Why psychology practices lose revenue

A psychologist’s revenue cycle has two halves. Psychotherapy claims are simple and frequent. Testing claims are large, infrequent, and denied for reasons that never touch a therapy practice: units billed over the authorization, the wrong split between evaluation and administration codes, a technician code billed under a payer that does not recognize it, or an evaluation that the payer decided was educational rather than medical. One denied neuropsychological evaluation can equal a month of therapy sessions.

Resilience Billing is a mental health billing company founded by clinicians, providing full revenue cycle management for psychotherapy and psychiatric private practices. Our staff started inside a large psychological group practice, so testing authorizations and 96130-series claims are work we have done since the first day. All of it is done in-house by our team in Woodstock, Illinois.

Psychological and neuropsychological testing codes

The current testing code set separates the psychologist’s evaluation work from test administration.

• 96130 is the first hour of psychological testing evaluation: integrating data, interpreting results, treatment planning, and writing the report. 96131 is each additional hour.
• 96132 is the first hour of neuropsychological testing evaluation, and 96133 each additional hour. The neuropsychological set is used for evaluations of cognitive function tied to a neurological or medical condition.
• 96136 is the first 30 minutes of test administration and scoring by the psychologist, with 96137 for each additional 30 minutes.
• 96138 and 96139 are the same administration and scoring services performed by a technician under the psychologist’s supervision.
• 96116 covers a neurobehavioral status exam, the clinical interview that often precedes neuropsychological testing.

The denial risks are specific. Payers cap total units; the evaluation and administration codes must be billed for the correct dates; some plans pay technician codes at a different rate or not at all; and the evaluation time must be documented separately from face-to-face administration time. We build the claim from the authorization and the psychologist’s time log so the two match.

Nearly every commercial payer, and its behavioral health administrator, requires prior authorization for testing beyond a small number of units. The request has to state the referral question, the presenting problem, the planned instruments, and the estimated hours in the language the payer’s medical necessity criteria use. We submit the request, track the authorized units and date span, and bill inside them. When the evaluation runs longer than planned, we request the extension before the claim goes out rather than appealing afterward. Authorization work is part of benefits verification.

Intake and psychotherapy billing for psychologists

The diagnostic evaluation, 90791, opens most cases and is limited by most payers to one per client per period. Ongoing therapy uses the time-based codes 90834 and 90837, family work uses 90847, and interactive complexity, 90785, is added only when the note supports it. Telehealth psychotherapy carries payer-specific modifiers and place-of-service rules covered on telehealth billing.

Work that is not billable to insurance

Psychologists do a great deal of work that insurance will not pay for: school and educational evaluations, custody and parenting evaluations, forensic and court-ordered assessments, fitness-for-duty and pre-employment testing, and many disability evaluations. Billing any of it to a health plan produces a denial and, worse, a pattern a payer may audit. We help the practice separate this work into private-pay accounts, so insurance claims stay clean and private-pay revenue is collected on its own schedule.

Supervision and pre-licensed billing

Whether a postdoctoral fellow or pre-licensed psychologist can bill under a supervising psychologist is decided payer by payer. Some commercial plans allow it with a supervision modifier and the supervisor as rendering provider; others require the trainee to be individually credentialed, which is rarely possible before licensure; Medicare does not pay for services by unlicensed psychologists except in narrow incident-to circumstances. We document each panel’s policy for your practice before the first supervised claim, which prevents a whole quarter of denials. Group practices with several supervisees should also read group practice billing.

Credentialing, pricing, and service area

Credentialing, including CAQH and Medicare enrollment, is available to our billing clients under a separate credentialing fee structure. Pricing is a percentage of net collections. We work inside the EHR you already use: TherapyNotes first, and also Tebra (formerly Kareo) and SimplePractice.

We serve practices nationwide, with the exception of New York and New Jersey. Request a consult to talk with the biller who would handle your practice.