CMHC Billing Services
Community Mental Health Centers mix several kinds of work. They may run outpatient counseling, crisis services, and structured day programs. Medicare pays CMHCs for partial hospitalization on an institutional claim, with revenue codes and procedure codes on each line. Medicaid and state contracts often add their own rules.
Mistakes are easy to make because each service line needs the right pairing and date. Westmont Revenue Partners connects community mental health centers with vetted medical billing experts who know these claims. Good CMHC billing helps centers stay funded so they can keep serving people who have limited access to care.
Who this is for
- Community mental health centers with partial hospitalization programs
- Centers that combine outpatient, crisis, and day program services
- Nonprofit and county-linked behavioral health agencies
- Psychiatrists, psychologists, clinical social workers, and nurse practitioners at centers
- Finance leaders who manage Medicare, Medicaid, and state contracts
What gets billed
- Partial hospitalization program days of care
- Individual psychotherapy sessions
- Group psychotherapy
- Family psychotherapy
- Psychiatric diagnostic evaluations
- Psychological and neuropsychological testing
- Occupational therapy and activity therapy in a structured program
- Patient education and training
- Drugs given as part of the program, where covered
- Medicaid and state-funded behavioral health services
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 761 to 764 | Bill type | CMHC claim types: full stay, first, continuing, and last interim claim |
| 0900 | Revenue code | Behavioral health treatment services |
| 0914 | Revenue code | Individual therapy |
| 0915 | Revenue code | Group therapy |
| 0904 | Revenue code | Activity therapy |
| 90791 | CPT | Psychiatric diagnostic evaluation without medical services |
| 90792 | CPT | Psychiatric diagnostic evaluation with medical services |
| 90837 | CPT | Individual psychotherapy, about an hour |
| G0410 | HCPCS | Group psychotherapy in a partial hospitalization or intensive outpatient program, about 45 to 50 minutes |
| G0411 | HCPCS | Interactive group psychotherapy in a partial hospitalization or intensive outpatient program, about 45 to 50 minutes |
| G0176 | HCPCS | Activity therapy in a partial hospitalization program |
| G0129 | HCPCS | Occupational therapy in a partial hospitalization program |
| G0177 | HCPCS | Patient training and education in a partial hospitalization program |
| 90846 | CPT | Family psychotherapy without the patient present |
| 90847 | CPT | Family psychotherapy with the patient present |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in community mental health centers
Pairing revenue codes with procedure codes. Each partial hospitalization line needs a revenue code and a matching procedure code. A mismatch can cause the claim to return. Billers build code pairs into the charge setup so staff do not have to guess.
Interim claim order. Medicare expects partial hospitalization claims in date order, and a prior claim must be finalized before the next is accepted. Billers track claim status each month to prevent chain delays.
Daily service minimums. Medicare payment for a program day depends on the number of services in a day. Billers check that notes support each billed service so the day is not reduced.
Provider eligibility. Only certain practitioners may furnish and order these services. Billers confirm credentials and supervision before billing.
Certification and plan of care. Medicare requires physician certification and a plan of care for partial hospitalization. Missing paperwork can lead to denials, so billers keep a checklist.
Medicaid and state contract differences. States often use their own code sets and units. Billers keep payer-specific rules by contract and update them as contracts change.
Group session documentation. Group notes must show who attended and for how long. Billers work with clinicians on simple templates that support each unit.
How Westmont can help
- Match your center with vetted billing experts who know CMHC and partial hospitalization claims
- Support end-to-end revenue cycle work for Medicare, Medicaid, and commercial payers
- Help with denial management and returned claims
- Connect you with experts for credentialing and enrollment questions
- Offer a way to compare options before you commit
Frequently asked questions
How does Medicare pay CMHCs?
Medicare pays CMHCs for partial hospitalization services on an institutional claim, using a daily payment based on the services given that day. Lines carry revenue codes and procedure codes. Rates and rules update each year, so check current Medicare guidance for your contractor.
What bill type do CMHCs use?
Medicare CMHC partial hospitalization claims use bill types starting with 76. The last digit shows whether the claim covers a full stay or is an interim claim. Your biller should confirm the format with your Medicare contractor before sending claims.
What is the difference between CMHC and hospital-based PHP billing?
Both bill partial hospitalization, but they differ by setting and bill type. Hospital-based programs bill as a hospital outpatient service, while a CMHC bills under its own provider type. A biller should know which rules apply to you and watch for updates.
Do group therapy sessions need special codes?
In a Medicare partial hospitalization program, group therapy uses specific HCPCS codes, G0410 or G0411. Other payers may use standard CPT group codes instead. Your biller should check each payer's policy and confirm documentation of attendance and time.
Can a CMHC outsource billing?
Yes. Westmont does not submit claims itself. We connect you with vetted billing experts who know behavioral health facility claims. Ask about their experience with partial hospitalization, state contracts, and reporting before you choose.
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