Counseling and Therapy Billing Services
Counseling and therapy practices run on session volume. Each claim is small, so a few denials add up fast. Licensed clinical social workers, professional counselors and marriage and family therapists are all paid differently by different plans, and some plans do not credential every license type.
Medicare added coverage for marriage and family therapists and mental health counselors in recent years, which opened a new payer for many practices. Credentialing and enrollment still take time. Westmont Revenue Partners connects therapy practices with vetted medical billing experts who handle these details. This page explains the services billed and the problems behind most counseling billing denials.
Who this is for
- Licensed clinical social workers (LCSW)
- Licensed professional counselors (LPC) and mental health counselors
- Marriage and family therapists (MFT)
- Group therapy practices with several clinicians
- Solo clinicians and telehealth-only practices
What gets billed
- Intake and diagnostic assessments
- Individual therapy at 30, 45 and 60-minute lengths
- Family therapy
- Group therapy
- Crisis sessions
- Interactive complexity when it applies
- Telehealth sessions
- Couples therapy where covered
- Treatment plan reviews, where payers allow
- Clinician-supervised sessions by associates, where allowed
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 90791 | CPT | Psychiatric diagnostic evaluation without medical services |
| 90832 | CPT | Psychotherapy, about 30 minutes |
| 90834 | CPT | Psychotherapy, about 45 minutes |
| 90837 | CPT | Psychotherapy, about 60 minutes |
| 90839 | CPT | Crisis psychotherapy, first 60 minutes |
| 90846 | CPT | Family therapy without the patient present |
| 90847 | CPT | Family therapy with the patient present |
| 90853 | CPT | Group psychotherapy |
| 90785 | CPT | Add-on for interactive complexity |
| F41.1 | ICD-10-CM | Generalized anxiety disorder |
| F32.A | ICD-10-CM | Depression, unspecified |
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 counseling and therapy
- License types and payer rules. Each plan decides which licenses it credentials. Billers check every plan before a clinician starts seeing its members.
- Credentialing delays. Enrollment can take months, and a clinician usually cannot bill a plan until it is complete. Billers keep applications moving and track re-credentialing dates.
- Medicare enrollment. Newer eligible provider types must meet Medicare requirements and enroll first. Billers confirm requirements and check current guidance.
- Associate and supervised clinicians. Pre-licensed clinicians often cannot bill under their own number. Billers apply payer rules on supervision and who appears on the claim.
- Session length and time. Codes follow time in session, and over-coding draws audits. Billers review notes for time.
- Authorization limits. Some plans cap sessions or ask for review after a set number. Staff track counts and request more when needed.
- Telehealth. Rules vary by payer and by state. Billers use correct modifiers and places of service.
How Westmont can help
- Match you with vetted billing experts experienced in counseling and therapy
- End-to-end revenue cycle support, including claim submission and follow-up
- Denial management and appeals
- Credentialing and payer enrollment, including new clinicians
- Reporting by clinician and by payer
Frequently asked questions
Which therapists can bill Medicare?
Clinical social workers have long been eligible. Marriage and family therapists and mental health counselors became eligible more recently under federal rule changes. Enrollment steps apply, so check current CMS guidance before billing.
Why is credentialing so slow?
Payers review each application, and errors cause restarts. Starting early, using complete documents and following up regularly help. Billing experts often manage this process for practices.
Can an associate-level clinician bill insurance?
It depends on the payer and state. Some allow billing under a supervisor, others do not pay for associate services. Confirm policy before scheduling members of that plan.
How do I choose between 90834 and 90837?
The code follows the length of therapy time. Document the minutes and use the code that fits. Do not pick a code based only on what pays more.
Can group practices share one billing process?
Yes. A group often uses a shared system, with each clinician's credentialing and billing details set up correctly. Billers check payer rules for group versus individual enrollment.
Related billing services
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