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Psychiatry billing requires precise synchronization of medical evaluation and management, psychotherapy add-ons, and pharmacological oversight. We establish disciplined, compliant billing operations for psychiatrists and psychiatric nurse practitioners.
Psychiatric practices operate at the intersection of medical pharmacotherapy and behavioral psychotherapy. Prescribers manage multi-layered clinical documentation on every encounter.
Billing an E/M code alongside a same-day psychotherapy add-on requires distinct clinical time logs. Diagnostic evaluations mandate comprehensive Mental Status Examinations. Managing controlled substances and Long-Acting Injectables creates continuous prior authorization friction.
We manage these operational complexities daily. We verify documentation integrity before claims reach the clearinghouse, ensuring you receive full reimbursement.
Compliant reimbursement depends on the specific clinical service delivered and applicable payer policy.
We audit E/M visit complexity across chronic psychiatric conditions, high-risk medication management, and laboratory monitoring.
Psychotherapy add-on codes performed on the same date as an E/M visit. These must represent a distinct, separately identifiable therapeutic intervention.
Initial comprehensive psychiatric evaluations, both with and without medical services.
Urgent assessment and crisis intervention billed when an individual presents with acute, life-threatening psychiatric distress.
Prescribing complex psychiatric regimens requires continuous prior authorization management.
We synchronize billing and administration for long-acting injectable antipsychotics using exact unit-dose J-codes and NDC tracking.
We secure pre-certifications and formulary tier exceptions for psychiatric medications, stimulants, and specialized treatments.
Telehealth billing rules are established by individual health plans, MACs, and state Medicaid programs. Applying uniform guidelines creates systematic rejections.
POS 10 denotes services provided when the patient is located in their home, while POS 02 designates telehealth provided outside the home. We verify payer-specific POS requirements prior to claim release.
Modifier -95 identifies synchronous real-time audio/video encounters, while modifier -93 applies to audio-only telephone visits where permitted by state regulations and payer contracts.
Psychiatric evaluation and management (E/M) visits may adjudicate through primary medical gateways, while same-day psychotherapy add-ons (+90833) are carved out to behavioral managers. MDRG ensures both halves adjudicate without unbundling clawbacks.
We establish a disciplined operational handoff connecting clinical charting to clean claim submission and denial resolution.
We establish a secure integration with your psychiatric EHR and audit active fee schedules.
We scrub every psychiatric claim for E/M complexity support, separate psychotherapy time logs, modifier accuracy, and telehealth place-of-service codes.
We post electronic remittances daily and match them to deposits. We file immediate clinical appeals with chart attachments for unbundled add-ons or downcoded evaluations.
You receive monthly reporting detailing net collections, E/M coding distribution curve analysis, and denial categories.
Therapy and behavioral practices often struggle between overburdened in-house staff and software-only auto-submission. See how a dedicated behavioral RCM pod changes the financial equation.
| Billing Capability & Standard | In-House Clinic Biller | Software Auto-Submit | MD Revenue GroupDedicated Behavioral Pod |
|---|---|---|---|
Specialized AAPC Behavioral Coders Certified experts who know psychotherapy timestamp rules, add-ons, and ASAM levels | Costly & Hard to Find ($65k+/yr) | None (No Human Review) | Included (Dedicated Behavioral Pod) |
Pre-Submission Timestamp Scrubbing Verifying notes match start/stop times before claims leave to stop 90837 downcoding | Inconsistent / Manual | Not Checked (Blind EDI) | 100% Pre-Claim Audit |
Automated Carve-Out Payer Rerouting Identifying Optum BH, Carelon, and Magellan before submitting to primary clearinghouse | High Error Rate | Routes to Primary (Rejection) | Automated Crosswalk Routing |
Aggressive Denial Appeals SLA Formal clinical narrative appeals for unworked denials within 48 business hours | Often Backlogged / Abandoned | Clinician Must Appeal | 48-Hour Systematic SLA |
Practice Pricing & Risk Alignment Compensation model aligned directly with actual collections and financial performance | Fixed Salary, Taxes & Overhead | Monthly Fee Regardless of Pay | Performance-Based (2.99%–8.5%) |
Long-Term Contract Commitment Flexibility to evaluate partnership value monthly without restrictive lock-ins | Severance & Re-hiring Friction | Annual Platform Lock-In | Month-to-Month (Earned Trust) |
We connect directly into Valant, AthenaHealth, AdvancedMD, Kareo/Tebra, DrChrono, and eClinicalWorks to support your clinical charting without disruption.
We partner with psychiatry practices that value compliant clinical documentation and dedicated US-managed billing operations. Here is how we evaluate fit:
We do not hide behind anonymous offshore call centers or unverified software bots. MDRG provides direct access to credentialed revenue cycle managers and certified coding specialists.
Our coding and audit specialists maintain active credentials with the American Academy of Professional Coders (AAPC), ensuring precise CPT, ICD-10, and modifier application for behavioral healthcare encounters.
All data exchange, clearinghouse connections, and EHR interactions strictly adhere to HIPAA Omnibus standards, including 256-bit SSL encryption, restricted role-based access, and signed Business Associate Agreements (BAAs).
Founded by Faisal and Salwa in 2023 with over 13 years of combined revenue cycle leadership. Every practice has a named billing operations manager with direct phone and email escalation pathways.
Transparent month-end reporting on net collections, gross claims, denial categorization, and days in AR. We earn your partnership through monthly performance without restrictive multi-year lock-ins.
“Independent behavioral health clinicians should never have to sacrifice patient session time to battle commercial insurance clearinghouses. We treat your revenue cycle with the exact operational discipline you apply to patient care.”Faisal & Salwa — Founders, MD Revenue Group
Direct answers to common questions about psychiatric billing, E/M plus psychotherapy synchronization, diagnostic evaluations, and prior authorizations.
Payers frequently deny psychotherapy add-on codes if they detect overlapping medical decision-making and therapy time. Our certified coders review notes before claim release to ensure the documentation clearly separates the medical management visit from the psychotherapy portion with distinct start/stop timestamps and therapeutic modalities.
Both represent comprehensive psychiatric diagnostic evaluations. Code 90791 is for diagnostic evaluations without medical services. Code 90792 is for evaluations that include medical services: complete mental status examination, medical and somatic history, prescription medication evaluation, and physical assessment integration performed by a licensed physician or psychiatric nurse practitioner.
Telehealth rules vary across Medicare MACs, commercial health plans, and state Medicaid programs. We apply payer-specific crosswalks to determine whether POS 10 (patient at home), POS 02 (telehealth facility), or modifier -95 (synchronous video) vs. -93 (audio-only) is required prior to electronic transmission.
Yes. We bill the therapeutic injection administration code (96372) alongside specific HCPCS J-codes and accurate National Drug Codes (NDCs) for medications such as Invega Sustenna, Vivitrol, and Aristada, ensuring proper units and drug wastage are accounted for.
Yes. Through our credentialing services, we manage Medicare Part B (PECOS) enrollment, state Medicaid applications, commercial health plan contracting, DEA certificate updates, and 90-day CAQH ProView re-attestations.
Our fees are performance-aligned as a percentage of net collections (typically 2.99% to 8.5%), scaled based on monthly claim volume, prescriber count, and payer mix complexity. See our pricing overview for detailed tier information.
This canonical page is dedicated specifically to physician-led psychiatry and psychiatric nurse practitioner practices managing medical evaluation and management (E/M), psychopharmacology, LAIs, and dual-modality care. For multidisciplinary outpatient counseling, psychotherapy group clinics, and addiction facilities, explore our Behavioral Health Billing hub.
No. Our baseline audit evaluates de-identified aggregate remittance data (835 ERAs or EOB summaries), coding distribution curves, and denial categorization logs. We never collect patient names, dates of birth, or confidential psychiatric session records.
Discover where unbundled psychotherapy add-ons, downcoded evaluations, or prior authorization delays are impacting your practice collections. Zero patient data required.
Speak directly with an MDRG billing operations manager about your EHR setup, E/M documentation scoring, or billing company transition. No sales pitch, zero claim data needed.
