You became a therapist to help people, not to spend your evenings on hold with insurance companies, decoding remittance advice, or chasing claims that were denied for a missing modifier. Maximum Billing handles insurance billing for therapists, counselors, marriage and family therapists, clinical social workers, and psychologists, so the money you have already earned actually reaches your account.
We work with solo therapists and group practices in twelve states, including Florida and Texas. You see clients. We handle the claims, the follow-up, and the payer paperwork. Schedule a consultation or call 800-820-0364.
Why Therapy Billing Is Different From General Medical Billing
Therapy billing looks simple from the outside: a small set of CPT codes, recurring weekly sessions, and one diagnosis that rarely changes. In practice it is one of the easiest specialties to lose money in, because the margin for error on each claim is so thin and the same mistake repeats every week.
- Time-based codes. Psychotherapy codes are chosen by session length, so a session documented at 50 minutes cannot be billed as a 60-minute session. Rounding up, even by habit, is exactly what audits look for.
- Behavioral health carve-outs. The card in your client’s wallet may say one insurer, while their mental health benefits are managed by an entirely different company. Send the claim to the wrong one and it is denied, sometimes weeks later.
- Telehealth rules. Place of service codes and telehealth modifiers vary by payer and have changed several times since 2020. A claim that paid last year can deny this year with no change on your side.
- Volume. A full-time therapist can submit 25 or more claims a week. A 5% denial rate that nobody works turns into dozens of unpaid sessions a quarter.
A general medical billing company can submit your claims. A billing team that specializes in therapy knows which of those claims are going to come back and fixes them before they do.
What Our Therapy Billing Services Include
- Insurance eligibility and benefits verification before the first session, including copays, deductibles, session limits, and whether mental health benefits are carved out to a separate administrator.
- Claim creation and submission for every session, with the correct CPT code, diagnosis, place of service, and modifiers for each payer.
- Payment posting from electronic remittance advice, so your ledger matches what each payer actually paid.
- Denial management and appeals. Every denial is worked, corrected, and resubmitted, not written off.
- Accounts receivable follow-up on claims that have gone quiet, before they pass the payer’s timely filing limit.
- Patient balance statements for copays, coinsurance, and deductibles.
- Credentialing and payer enrollment so you can join insurance panels and get paid in network.
- Reporting that shows what you billed, what was paid, what is outstanding, and why.
See also our insurance verification services and accounts receivable management.
The CPT Codes Therapists Bill Most
Most therapy practices bill from a short list of codes. Getting each one right on every claim is the difference between steady cash flow and a pile of resubmissions.
| Code | What it covers |
|---|---|
| 90791 | Psychiatric diagnostic evaluation (the intake assessment) |
| 90832 | Psychotherapy, 16 to 37 minutes |
| 90834 | Psychotherapy, 38 to 52 minutes |
| 90837 | Psychotherapy, 53 minutes or more |
| 90846 | Family psychotherapy without the client present |
| 90847 | Family or couples psychotherapy with the client present |
| 90853 | Group psychotherapy |
| 90839 / 90840 | Psychotherapy for crisis, first 60 minutes and each additional 30 minutes |
| 90785 | Interactive complexity add-on, when communication factors complicate the session |
Two details cause a large share of therapy denials. First, 90837 requires at least 53 minutes of documented face-to-face time, and some payers review practices that bill it for most sessions. Second, couples work is not covered by every plan. Many payers cover 90847 only when it treats a diagnosed condition of the identified client, so the diagnosis and the documentation have to support it.
For a deeper walkthrough, read Behavioral Health Billing and Coding 101.
Telehealth Billing for Therapists
Telehealth is now a routine part of most therapy practices, and it is also one of the most common reasons therapy claims deny. The rules depend on the payer, not on what was true for your last claim.
- Place of service. POS 10 is used when the client is at home and POS 02 when they are somewhere other than home. Some payers still expect POS 11 with a telehealth modifier instead.
- Modifiers. Many commercial plans require modifier 95 on telehealth sessions; others do not accept it at all. Audio-only sessions can require a different modifier again.
- State lines. You must be licensed in the state where the client is located at the time of the session, not the state where you sit.
We keep the telehealth rules for each of your payers on file and apply them per claim, so a session delivered by video is billed the way that specific plan expects.
Credentialing and Getting on Insurance Panels
You cannot bill a payer in network until that payer has credentialed you and loaded your contract, and that process routinely takes 60 to 120 days. Most therapists lose money here without realizing it, by seeing clients before their effective date or by letting a CAQH profile lapse.
- NPI numbers. You need an individual (Type 1) NPI, and a group practice also needs an organizational (Type 2) NPI.
- CAQH ProView. Most commercial payers pull your information from CAQH, and it must be re-attested every 120 days or applications stall.
- Medicare. Since January 2024, licensed marriage and family therapists and licensed mental health counselors can enroll in Medicare and bill for their services, which opened a large new group of clients to many practices.
- Effective dates. Being credentialed and being contracted are two different things. Sessions billed before your contract is effective are paid out of network or not at all.
We manage applications, follow-up, CAQH maintenance, and re-credentialing dates. Learn more about our mental health credentialing services.
Billing for Associates and Pre-Licensed Clinicians
Group practices that train associates face a particular billing problem: many commercial payers will not credential a clinician who is not yet fully licensed, while some Medicaid plans and a smaller number of commercial plans will reimburse supervised services under specific conditions. The rules differ by payer and by state, and billing an associate’s session under a supervisor’s credentials without meeting those conditions creates real compliance risk.
We confirm which of your payers reimburse pre-licensed clinicians, under what supervision rules, and how the claim must be submitted, before those sessions are billed. The details for each state are covered on our Florida and Texas behavioral health billing pages.
Out-of-Network Clients, Superbills, and Self-Pay
Not every client uses in-network benefits. Many therapy practices are partly or fully out of network, and that side of the practice has its own paperwork.
- Superbills. Out-of-network clients need an itemized statement with your NPI, license, CPT codes, and diagnosis to seek reimbursement from their plan. Incomplete superbills are the most common reason clients are not reimbursed. See our guide to superbills for therapists for what to include.
- Good Faith Estimates. Under the No Surprises Act, uninsured and self-pay clients are entitled to a written Good Faith Estimate of expected charges.
- Single case agreements. When an in-network option is not available for a client’s needs, a single case agreement can allow you to be paid at a negotiated rate.
Common Reasons Therapy Claims Are Denied
- Mental health benefits carved out to a separate administrator, and the claim sent to the medical plan instead.
- Coverage terminated or changed, discovered only after several sessions were billed.
- Wrong place of service or a missing telehealth modifier.
- A session length that does not support the psychotherapy code billed.
- Services billed before the clinician’s credentialing effective date.
- Session limits or authorization requirements, including employee assistance program sessions that require an authorization code.
- Claims filed after the payer’s timely filing limit, which can be as short as 90 days.
Most of these are preventable at intake, and the rest can be recovered if someone follows up quickly. Read more in The Most Common Claim Rejections in Mental Health Billing and How to Avoid Them.
Solo Therapists and Group Practices
For solo practitioners, outsourcing billing usually means getting your evenings back. You stop logging into payer portals, stop researching denial codes, and stop wondering whether a claim from six weeks ago was ever paid.
For group practices, the challenge is consistency. Different clinicians document and code differently, credentialing dates are staggered, and one clinician’s errors can quietly drag down the whole practice’s collections. A dedicated billing team applies the same rules to every claim and shows you, clinician by clinician, where revenue is being lost. If your group also includes psychiatrists or psychiatric nurse practitioners, see our mental and behavioral health billing services for how we handle a mixed practice.
HIPAA and Protecting Your Clients’ Privacy
Mental health records are among the most sensitive information a practice holds. Any billing partner you work with will handle protected health information, and should sign a business associate agreement, limit access to the minimum necessary, and use secure systems for every file and conversation. Read how we approach HIPAA compliant billing.
What to Look For in a Therapy Billing Company
Therapy billing companies range from large national firms that treat mental health as one specialty among dozens to small teams that bill for therapists every day. Before you sign with anyone, ask:
- How many therapy practices do you bill for today? Experience with psychotherapy codes, carve-outs, and telehealth rules matters more than general medical billing experience.
- Who works my denials, and how quickly? A company that only submits claims is a clearinghouse with a monthly fee. Ask what happens to a denial the day it arrives.
- What will I see each month? You should get clear reports on charges, payments, outstanding claims, and denial reasons, not just a deposit to reconcile on your own.
- Do you handle credentialing too? Billing and credentialing are tightly linked. When they sit with different vendors, effective-date problems fall through the gap.
- Will you sign a business associate agreement? If the answer is anything but an immediate yes, keep looking.
The right billing partner should feel like part of your practice, not a vendor you chase for answers.
How Getting Started Works
- Consultation. We talk through your practice, your payers, your current billing process, and where you think money is being lost.
- Review. We look at your outstanding claims and recent denials to find what can still be recovered.
- Setup. We confirm payer enrollment, electronic remittance, and the details we need for each clinician.
- Ongoing billing. From then on, we verify, submit, post, and follow up on every claim, and report back to you each month.
Frequently Asked Questions
Do you work with individual therapists, or only group practices?
Both. We work with solo therapists and counselors as well as multi-clinician group practices.
Which clinicians do you bill for?
Licensed mental health counselors and professional counselors, marriage and family therapists, clinical social workers, psychologists, and psychiatric providers, along with pre-licensed associates where the payer allows it.
Can you help me get on insurance panels?
Yes. Credentialing and payer enrollment are part of our services, including CAQH setup and maintenance and Medicare enrollment for eligible counselors and marriage and family therapists.
Do you bill for telehealth sessions?
Yes. We apply each payer’s place of service and modifier rules to every telehealth claim.
What happens to claims that are already denied or unpaid?
We can review your outstanding claims, identify which are still within the payer’s filing limits, and work them for payment.
Which states do you serve?
We work with therapy practices in twelve states: Colorado, Connecticut, Florida, Georgia, Illinois, Missouri, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, and Texas.
Get Your Evenings Back
If insurance billing is taking time away from your clients, or you suspect money is slipping through denied and unpaid claims, we can help. Schedule a consultation with Maximum Billing or call 800-820-0364, and we will walk through your current billing and show you where the gaps are.