M&M Claims Care is a U.S. revenue cycle management (RCM) partner that manages billing for mental and behavioral health practices. Our team handles eligibility checks, payer enrollment, coding review, claim submission, payment posting, denial appeals and A/R follow-up. Therapists, psychiatrists, psychologists and group practices believe in us. We ensure you get paid accurately and on time while clinicians stay focused on patients. Let’s show you how M&M Claims Care became a leading billing partner for mental health practices.
Why Mental and Behavioral Health Billing Is Different
With the growing mental health issues, practices’ need for accurate billing operations is also increasing. But due to difficult coding and strict privacy rules, claim denial rate is increasing and as a result practices receive low revenue that make it difficult for them to manage all the expenses and run their practice. Some of the factors that make mental health billing different and harder than other specialties include:
- Time-based coding. Psychotherapy codes depend on documented session length. A 50-minute session billed as a 60-minute code is a coding error and payers audit this area heavily.
- Subjective medical necessity. There is no lab value or imaging report to prove depression or anxiety. The clinical note and treatment plan carry the whole claim.
- Authorization limits. Many plans approve a fixed number of visits then require re-authorization. A lapsed authorization is a common reason for a denial.
- Carve-outs. Many employers route behavioral health to a separate managed behavioral health organization (MBHO), so the card in the patient’s wallet can not be the right payer.
- Credentialing complexity. Psychiatrists, psychologists, LCSWs, LMFTs, LPCs and PMHNPs each have different enrollment and reimbursement rules.
- Stricter privacy. Psychotherapy notes get special HIPAA protection and substance use disorder (SUD) records fall under 42 CFR Part 2.
- Fast-moving telehealth rules. Place-of-service codes, modifiers and in-person visit requirements vary by payer and keep changing.
Those practices that partner with a general medical billing services provider can face more billing complications because their main focus is just to submit claims. But a behavioral health RCM partner understands why those claims fail and how to fix the cause.
What Is RCM for a Behavioral Health Practice?
Revenue cycle management (RCM) is every step between scheduling a patient and collecting the final payment. It includes registration, insurance verification, coding, claim submission, payment posting, denial management, patient billing and reporting. For a behavioral health practice, RCM also includes payer credentialing, authorization tracking and parity-based appeals.
When you outsource RCM, it means you need a dedicated team that knows how to run that cycle for you, usually inside your EHR or practice management system. You keep ownership of your data, your payer contracts and your patient relationships.
How M&M Claims Care Supports Mental and Behavioral Health Practices
The main goal of M&M Claims Care is to process each claim with attention and ensure compliance at each step. Our mental health billing services cover the full cycle.
Eligibility and Benefits Verification
Before the first appointment, we confirm active coverage, behavioral health benefits, copay or coinsurance, deductible status, visit limits, telehealth coverage, and whether a carve-out or prior authorization applies. We believe that finding those problems at the start only costs some minutes but getting them after the claim is denied costs weeks.
Mental Health Credentialing and Payer Enrollment
A clinician cannot bill what a payer has not enrolled. We prepare and track applications for Medicare, Medicaid and commercial plans, keep CAQH profiles current, and monitor re-credentialing dates so enrollment never lapses mid-year. This early enrollment benefits most practices that want to add a new therapist or prescriber.
Coding and Documentation Review
Our coders check that the CPT code, ICD-10-CM diagnosis, modifiers and documented session time match the medical records. We flag notes that are missing start and stop times or measurable progress so they can be fixed before submitting the claim. We provide billing feedback only while the clinician makes all clinical decisions.
Clean Claim Submission
Claims pass through scrubbing for demographic errors, missing authorization numbers, mismatched rendering and billing NPIs, and payer-specific rules before submission. We submit clean claims on time because we know that many payers have strict filing deadlines.
Payment Posting and Reconciliation
We post ERAs and EOBs, reconcile deposits, identify underpayments against your contracted rates and route patient balances correctly.
Denial Management and Appeals
Every denial is categorized by root cause such as medical necessity, authorization, coding, eligibility, credentialing, timely filing) and work to resolve them. If a payer applies stricter limits to mental health care than to similar medical care, we file a parity-based appeal and request supporting documents from the plan.
Accounts Receivable Follow-Up
We follow up on unpaid claims based on how long they have been outstanding. Older balances are escalated early to prevent delays in payment.
Patient Billing Support
Clear statements, accurate balances and courteous follow-up protect the therapeutic relationship which matters more in mental health than in almost any other specialty.
Reporting and Analytics
Every practice has full rights to know about the billing condition of their practice. That’s why we provide you with regular reports on clean claim rate, denial rate by reason and payer, days in A/R, net collection rate and revenue by provider. These reports help you make informed decisions based on data.
Behavioral Health Coding: The Codes Our Team Reviews Every Day
We always prefer experienced and well-trained coders who have knowledge of how to use accurate codes. Some of the common CPT codes we widely use to submit accurate mental health codes include:
Service | CPT Code(s) | What Billers Check |
Psychiatric diagnostic evaluation | 90791 (without medical services), 90792 (with medical services) | Correct code based on the provider and whether medical services are included. Used for initial evaluations, not routine follow-ups |
Individual psychotherapy | 90832 (16–37 min), 90834 (38–52 min), 90837 (53+ min) | Documented session time matches the selected code |
Psychotherapy add-on with E/M | 90833, 90836, 90838 (with an E/M code such as 99214) | Separate psychotherapy time is documented apart from the E/M service |
Crisis psychotherapy | 90839 (first 60 min), 90840 (each additional 30 min) | Crisis details, session time, and payer limits are documented |
Family psychotherapy | 90846 (without patient), 90847 (with patient) | Attendees and reason for the session are documented |
Group psychotherapy | 90853 | Group details and each patient’s documentation are complete |
Interactive complexity add-on | 90785 | A qualifying primary code is used and communication barriers are documented |
Psychological and neuropsychological testing | 96130–96139 | Evaluation, testing, and scoring time are documented, authorization is checked |
Brief emotional or behavioral assessment | 96127 (e.g., PHQ-9, GAD-7) | The assessment tool is completed, scored, and documented |
Behavioral health integration | 99484, 99492–99494 (collaborative care) | Care requirements and monthly time limits are met |
Diagnosis coding matters just as much. Payers expect a specific ICD-10-CM behavioral health diagnosis (for example, major depressive disorder, generalized anxiety disorder or PTSD) to support medical necessity. A Z-code alone usually will not justify ongoing psychotherapy. The FY 2027 ICD-10-CM code set took effect on October 1, 2026, so code libraries should already be updated.
Who can bill Medicare? Psychiatrists, clinical psychologists, clinical social workers, nurse practitioners and, from 2024, marriage and family therapists and mental health counselors can enroll. Medicare pays clinical social workers 75% of the physician fee schedule amount, which is one more reason accurate rate tracking matters.
Telehealth Mental Health Billing in 2026–2027
Telehealth is now an important part of behavioral health care and its billing rules are among the most misunderstood.
- Medicare telehealth rules: Medicare telehealth flexibilities have been extended through December 31, 2027. These include home-based telehealth, more eligible providers, and audio-only services.
- In-person visit requirement: Medicare has delayed enforcement of the in-person visit rule for mental health telehealth until January 1, 2028. After that, most patients receiving home-based telehealth will need an in-person visit within six months before their first service and at least once a year afterward, with some exceptions.
- Audio-only services: Medicare permanently allows audio-only telehealth for behavioral health when patients cannot use video or do not consent to it.
- Commercial payers and Medicaid: Rules vary by plan, including place of service (POS 02 or POS 10), modifiers (such as 95 or 93), and payment rates. Using the wrong settings can lead to claim denials.
- Prescribers: DEA telemedicine prescribing flexibilities were extended through December 31, 2026, according to the latest information available in this draft. Confirm current rules before planning 2027 workflows.
Our team always keeps updated with these changes and tracks telehealth rules for each payer to make sure every claim uses the correct code, place of service, and modifier.
In-House Billing vs. Outsourcing to a Behavioral Health RCM Partner
Factor | In-House Billing | Outsourced to M&M Claims Care |
Staffing | Hire, train and cover absences | Dedicated team and coverage continuity |
Specialty knowledge | Depends on one or two staff members | Behavioral health coding and payer experience across many practices |
Technology costs | Clearinghouse, billing software, scrubbers | Included in the service model |
Denial follow-up | Often delayed when the front desk is busy | Systematic, tracked and appealed |
Regulatory updates | You track every change | We monitor and apply changes |
Scalability | Adding providers means adding staff | Capacity scales with your claim volume |
Control and visibility | Direct but dependent on one person | Transparent dashboards and regular reporting |
Outsourcing is not right for every practice. Very small cash-only practices do not need it. But for practices that accept insurance, are adding clinicians, or are losing revenue to denials, a specialized partner like M&M Claims Care often pays for itself in recovered claims and reclaimed clinician time.
Who We Serve
M&M Claims Care supports behavioral health professionals across the United States, including:
- Psychiatrists and psychiatric nurse practitioners (PMHNPs)
- Clinical psychologists and neuropsychologists
- Licensed clinical social workers (LCSWs)
- Licensed marriage and family therapists (LMFTs)
- Licensed professional counselors (LPCs)
- Solo practitioners, group practices and telehealth-only practices
What Getting Started Looks Like
Ready to improve your billing process and get paid faster? Just make a discovery call to M&M Claims Care. We review your specialty, payer mix, EHR and current billing results. We look at recent claims, denials and A/R to find where revenue is leaking. We make a customized billing plan according to your current condition and share it with you before implementation.
M&M Claims Care takes complete responsibility for your billing issues, claim denials, and accounts receivable to make your revenue cycle smooth. Contact our team today to discuss your practice’s needs and learn how our medical billing services can help you spend less time on billing and more time caring for your patients.
