Many therapists begin their careers because they want to help people improve their mental health, not because they enjoy dealing with insurance claims. Unfortunately, insurance billing is part of running a successful behavioral health practice.
Submitting claims correctly helps you receive timely reimbursement, reduce claim denials, and create a smoother experience for your patients. Even small billing mistakes can delay payments, increase administrative work, and affect your practice’s cash flow.
The good news is that therapist billing becomes much easier once you understand the process.
Whether you’re opening a private practice, joining an existing group, or expanding your insurance network, this guide explains how to become credentialed, verify patient benefits, choose the correct CPT codes, submit clean claims, respond to denials, and improve reimbursement.
This guide is written for behavioral health providers, including licensed professional counselors, clinical social workers, marriage and family therapists, psychologists, and psychiatric providers who bill outpatient psychotherapy services in the United States. Massage therapists and physical therapists follow a different code set and credentialing path, although the claim workflow described here follows the same CMS-1500 structure.
How Does Insurance Billing for Therapists Work?
Insurance billing is the process of requesting payment from a health insurance company for behavioral health services you provide.
After completing a therapy session, you submit a medical claim that tells the insurance company:
- Who received treatment
- Who provided the service
- What service you performed
- Why treatment was medically necessary
- When the service occurred
- How much you charged
The insurance company reviews the claim, determines whether the service qualifies for coverage under the patient’s plan, and calculates the payment based on the provider contract and the patient’s benefits.
If everything is correct, the insurer issues payment and sends an Explanation of Payment (EOP) or Electronic Remittance Advice (ERA) explaining how it processed the claim.
Should You Bill In Network, Out of Network, or Both?
Before you submit your first claim, decide how your practice will participate with insurance. This decision shapes your credentialing workload, your rates, and the way you bill every session.
In Network Billing
An in-network provider holds a signed participating provider agreement with the insurance company. You bill the payer directly, accept the contracted rate as payment in full, and collect only the copayment, deductible, or coinsurance from the patient. In-network status brings referrals from the payer directory and a larger patient base, in exchange for contracted rates and the payer’s documentation and billing rules.
Out of Network Billing
An out-of-network therapist has no contract with the patient’s insurance company. You collect your full fee from the patient at the time of service and, when the patient’s plan includes out-of-network benefits, you provide a superbill. A superbill is an itemized receipt that lists your NPI, tax ID, the CPT code, the ICD-10-CM diagnosis code, the date of service, and your fee. The patient submits it to the insurance company and receives any reimbursement directly. PPO plans commonly include out-of-network mental health benefits after a separate deductible. HMO and EPO plans usually pay nothing out of network, so verify the plan type before promising a patient that a superbill will lead to reimbursement.
You can also bill out of network directly. Some plans accept a CMS-1500 claim from a non-participating provider and send payment to the patient unless the patient signs an assignment of benefits authorizing payment to you. Confirm the payer’s non-participating claim rules during benefit verification.
The Hybrid Model
Many practices join the two or three panels that insure most patients in their area and stay out of network with the rest. This model keeps credentialing manageable, protects a private pay revenue stream, and lets you drop a panel later if the contracted rate stops covering your costs.
How to Choose Which Insurance Panels to Join
Not every panel deserves a credentialing application. Evaluate each payer before you invest 60 to 180 days in the process.
Contracted rates. Ask colleagues in your license type and region what each payer actually reimburses for 90834 and 90837, and compare every offer against your session cost.
Local membership. A payer that insures the largest employers in your area fills your schedule. A payer with little local membership sends few referrals no matter how good the rate looks.
Panel status. Panels open and close as network needs change. If a panel is closed, reapply every six months and document each attempt.
Administrative burden. Compare prior authorization requirements, session limits, claim portals, and payment speed. A payer that pays $10 more per session but denies twice as often can net less.
Behavioral health carve outs. Some medical plans delegate mental health benefits to a separate company such as Carelon Behavioral Health or Optum Behavioral Health. You must be credentialed with the carve out entity, not the medical plan, or every claim will deny.
Once you sign each agreement, treat the rate as a starting point. Practices with strong performance data can [negotiate reimbursement rates with insurance companies] from the first contract onward and at every renewal
How to Bill Insurance as a Therapist
Here’s a step-by-step process to bill insurance as a therapist.
Step 1: Obtain Your National Provider Identifier (NPI)
Before you can bill most insurance companies, you need a National Provider Identifier (NPI).
The Centers for Medicare & Medicaid Services (CMS) issues NPIs through the National Plan and Provider Enumeration System (NPPES). The NPI is a unique 10-digit identification number used on healthcare claims.
Most therapists use:
- Type 1 NPI for individual healthcare providers.
- Type 2 NPI if they operate as an organization or group practice.
Always use the correct NPI when submitting claims because an incorrect provider identifier can result in claim rejection.
Step 2: Complete Insurance Credentialing
You cannot bill an insurance company as an in-network provider until the payer approves your credentialing application.
Credentialing verifies your qualifications, including your:
- Professional license
- Education
- Clinical training
- Work history
- Malpractice insurance
- National Provider Identifier (NPI)
- CAQH profile
- DEA registration, when applicable
Most commercial insurers also require providers to maintain an up-to-date CAQH Provider Data Portal profile because they use it during credentialing and recredentialing.
Credentialing often takes 60 to 180 days, depending on the payer and the completeness of your application.
Step 3: Sign a Provider Agreement
After the insurance company approves your credentialing application, it usually offers a participating provider agreement.
This contract outlines important details, including:
- Covered services
- Reimbursement rates
- Timely filing limits
- Medical necessity requirements
- Documentation standards
- Appeal procedures
- Payment policies
Read the agreement carefully before signing.
Your provider contract determines how much the insurance company reimburses for each CPT code.
Step 4: Verify the Patient’s Insurance Benefits
Never assume that a patient’s insurance covers therapy simply because they present an insurance card.
Verify benefits before the first appointment and periodically throughout treatment.
Confirm:
- Active coverage
- Effective dates
- Mental health benefits
- Copayment
- Deductible
- Coinsurance
- Prior authorization requirements
- Session limits
- Telehealth coverage
- Referral requirements, if applicable
Benefit verification helps prevent unexpected claim denials and allows you to discuss financial responsibility with the patient before treatment begins.
Step 5: Obtain Prior Authorization When Required
Some behavioral health services require prior authorization before treatment begins.
Requirements vary by:
- Insurance company
- Employer group
- Health plan
- Type of behavioral health service
If authorization is required, submit the request before providing the service whenever possible.
Failure to obtain required authorization may result in claim denial even if the therapy itself was medically necessary.
Step 6: Document the Therapy Session
Accurate documentation supports both medical necessity and reimbursement.
Every progress note should clearly explain:
- The patient’s symptoms
- Mental status findings
- Diagnosis
- Treatment goals
- Therapeutic interventions
- Patient response
- Progress toward goals
- Follow-up plan
- Session duration
- Provider signature
Documentation should support the CPT code billed.
For example, if you bill CPT 90837, your documentation should support a psychotherapy session lasting 53 minutes or longer, along with the medical necessity for that level of service.
Step 7: Choose the Correct CPT Code
Selecting the correct CPT code is one of the most important parts of therapist billing.
Some of the most commonly reported psychotherapy codes include:
| CPT Code | Service |
| 90791 | Psychiatric diagnostic evaluation |
| 90792 | Psychiatric diagnostic evaluation with medical services |
| 90832 | Individual psychotherapy, 30 minutes |
| 90834 | Individual psychotherapy, 45 minutes |
| 90837 | Individual psychotherapy, 60 minutes |
| 90846 | Family psychotherapy without patient |
| 90847 | Family psychotherapy with patient |
| 90853 | Group psychotherapy |
| 90839 | Psychotherapy for crisis, first 60 minutes |
| 90840 | Psychotherapy for crisis, each additional 30 minutes (add on to 90839) |
| 90785 | Interactive complexity (add on code) |
Always choose the code that accurately reflects the service provided and ensure your documentation supports the code selection.
Psychotherapy Add On and Crisis Codes
Add on codes are never billed alone. Report 90785 alongside a primary psychotherapy code when specific communication barriers complicate the session, such as involving a third party interpreter, managing maladaptive communication among family members, or reporting requirements involving a child. Report 90839 instead of a standard psychotherapy code when the session addresses an urgent crisis with high distress and complexity, and add 90840 for each additional 30 minutes. Psychiatric providers who perform evaluation and management services report psychotherapy through the add on codes 90833, 90836, and 90838 together with the E/M code, a structure that applies to prescribers rather than therapists.
License Level Modifiers
Medicaid plans and some commercial payers require a modifier that identifies the rendering provider’s license level, and reimbursement often differs by level. Commonly required modifiers include AJ for clinical social workers, HP for doctoral level psychologists, HO for master’s level clinicians, and HN for bachelor’s level providers. Requirements vary by state and by plan, so confirm the required modifier during credentialing and apply it consistently, because a claim with a missing or mismatched license modifier denies or pays at the wrong rate. Most national guides skip this detail, and it is one of the most common preventable denial causes in Medicaid behavioral health billing.
Step 8: Assign the Correct ICD-10-CM Diagnosis Code
After selecting the appropriate CPT code, assign the diagnosis code that explains why the therapy service was medically necessary.
Insurance companies use ICD-10-CM diagnosis codes to evaluate medical necessity and determine whether the patient’s health plan covers the service.
Your diagnosis should accurately reflect the provider’s clinical assessment and documentation. Never select a diagnosis solely because it is more likely to receive reimbursement.
Some commonly reported behavioral health diagnoses include:
| ICD-10-CM Code | Diagnosis |
| F32.9 | Major depressive disorder, single episode, unspecified |
| F33.1 | Major depressive disorder, recurrent, moderate |
| F41.1 | Generalized anxiety disorder |
| F41.0 | Panic disorder |
| F43.10 | Post-traumatic stress disorder (PTSD), unspecified |
| F42 | Obsessive-compulsive disorder |
| F90.9 | Attention-deficit hyperactivity disorder (ADHD), unspecified |
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood |
Always code to the highest level of specificity supported by the clinical documentation and follow the current ICD-10-CM Official Guidelines for Coding and Reporting.
Step 9: Complete the CMS-1500 Claim Form
Most outpatient therapists submit professional claims using the CMS-1500 Claim Form or its electronic equivalent in their practice management software.
Every field on the claim serves a specific purpose. Incorrect or missing information can delay reimbursement or result in claim rejection.
Step 10: Submit the Claim
Most therapists submit claims electronically because electronic claims process faster and reduce data-entry errors.
Electronic claims typically follow this workflow:
Therapist → Practice Management Software → Clearinghouse → Insurance Company
A clearinghouse checks the claim for formatting errors before forwarding it to the insurance payer. If the claim contains missing or invalid information, the clearinghouse usually rejects it before it reaches the insurance company, allowing you to correct the error quickly.
Some insurers also allow providers to submit claims directly through their secure provider portals.
Know Your Timely Filing Limits
Every payer contract sets a timely filing limit, the maximum number of days between the date of service and claim receipt. Commercial plans commonly allow 90 to 180 days, some as few as 60. Medicare allows 12 months, and state Medicaid limits vary. A claim received after the deadline denies automatically, the denial cannot be appealed on the merits, and the patient cannot be billed for the loss. Submit claims daily or on a fixed weekly schedule, and calendar the shortest filing limit among your contracts as the default deadline for the whole practice. If a claim must be resubmitted or corrected, the corrected claim usually has its own deadline measured from the original denial, so track both dates.
Step 11: Monitor Claim Status
Submitting a claim does not guarantee payment.
Track every claim until the insurer reaches a final determination.
Claims generally move through one of these stages:
- Received – The insurance company acknowledges receipt of the claim.
- In Process – The insurer reviews eligibility, benefits, coding, and medical necessity.
- Paid – The claim is approved, and payment is issued.
- Denied – The insurer refuses payment and provides a denial reason.
- Rejected – The claim contains administrative or formatting errors and requires correction before processing.
Monitoring claim status helps identify problems early and reduce reimbursement delays.
Step 12: Review the Explanation of Payment (EOP) or Electronic Remittance Advice (ERA)
After processing the claim, the insurer sends an Explanation of Payment (EOP) or an Electronic Remittance Advice (ERA).
Review it carefully to confirm:
- The billed CPT code
- The allowed amount
- The insurance payment
- Patient responsibility
- Any claim adjustments
- Denial or remark codes
- Remaining deductible or coinsurance, if applicable
If the reimbursement does not match your contract or you identify an error, investigate the reason promptly and follow the payer’s appeal process when appropriate.
Step 13: Post Payments and Bill the Patient
Once you receive payment:
- Post the insurance payment to the patient’s account.
- Apply contractual adjustments according to your provider agreement.
- Bill the patient only for legitimate patient responsibility, such as copayments, deductibles, coinsurance, or non-covered services.
Providing patients with a clear, itemized statement helps reduce confusion and improves collections.
The next section will cover claim denials and appeals, common therapist billing mistakes, in-house versus outsourced billing, best practices to maximize reimbursement, FAQs, and the conclusion, completing the guide.
How to Bill Insurance for Telehealth Therapy Sessions
Telehealth sessions use the same CPT codes as office visits. There is no separate telehealth psychotherapy code, so bill 90791, 90832, 90834, 90837, or the applicable family code and identify the telehealth setting through the place of service code and modifier.
- Place of service 10 reports telehealth provided in the patient’s home.
- Place of service 02 reports telehealth provided anywhere other than the patient’s home.
- Modifier 95 identifies synchronous audio and video care and remains the modifier most commercial payers require. A few payers still use the older GT modifier, and audio only sessions, where covered, are reported with modifier 93.
Requirements vary by payer, so confirm the expected place of service code, modifier, and telehealth reimbursement rate during benefit verification, and document in the session note that the service was delivered by synchronous video along with the patient’s location. Some plans reimburse telehealth at parity with office visits and others pay a reduced facility style rate, which is worth confirming before you build a virtual only caseload.
How to Handle Claim Denials, Rejections, and Appeals
Even careful billing produces denied and rejected claims. What separates a healthy practice from a struggling one is how quickly each unpaid claim is identified, understood, and corrected.
Rejections vs Denials
A rejection happens before processing. The clearinghouse or the payer’s front end returns the claim because of a formatting or data error, an invalid subscriber ID, a missing NPI, or a payer enrollment problem. Rejected claims never enter the payer’s system, so fix the error and resubmit as a new claim. A denial happens after processing. The payer adjudicated the claim and refused payment, and the denial reason appears on the ERA or EOP as a claim adjustment reason code. Denied claims require a corrected claim or an appeal, not a simple resubmission, and resubmitting an unchanged denied claim only produces a duplicate denial.
Common Denial Codes in Therapy Billing
| Code | Meaning | What to Do |
|---|---|---|
| CO 29 | Timely filing limit expired | Appeal only with proof of timely submission, such as a clearinghouse acceptance report |
| CO 27 | Coverage terminated before the date of service | Bill the patient’s active plan; reverify benefits and update the claim |
| CO 22 | Coordination of benefits issue, another payer is primary | Ask the patient to update COB with the insurer, then bill the correct primary plan |
| CO 197 | Prior authorization missing | Request retro authorization where allowed, then appeal with clinical documentation |
| CO 97 | Service bundled into another paid service | Review the code pair; append a modifier only when documentation supports a distinct service |
| CO 16 | Claim lacks required information | Read the accompanying remark code, complete the missing element, and submit a corrected claim |
| PR 204 | Service not covered under the patient’s plan | Confirm the exclusion, then bill the patient according to your financial policy and disclosures |
How to Appeal a Denied Claim
- Read the ERA and identify the exact reason and remark codes before calling anyone.
- Correct data errors with a corrected claim, using resubmission code 7 and the original claim number, rather than a new claim.
- For medical necessity or authorization denials, file a written appeal within the payer’s deadline, typically 30 to 180 days from the denial date, and attach the progress note, the treatment plan, and the benefit verification reference number.
- Track every appeal to a final determination, and escalate to a second level appeal when the contract provides one.
Clawbacks and Recoupments
A clawback, formally a recoupment or overpayment demand, happens when a payer pays a claim and later decides the payment was an error, often because coverage had lapsed or a post payment audit questioned the documentation. State laws limit how far back most commercial payers can reach, commonly 12 to 24 months, and every recoupment notice carries appeal rights with a deadline. Never ignore a recoupment letter, because payers offset unanswered demands against your future payments. Verify the payer’s lookback right under your contract and state law, appeal when your documentation supports the original payment, and keep complete records for every paid claim so an audit years later does not become a loss.
Common Therapist Billing Mistakes to Avoid
Most therapy claim problems trace back to a short list of repeatable errors. Audit your own workflow against each one.
- Billing 90837 for every session by default. Payers profile providers whose 90837 volume far exceeds peers, and several send warning letters or request records. Bill the code the documented session time supports, and record start and stop times in every note.
- Using unspecified diagnoses. Codes ending in “unspecified” invite denials and reviews. Code to the highest specificity the clinical assessment supports.
- Skipping January reverification. Deductibles reset and plans change at the start of every year. Reverify every active patient’s benefits each January and after any job change.
- Billing under the wrong NPI. Group practices must report the organization’s Type 2 NPI as the billing provider and the clinician’s Type 1 NPI as the rendering provider. Reversing them causes rejections and misdirected payments.
- Missing telehealth elements. A telehealth claim without the correct place of service code and modifier processes as an office visit and risks denial or recoupment.
- Ignoring timely filing on corrected claims. The clock on a correction runs from the denial, and missing it converts a fixable error into a write off.
- Not enrolling in ERA and EFT. Paper checks and paper EOBs slow posting, hide underpayments, and delay denial follow up.
- Letting patient balances age. Collect copayments at the time of service and send statements promptly. Waived copays can violate payer contracts, so apply financial hardship policies consistently and in writing.
Secondary Insurance and Coordination of Benefits
- When a patient holds two plans, coordination of benefits rules decide which plan pays first. The plan through the patient’s own employer is usually primary, and a spouse’s plan is secondary. For children covered by both parents, most plans follow the birthday rule, which makes the plan of the parent whose birthday falls earlier in the calendar year primary. Medicare’s position depends on employer size and the patient’s employment status.
- Bill the primary plan first and wait for the ERA. Then submit the claim to the secondary plan with the primary plan’s payment and adjustment details attached, which electronic claims carry automatically when your system supports secondary claims. The secondary plan considers the remaining balance under its own benefits. Claims sent to the wrong payer first deny with code CO 22, and the fix always starts with the patient updating their coordination of benefits information with both insurers, so ask about dual coverage at intake and at every January reverification.
How Much Do Insurance Companies Reimburse Therapists?
Reimbursement depends on the payer, your license level, your state, and the CPT code. Commercial rates for a 90837 session commonly range from roughly $90 to $180, with psychologists and prescribers contracted above master’s level clinicians, and Medicare publishes its rates annually through the Medicare Physician Fee Schedule. Review current mental health reimbursement rates by insurance company before joining a panel, and reread your fee schedule every year, because rates never rise on their own.
Should You Bill In House or Outsource Your Billing?
Every practice answers the same question eventually: who works the claims? There are three real options.
- Do it yourself. Free apart from software costs, and workable for a small caseload with two or three payers. The tradeoff is clinical time. A full caseload can generate five or more hours of weekly billing work once denials and benefit checks are counted.
- Hire billing staff. An in house biller gives you direct oversight, but a solo or small group rarely generates enough claim volume to justify a full salary, and a single resignation can stall your entire revenue cycle.
- Outsource to a billing company. A specialized service handles verification, claim submission, denial follow up, and payment posting for a percentage of collections, and its performance scales with yours because it is paid on what it collects.
The right choice depends on caseload, payer mix, and how much administrative work you are willing to own. The wrong choice is the passive one, where claims are submitted but nobody works the denials, because unworked denials quietly become write offs.
If billing is consuming clinical hours or your denial backlog is growing, a dedicated mental health billing service takes over the full cycle, from eligibility checks through appeals, so your revenue depends on the care you deliver rather than the paperwork behind it.
Best Practices to Maximize Reimbursement
- Verify benefits before the first session, at every January renewal, and whenever a patient changes employment.
- Submit claims daily. Short submission cycles shorten payment cycles and keep every claim far inside timely filing.
- Enroll in ERA and EFT with every payer so payments post fast and underpayments surface immediately.
- Reconcile every ERA against your contracted fee schedule. Payers underpay quietly, and only practices that compare allowed amounts to contracts catch it.
- Track four numbers monthly: clean claim rate, denial rate, days in accounts receivable, and net collection rate. These metrics reveal problems early and become your evidence when you request a rate review.
- Audit documentation quarterly against the codes billed, especially 90837 time support and diagnosis specificity.
- Work every denial within a week of the ERA. Denial recovery rates fall sharply as denials age.
- Keep credentialing, CAQH attestations, and licenses current with every payer, because lapsed credentialing stops payment on otherwise perfect claims.
Conclusion
Billing insurance as a therapist may seem overwhelming at first, but it becomes much more manageable once you understand the process and establish consistent workflows. Every successful claim starts with accurate medical credentialing, thorough benefit verification, proper documentation, correct CPT and ICD-10-CM coding, and timely claim submission.
Insurance companies expect providers to demonstrate medical necessity, maintain complete clinical records, and follow their billing policies. Paying close attention to these requirements can help you reduce claim denials, improve first-pass acceptance rates, and receive reimbursement more quickly.
Whether you manage billing in-house or work with a professional medical billing company, regularly reviewing payer policies, monitoring claim status, and staying current with coding updates are essential for maintaining a healthy revenue cycle.
Most importantly, remember that insurance billing is more than an administrative task. It directly supports the financial stability of your practice, allowing you to spend more time focusing on what matters most: providing high-quality mental health care to your patients.
FAQs
How do therapists bill insurance?
Therapists bill insurance by documenting the therapy session, selecting the appropriate CPT and ICD-10-CM diagnosis codes, completing a CMS-1500 claim (or its electronic equivalent), and submitting the claim electronically through a clearinghouse or directly to the insurance company. The insurer reviews the claim, determines coverage, and issues payment according to the provider’s contract and the patient’s benefits.
Do therapists need to be credentialed before billing insurance?
Yes. To bill as an in-network provider, therapists must complete the insurance company’s credentialing process and sign a participating provider agreement. Without credentialing, most insurers will not reimburse providers at in-network rates.
What is the CMS-1500 claim form?
The CMS-1500 is the standard claim form that healthcare professionals use to bill Medicare, Medicaid, and most commercial insurance companies for professional services. Most therapists submit the electronic version of this form through their practice management software or a clearinghouse.
How do I know if a patient’s insurance covers therapy?
Always verify benefits before the appointment. Confirm:
- Active coverage
- Mental health benefits
- Copayment
- Deductible
- Coinsurance
- Prior authorization requirements
- Session limits
- Telehealth coverage
- Referral requirements, if applicable
Benefit verification helps prevent unexpected denials and patient billing issues.
Do all therapy sessions require prior authorization?
No. Prior authorization requirements vary by insurance company and health plan. Some plans require authorization only for specific services or after a certain number of visits, while others do not require it at all. Always check the patient’s benefits before beginning treatment.
Can therapists submit insurance claims electronically?
Yes. Most therapists submit claims electronically using practice management software connected to a clearinghouse. Electronic claims generally process faster, reduce data-entry errors, and allow providers to track claim status more efficiently than paper claims.
What information should a therapy progress note include?
A complete therapy note should generally include:
- Date of service
- Session duration
- Patient’s symptoms and presenting concerns
- Mental status observations
- Diagnosis
- Therapeutic interventions provided
- Patient’s response to treatment
- Progress toward treatment goals
- Plan for future care
- Provider’s signature and credentials
Your documentation should support the medical necessity of the service and the CPT code billed.
Can I bill insurance as a therapist without being credentialed?
Not as an in-network provider. Without a signed contract, you can only bill plans that include out-of-network benefits, either by submitting a non-participating claim or by giving the patient a superbill to file. HMO and EPO plans generally pay nothing out of network, and Medicare, Medicaid, and TRICARE do not reimburse non-enrolled providers, so verify out-of-network mental health benefits before treating a patient whose plan you do not participate with.
How do I bill insurance for online therapy sessions?
Bill the same psychotherapy CPT code you would use in the office, add the telehealth modifier the payer requires, usually modifier 95, and report place of service 10 when the patient is at home or place of service 02 when they are anywhere else. Confirm each payer’s telehealth rules and reimbursement rate during benefit verification, because coverage and parity vary by plan.
How long does it take to get paid by insurance?
Clean electronic claims commonly pay within 14 to 30 days, and most states enforce prompt payment laws requiring insurers to pay clean claims within 30 to 45 days. Paper claims, claims with errors, and claims needing development take longer. Daily submission, ERA enrollment, and weekly status checks keep the payment cycle short.
Does the billing process vary by state?
The claim structure is national: the same CPT codes, ICD-10-CM codes, and CMS-1500 format apply everywhere. What varies by state is Medicaid, including its fee schedules, covered license types, and required license level modifiers, along with prompt payment deadlines and recoupment lookback limits. Therapists in states such as California should verify their Medicaid plan rules and any state specific telehealth payment laws with each payer.
Can I bill insurance for missed appointments?
No. Insurance pays only for services actually delivered, so no show and late cancellation fees cannot be billed to a payer or coded as a session. Charge them directly to the patient under a written financial policy the patient signed at intake, and note that Medicaid programs restrict or prohibit charging their members missed appointment fees.
