We Don’t Miss 90791 or 90837 — We Code and Bill Them Right the First Time
Behavioral Medical Billing and Coding Services
Behavioral health billing and coding is complex. Time-based psychotherapy CPTs. prior authorizations that expire. payer carve-outs. and shifting telehealth rules all create costly barriers.
Preferred MB provides behavioral health billing services and mental health billing services for solo and group practices.
- 97% first-pass claim success
- 20-day average AR turnaround
- 95% prior auth approval rate
Why Behavioral Claims Get Stuck in Prior Authorization
The biggest barrier to behavioral health revenue isn’t just coding errors — it’s authorization delays and payer carve-out rules. Miss one re-auth date or submit therapy without the right session notes and claims never move forward.
At Preferred MB, we track every approval, renewal, and session limit in real time so treatment isn’t interrupted and payments aren’t blocked.
Where Pain Revenue Gets Lost
- IOP/PHP programs billed without updated re-auth requests
- Testing codes (96130–96133) submitted without medical necessity justification
- MAT visits denied because payer OTP requirements not documented
- Telehealth therapy denied under carve-out rules not flagged at intake
- COB denials when secondary wasn’t billed within filing limits
Preferred MB enforces behavioral-specific authorization checks and payer rules — before sessions are even billed.
Critical Authorization and Payer Friction Points We Eliminate
Your Behavioral Billing and Coding Workflow — Built to Prevent Revenue Loss
We manage the full behavioral billing cycle with one focus: reduce auth delays, code rejections, and payer carve-out denials — while keeping your clinical team free to focus on patient care.
Eligibility & Benefits Locked at Intake
We verify mental health coverage, visit caps, parity restrictions, and carve-out payers before treatment begins.
Precise Code and Modifier Mapping
90791, 90837, 90853, and 96130–96133 coded directly from session notes with modifier 25, 59, or 95 applied only when payer rules allow.
Flexible Tech Integration
Whether you use TherapyNotes, SimplePractice, Valant, or spreadsheets — our workflows adapt with no forced EHR switch.
Payer-Specific Claim Routing
Claims scrubbed with behavioral payer edits (Medicare, Medicaid, commercial, Optum, Magellan) before submission. Denials stopped at the source.
Denial Management With Policy Proof
Appeals tied to parity laws, LCDs, and payer bulletins — not just blind resubmission.
Actionable AR Intelligence
Accounts receivable segmented by payer, service line, and denial type so providers know exactly where money is getting stuck.
Gaps often come from workflow habits or payer-specific rules that go unchecked.
Our reviews expose recurring issues in compliance, coding, and claim management that cost behavioral providers thousands of dollars every year.
- 38% of psychotherapy claims denied due to missing or incomplete time logs
- One in three prior authorizations expired before the treatment plan was finished
- 29% of collaborative care claims rejected without required provider communication
- $900+ per provider lost monthly from group therapy claims not fully billed
- 22% of COB denials unresolved when secondary claims missed payer deadlines
- 18% of psychological testing claims denied without medical necessity support
- Carve-out claims underpaid when submitted through the wrong payer channel
- 25% of EHR templates failed to meet Medicaid or state-level documentation rules
- Appeals rarely filed, with denied behavioral claims simply written off by staff
- Denial tracking is absent, leaving providers unaware of repeated payer rejections
Preferred MB brings visibility to these recurring issues and resolves them through payer-specific coding checks, compliance-driven workflows, and denial prevention strategies that secure revenue before it slips away.
Are These Billing Gaps Slowing Your Behavioral Reimbursement?
You Serve Different Specialities in Behavioral, and We Cover the Billing
Preferred MB is a behavioral health billing company trusted nationwide. We handle billing for the most complex and denial-prone behavioral health services — applying correct coding, modifiers, payer rules, and documentation standards to keep revenue consistent.
Clinical Scenario
Patient attends weekly psychotherapy (90837) combined with neuropsychological testing.
- Start and stop times documented for each psychotherapy session
- Testing services supported with scoring and interpretation notes
- Session notes linked to measurable progress indicators
Billing Scenario
- 90832–90837 and 96130–96133 mapped directly to notes and duration
- Modifiers and POS codes validated against telehealth policies
- We also provide behavioral health coding services for all psychotherapy and testing CPTs.
Clinical Scenario
Patient enrolled in MAT program receiving buprenorphine therapy with tox screens.
- Medication management documented per OTP or office-based rules
- Lab tests linked to treatment plan and patient records
- Visit notes updated for continuity and compliance
Billing Scenario
Preferred MB manages SUD and MAT billing with payer and state-level accuracy.
- 99408–99409 coded with tox screen documentation
- OTP regulations applied for Medicaid and commercial payers
- Claims sequenced with diagnosis and service codes that support medical necessity
Clinical Scenario
Patient participates in a structured therapy program multiple hours per day.
- Daily attendance and participation documented for each session
- Treatment plans updated with progress across the program
- Prior authorization renewals requested before expiration
Billing Scenario
Preferred MB secures correct reimbursement for high-volume program services.
- Prior authorizations tracked with session-level updates
- Claims sequenced according to payer-specific IOP/PHP rules
- Denials prevented with documented daily progress evidence
Clinical Scenario
Primary care physician and behavioral health provider manage shared treatment plan.
- Patient identified with behavioral and medical condition linkages
- Time logs kept for care coordination and provider communication
- Documentation aligned with payer-specific collaborative care rules
Billing Scenario
Preferred MB ensures collaborative care codes are fully reimbursed.
- 99492–99494 coded with documented communication and time logs
- Claims supported with compliance templates for provider efficiency
- Denials appealed with parity laws and payer documentation guidance
Clinical Scenario
- Fluoroscopy with contrast recorded
- Pain scale tracked before and after injection
- Conservative treatment documented in history
Billing Scenario
- Modifier -25 added for same-day E/M if applicable
- Bilateral coding applied based on fluoroscopy image
- EHR tags used to link scans and diagnosis
How Behavioral Claims Lose Value After Submission
Most behavioral health claims don’t just get denied — they get underpaid, delayed, or stuck in follow-up. Preferred MB pinpoints where this happens and recovers lost revenue before it disappears.
Psychotherapy and Testing Claims
- Downcoded when session length or testing documentation is unclear
- Paid at partial rates when CPT bundles not billed correctly
- Denied when modifiers are missing for telehealth delivery
Substance Use and MAT Claims
- Underpaid when tox screens are not properly linked to MAT visits
- Delayed when OTP documentation isn’t filed with the claim
- Rejected when state Medicaid billing sequences aren’t followed
Group and Family Therapy Claims
- Denied if no attendance roster is submitted with the session note
- Reduced to “single session” payments without clear group size coding
- Lost when commercial plans apply visit caps not tracked in real time
IOP and PHP Program Claims
- Interrupted when prior auth is not renewed mid-program
- Denied for missing daily progress documentation
- Delayed when claims aren’t sequenced to payer-specific PHP/IOP rules
Collaborative Care Claims
- Denied when PCP communication isn’t documented properly
- Lost when time logs are incomplete or missing entirely
- Underpaid when claims are routed through the wrong payer channel
How Behavioral Practice Models Lose Revenue — And How We Fix It
Medicare requires strict alignment with psychotherapy rules, LCDs, and telehealth compliance.
- Audio-only and telehealth sessions billed per current CMS rules
- Documentation validated for psychotherapy LCD medical necessity
- Visit frequency tracked against Medicare care guidelines
- Claims formatted to match Medicare Advantage plan submission cycles
- Reviews documentation timelines against staged care protocols
96.9%
Approval rate on Medicare behavioral claims with LCD-compliant documentation.
Commercial insurers enforce visit caps, prior auths, and same-day billing limits.
- Session counts tracked in real time to prevent exceeding visit caps
- Same-day E/M and therapy claims paired with Modifier 25 when compliant
- Extended care plans billed with accurate sequencing to avoid partial payouts
- Denials appealed using parity law when mental health benefits are restricted
95.6%
First-pass rate on behavioral claims across high-volume commercial payers.
State Medicaid programs vary widely in encounter formats, visit limits, and prior auth triggers.
- State-specific Medicaid templates applied to each behavioral claim
- IOP/PHP services billed with session-level documentation
- Prior auth renewals tracked before continuation of care
- Claims batched and submitted according to state schedule requirements
94.2%
Compliance rate for behavioral Medicaid claims under state program rules.
Carve-out payers require separate workflows, specialized routing, and strict documentation proof.
- Claims routed through correct behavioral carve-out payer systems
- Authorization rules applied for therapy, testing, and MAT services
- Denials appealed with parity laws and payer policy documentation
- Payment cycles tracked separately from medical claims
93.8%
Acceptance rate on carve-out behavioral claims processed through Preferred MB.
What Changes When We Take Over Your Behavioral Claims
Before: 24% Denial Rate
After Preferred MB: 8%
Denials reduced by correcting missing time logs, fixing telehealth POS errors, and ensuring prior auths were secured before submission.
Before: 42-Day AR Cycle
After Preferred MB: 20 Days
Accounts receivable cut in half with payer-specific claim scrubbing, real-time edits, and faster secondary claim routing.
Before: Frequent Telehealth Rejections
After Preferred MB: 96.3% Approval
Claims approved by applying correct modifiers, POS codes, and tracking state parity rules for behavioral telehealth.
Before: Expired Prior Authorizations
After Preferred MB: 95% Approval on First Request
Authorizations tracked and renewed automatically to prevent treatment interruptions and unpaid sessions.
Before: $900+ Lost Monthly Per Provider
After Preferred MB: $0 Documented Revenue Leakage
Recovered income from unbilled group therapy sessions, overlooked collaborative care codes, and denied COB claims that were never appealed.
Stop Leaving Behavioral Billing and Coding Revenue Behind
Every denied session, expired authorization, or missed code is money your practice earned but never collected. Preferred MB closes those gaps with behavioral billing and coding built to match payer rules and protect your revenue.
- Lower denial rates across psychotherapy, testing, and IOP/PHP
- Faster reimbursements from Medicare, Medicaid, commercial, and carve-out payers
- Full recovery of income lost to auth lapses, COB issues, and unbilled services
The results our clients see are not rare — they’re what we deliver every day.