Open Daily: 10am - 10pm | Alley door pickup 10am - 7pm 3038 Hennepin Ave Minneapolis, MN
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  • Open Daily: 10am - 10pm
    Alley-side Pickup: 10am - 7pm

    3038 Hennepin Ave Minneapolis, MN
    612-822-4611

Open Daily: 10am - 10pm | Alley-side Pickup: 10am - 7pm
3038 Hennepin Ave Minneapolis, MN
612-822-4611
The Complete Behavioral Health Billing Handbook: Mental Health, Substance Use Disorder, Telehealth, Parity Law, Prior Authorization, and Revenue Cycle

The Complete Behavioral Health Billing Handbook: Mental Health, Substance Use Disorder, Telehealth, Parity Law, Prior Authorization, and Revenue Cycle

Finch, Clive

Paperback

Medical ReferenceMental Health

Currently unavailable to order

ISBN13: 9798170897292
Publisher: Independently Published
Pages: 250
Weight: 0.75
Height: 0.53 Width: 6.00 Depth: 9.00
Language: English
Behavioral health practices see denial rates 20 to 30 percent higher than primary care. Not because their patients are sicker. Because the billing system is structurally harder. The carved-out managed behavioral health organization. The MHPAEA parity law that most billing teams have never used to appeal a denial. The time-based CPT codes where a single minute of documentation error downcodes the claim. The telehealth modifier combinations that are different for every payer. The prior authorization requirements that apply to psychotherapy but not to physical therapy - a discrepancy that may be illegal under federal parity law and that almost no one appeals. This handbook is the operational reference for the full behavioral health billing workforce: licensed clinical social workers, licensed marriage and family therapists, licensed mental health counselors, psychologists, psychiatric nurse practitioners, psychiatrists, and the billing teams who support them. What's Inside: 20 chapters covering every major behavioral health billing domain - from provider type Medicare coverage rules through CPT code selection, telehealth billing, prior authorization management, eligibility and MBHO carve-out verification, substance use disorder billing, psychiatric E/M and add-on codes, group practice supervision and incident-to rules, Collaborative Care Model billing, intensive outpatient and partial hospitalization, crisis services, denial management, documentation standards, credentialing, revenue cycle metrics, Medicare Advantage, ICD-10-CM diagnosis coding, and compliance program development. Complete CPT quick-reference for all behavioral health codes - diagnostic evaluation (90791/90792), time-based individual psychotherapy (90832/90834/90837) with exact minute thresholds, psychotherapy add-on codes for psychiatrists (90833/90836/90838), group therapy (90853), family therapy (90846/90847), interactive complexity (90785), and Collaborative Care Model codes (99492-99494). Medicare coverage for LMFTs and licensed mental health counselors - what changed in January 2024, how to enroll, and how to bill. Telehealth billing framework for 2026 - modifier 95, modifier 93, modifier FQ (audio-only), POS 10 vs. POS 02, payer-by-payer modifier matrix, the 2028 in-person visit requirement, and cross-state licensure rules for telehealth. MHPAEA parity appeals - how to identify a Non-Quantitative Treatment Limitation violation, how to cite the 2024 MHPAEA final rule, and how to request the payer's comparative analysis. Includes a complete parity appeal letter template. Prior authorization workflow - the authorization cycle, renewal triggers, medical necessity documentation, step therapy parity analysis, and authorization tracking template. 42 CFR Part 2 - the 2026 amendments (effective February 16, 2026), SUD billing compliance, and the difference between Part 2 and HIPAA for billing purposes. MBHO carve-out eligibility verification - how to identify carved-out behavioral health benefits, credential separately with MBHOs, and prevent the most common source of in-network denial in behavioral health. Case studies, applied billing scenarios, compliance calendar, credentialing checklist, denial reason code reference, and a complete behavioral health billing glossary. This handbook covers what the textbooks skip and the payer policies bury. It is written for practitioners and billing professionals who deal with behavioral health claims every day and need a single accurate reference that reflects how the system actually works in 2026. Not affiliated with or endorsed by CMS or AAPC.

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