Mental Health Reimbursement Rates

Mental Health Reimbursement Rates: Complete Provider Guide

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QUICK REFERENCE: What Changes Reimbursement Each Year | Medicare Reimbursement | Rates by Payer | Factors that Influence Reimbursement | What Reimbursement Looks Like In Practice | Comparing What Insurance Companies Pay | Essential CPT Codes for Mental Health | 7 Strategies to Maximize Reimbursement | LMFT & LMHC Billing | Telehealth Reimbursement | Credentialing and Panel Management | Value-Based Care and Outcome Tracking | Common Billing Challenges | Tools and Technology to Optimize Reimbursement | FAQ | How Behave Health Helps Maximize Reimbursement

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Insurance reimbursement can make or break a mental health practice. Therapists, psychologists, social workers, and mental health clinics are paid under rules that change every year: Medicare updates its fee schedule annually, value-based arrangements are spreading, and commercial payers tie rates to contracts and network participation. Understanding how each payer sets what it pays, and how to optimize billing, is essential to maximizing practice revenue while maintaining access to care.

This guide explains how Medicare, Medicaid, and commercial insurers set what they pay for common mental health services, how to compare payers, how to negotiate better contracts, and how Behave Health’s EHR can help you track and maximize collections across all payers.

About rates in this guide: This guide explains how rates are set and does not list dollar amounts, which change every year. Medicare rates change annually with the Physician Fee Schedule; Medicaid rates vary by state; commercial rates are renegotiated periodically. For current figures, use the CMS Physician Fee Schedule lookup tool ↗, your state Medicaid fee schedule, and your payer contracts.

What Changes Mental Health Reimbursement Each Year

• The Medicare Physician Fee Schedule: CMS publishes a final rule each year that sets the conversion factor and the relative value units (RVUs) for every code. When the conversion factor or a code’s RVUs change, so does the Medicare amount for that code. Check the CMS Physician Fee Schedule ↗ each year.

• Who can bill Medicare: Since January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare independently, paid at 75% of what a clinical psychologist is paid under the Physician Fee Schedule (CMS ↗).

• Telehealth rules: Medicare’s telehealth rules for behavioral health are set by law and the annual fee schedule rule, and some of them have been changed by Congress several times. Commercial and Medicaid telehealth policies vary by plan and state.

• Innovation in Behavioral Health Model: On January 1, 2025, CMS issued IBH Model cooperative agreement awards to three state Medicaid agencies; its model page names Michigan, New York, and South Carolina as the participating states. The model begins with a multi-year pre-implementation period before care delivery begins. Participation does not establish a general enhanced reimbursement rate for every practice in those states. See the CMS model overview ↗ and IBH Model FAQ ↗.

• Credential-based rates: Many commercial plans pay different rates by credential for the same CPT codes, so check how each contract tiers credentials.

Medicare Reimbursement Rates for Mental Health

Medicare remains the most standardized payer for mental health services. Rates are published annually via the Physician Fee Schedule and adjusted by geographic locality.

How Medicare Sets Rates by CPT Code

Each CPT code’s Medicare amount is its RVUs, adjusted by your locality’s geographic practice cost indices, multiplied by the year’s conversion factor. Look up the current amount for each code in the CMS Physician Fee Schedule lookup tool ↗.

Important notes:

• Rates vary by locality. Medicare adjusts every amount by geographic cost indices, so the same code pays more in some areas than in others.

• Clinical social workers, marriage and family therapists, and mental health counselors billing independently are paid 75% of the clinical psychologist’s fee schedule amount.

• Medicare pays 80% of the allowed amount; the patient is responsible for 20% coinsurance after the Part B deductible (or secondary insurance may cover it).

• The fee schedule lists a non-facility (office) amount and a facility amount for each code. For a professional service, the facility amount is generally lower, because the facility bills its own costs separately.

Commercial and Medicaid Reimbursement by Payer

Commercial insurance often pays more than Medicare, but varies by region, plan, and credential. Medicaid, by contrast, pays less than Medicare on average but is essential for patient access.

Commercial Payers

Commercial rates are set by contract. Many contracts express rates as a percentage of the Medicare fee schedule, and that percentage varies by market, plan, credential and your negotiating position. Under the federal Transparency in Coverage rules, most group health plans and insurers publish machine-readable files of their in-network negotiated rates (CMS health plan price transparency ↗), which you can use to compare payers in your market.

Medicaid Reimbursement for Mental Health

Medicaid is a major payer for mental health services in the U.S., covering millions of adults with behavioral health conditions. Its fees are set by each state and vary widely.

Key facts:

• Average Medicaid fees are lower than Medicare’s: KFF’s Medicaid-to-Medicare Fee Index ↗ compares each state’s Medicaid physician fees with Medicare’s.

• State variation is wide: a Health Affairs study ↗ compared Medicaid fee schedules for psychiatric services across states and with Medicare. Some states raise behavioral health rates while others leave them unchanged for years, so check your state’s current fee schedule.

• Managed care dominance: Most states use Medicaid managed care organizations (MCOs) for behavioral health, which may negotiate above or below the state fee schedule.

Why Medicaid matters despite lower rates:

• Covers uninsured and low-income individuals who have no other insurance options.

• Often required to accept as in-network provider in certain state regions.

• Volume can offset lower per-session rates in high-capacity practices.

Factors That Influence Your Mental Health Reimbursement Rate

Understanding what drives your reimbursement helps you negotiate better contracts and position your practice strategically.

Provider Credentials Medicare pays physicians and clinical psychologists the full fee schedule amount, and pays independently billing clinical social workers, marriage and family therapists, and mental health counselors 75% of the clinical psychologist amount. Many commercial plans also pay by credential tier.

Service Type The fee schedule assigns different RVUs to each code, so psychiatric evaluations, psychological testing, and psychotherapy codes pay different amounts. Check the amount for each code you bill.

Geographic Location Medicare explicitly adjusts rates by locality; commercial plans often do too.

Network Status (In-Network vs. Out-of-Network) In-network providers have negotiated (often lower) rates but benefit from patient volume and direct payer payment. Out-of-network providers may cite higher chargemaster rates but face greater patient responsibility and billing challenges ↗.

Insurance Plan Type HMO, PPO, and EPO products can carry different networks, authorization rules and fee schedules, even from the same insurer.

What Medicare Reimbursement Looks Like in Practice

For a clinical social worker billing independently under the CSW benefit, the payment basis is 75% of the Physician Fee Schedule (PFS) amount for a clinical psychologist. The provider-type adjustment determines the allowed amount before the usual Part B payment and coinsurance split. Confirm the service date, code, locality, setting, and enrollment details before estimating payment.

The following is an illustration of the arithmetic, not a published rate for CPT 90837:

• Assumed clinical-psychologist PFS amount: $100.00, with an actual charge high enough not to limit the allowed amount.
• CSW allowed amount: $100.00 × 75% = $75.00.
• Medicare’s 80% share: $75.00 × 80% = $60.00, assuming the Part B deductible is met and before other payment adjustments.
• Remaining 20% coinsurance: $75.00 × 20% = $15.00. Supplemental coverage or other rules may affect what the patient owes.

Use the current CMS fee schedule and the claim’s provider and setting details for an actual estimate. Medicare Advantage, facility billing, and incident-to arrangements require their own review.

Sources: CMS Medicare & Mental Health Coverage booklet (PDF) ↗ and Medicare outpatient mental health coverage and costs ↗.

How to Compare What Insurance Companies Pay

No public ranking says which insurer pays the most for mental health: rates are set contract by contract and vary by region, plan, credential and code. To compare the payers in your market:

1. Express each contracted rate as a percentage of Medicare for the same code in your locality.

2. Check the in-network rate files health plans publish under the federal price transparency rules.

3. Weigh volume and administrative cost, not just the rate: authorization rules, denial rates and payment speed change what you actually collect.

Negotiation strategy: If you’re in-network with a low-paying plan but see high volume from that plan, use that volume as leverage to negotiate higher rates, or consider dropping the plan if it significantly underperforms.

Essential CPT Codes for Mental Health Providers

Using the right CPT code is critical for accurate reimbursement. Here are the codes you’ll use most frequently. For each code’s current Medicare amount, use the CMS Physician Fee Schedule lookup tool ↗.

Initial Assessment Codes

• 90791 – Psychiatric diagnostic evaluation (without medical services): Used once per episode of care; includes comprehensive history, mental status exam, and treatment plan.

• 90792 – Psychiatric diagnostic evaluation with medical services (e.g., if an MD does the evaluation): Higher reimbursement than 90791.

Individual Psychotherapy Codes (Most Common)

• 90832 – 30 minutes: Use for brief sessions or short interventions.

• 90834 – 45 minutes: Standard session length.

• 90837 – 60 minutes: Extended sessions for complex cases.

Important: Bill the code that matches your actual session length. Billing 90837 for a 50-minute session is upcoding and risks audits and recoupment.*

Group and Family Codes

• 90853 – Group psychotherapy: One code per patient per session, regardless of group size. Pays less per patient than individual therapy.

• 90847 – Family psychotherapy with patient present: Use when family members attend and the focus is the patient’s treatment.

• 90846 – Family psychotherapy without patient present: Medicare covers this code. Coverage and payer rules vary; verify with your payer before billing.

Specialized/Advanced Codes

• 96130 – Psychological testing/evaluation, first hour: Neuropsych testing, psychodiagnostic testing.

• 96131 – Psychological testing, each additional hour: Add-on code; bill for each hour beyond the first.

• 90839 + 90840 – Psychotherapy for crisis: For urgent, high-complexity sessions. 90839 is the first 60 minutes; 90840 is each additional 30 minutes. Only use for true psychiatric crises.

Add-On Codes (Used with Other Services)

• 90833, 90836, 90838 – Can be added to evaluation codes or other services to capture psychotherapy time in integrated care settings.

Billing Tips:

• Choose the code that matches your actual session length. If a session runs 50 minutes, 90834 (45 min) is more defensible than 90837 (60 min).

• Do not bill multiple psychotherapy codes for the same patient on the same day to the same payer, as it may trigger denial for duplicate billing.

• Different payers may have different requirements for which code to use; verify payer guidelines before billing.

How to Maximize Reimbursement: 7 Strategies

1. Benchmark Your Current Rates Against Medicare

Compare what each payer is actually paying you, code by code, with the Medicare amount for your locality. A payer whose rates are a much lower percentage of Medicare than your other payers is a candidate for renegotiation, especially if you see high volume from that plan.

2. Prioritize In-Network Status with Your Best-Paying Payers

Use your benchmark to find the payers in your market that pay best relative to Medicare. Higher per-session rates often offset the work of in-network credentialing.

3. Use Credential Differentials to Your Advantage

If you hold a PhD, PsyD, or MD, ensure your contracts explicitly recognize this and pay the higher tier. If you’re master’s-level, consider whether additional certifications or specialization (e.g., in trauma, substance abuse, couples therapy) can justify higher rates.

4. Optimize Your Insurance Panel Composition

Analyze your payer mix quarterly. If a large share of your patients are on your lowest-paying plans, consider working to shift the mix by accepting more patients from better-paying plans. (This is a business decision, not a clinical one; always ensure you’re meeting community needs.)

5. Leverage Outcome Data in Negotiations

Some commercial payers offer bonuses or enhanced rates for providers who can demonstrate good outcomes on standardized measures (PHQ-9, GAD-7, functional assessment scales). Start tracking these metrics if you’re not already.

6. Implement Precise Documentation and Billing

• Bill the CPT code that matches your exact session length (no upcoding).

• Ensure all documentation is thorough and supports medical necessity (especially for mental health diagnoses that insurers may scrutinize).

• Follow each payer’s billing guidelines exactly to avoid denials and recoupment.

7. Track Denials and Underpayments Systematically

Use billing software or an EHR with denial tracking to identify patterns. If you’re consistently underpaid for a particular code by one payer, escalate it. Many underpayments are due to billing errors—fixing them can materially improve net revenue.

LMFT and LMHC Medicare Billing

Since January 1, 2024, Licensed Marriage and Family Therapists (LMFTs) and Licensed Mental Health Counselors (LMHCs) can bill Medicare independently.

What this means:

• LMFTs and LMHCs can enroll in Medicare directly and bill for services for the diagnosis and treatment of mental illness.

• Medicare Part B pays them 75% of what a clinical psychologist is paid under the Physician Fee Schedule for the same CPT codes.

• For example, if the clinical psychologist amount for a code in your locality is $100.00, the LMFT/LMHC amount is $75.00 (an illustration of the arithmetic, not a published rate).

Eligibility requirements:

• Must be licensed as an LMFT or LMHC in your state.

• Individual states have different licensing standards; verify yours meets Medicare’s criteria.

• Enrollment process is similar to other providers: apply through PECOS (Provider Enrollment, Chain, and Ownership System).

This is an opportunity for:

• Independent LMFT/LMHC practices wanting to accept Medicare directly

• Couples and family therapy specialists

• Expanding the mental health workforce for Medicare beneficiaries

For detailed enrollment and payment information, see CMS’s guidance ↗ on LMFT/LMHC billing.

Telehealth Reimbursement

Telehealth for mental health services is part of standard practice, but payment rules differ by payer and can change.

Medicare:

• Medicare’s telehealth rules for mental and behavioral health services are set by law and the annual Physician Fee Schedule rule, and Congress has changed some of them several times.

• Check CMS’s telehealth page ↗ and its current FAQ for the rules on your date of service, including the place-of-service code, any telehealth modifier, and any in-person visit requirement.

Commercial Insurance:

• Telehealth payment and authorization rules vary by plan: some plans pay telehealth and in-person sessions at the same rate, while others pay less or require prior authorization. Verify with each payer.

Medicaid:

• Varies by state. Some services must be delivered in person in some states.

• Check your state Medicaid’s telehealth policies.

Practical tips:

• Use the place-of-service code and modifier each payer requires for telehealth, so the claim is paid at the right rate.

• Maintain documentation that the session was delivered via telehealth (required for audits).

• Ensure your telehealth platform is HIPAA-compliant and secure.

Credentialing and Panel Management: Getting In-Network

Being in-network with commercial insurance is often worth a lower per-session rate, given the increase in patient volume and simplified billing. Here’s how to approach credentialing.

Steps to Credential with a New Insurance Plan

1. Research: Identify plans you want to join based on patient demographics, reimbursement rates, and market demand.

2. Prepare: Gather required documents (license, malpractice insurance, DEA if applicable, CV, references).

3. Apply: Submit application through the payer’s online credentialing portal or via phone.

4. Follow up: Check status regularly; credentialing can take months.

5. Negotiate: Once credentialed, review the contract carefully. Your Medicare benchmark and your rates with other payers give you leverage to negotiate higher fees.

How to Negotiate Better Rates When Credentialing

• Use volume as leverage: “I’m seeing 15+ patients per week. Can you match [competitor payer rate]?”

• Highlight credentials: “I hold a PhD and board certification in [specialty]. What’s your PhD tier rate?”

• Reference market data: Share your rates as a percentage of Medicare, or your own contracted rates with other payers.

• Consider a trial period: Offer to accept a slightly lower rate for 6–12 months if metrics are met, then renegotiate upward.

When to Drop a Low-Paying Plan

If a payer consistently pays a low percentage of Medicare for your core codes and provides a small share of your patient volume, the administrative overhead may not justify continued participation. Periodically audit your panel to optimize reimbursement.

Value-Based Care and Outcome Tracking: The Future of Mental Health Reimbursement

Value-based care—where providers are reimbursed based on patient outcomes rather than volume of services—is growing in behavioral health. It can affect your practice in several ways.

CMS Innovation in Behavioral Health Model

On January 1, 2025, CMS issued IBH Model cooperative agreement awards to three state Medicaid agencies, and its model page names Michigan, New York, and South Carolina as the participating states. The model supports state-led integration of behavioral, physical, and social care.

The model begins with a multi-year pre-implementation period, followed by a care-delivery implementation period. Practices may enroll and receive Medicaid infrastructure funding during pre-implementation at the state’s discretion. That is different from assuming that all participating practices receive enhanced payment for care-delivery services.

Check CMS and the participating state Medicaid agency for the model’s timeline, practice eligibility, enrollment, payment methodology, and later-cohort announcements. Do not assume a universal reimbursement increase for providers in a participating state; verify the applicable payment methodology.

Sources: CMS IBH Model overview ↗ and IBH Model Frequently Asked Questions ↗.

Collaborative Care Model (CPT 99492–99494)

Medicare and many commercial payers pay for collaborative care—where a mental health care manager and a psychiatric consultant work with primary care to treat behavioral health in a primary care setting—under CPT 99492–99494. Check each payer’s coverage and the codes’ requirements before you build a program.

Who should participate:

• Practices that can integrate with primary care providers

• Clinicians comfortable using standardized outcome measures

• Providers with the infrastructure to coordinate care remotely

Private Payer Outcome-Based Bonuses

Some commercial payers offer outcome-based contracts, where providers earn bonuses for meeting quality thresholds on PHQ-9/GAD-7 improvement, engagement metrics, or follow-up completion rates. Ask your payers whether they offer one.

To prepare for value-based care:

• Start tracking standardized outcome measures (PHQ-9 for depression, GAD-7 for anxiety) at intake and regularly throughout treatment.

• Document progress toward treatment goals.

• Ensure your EHR can generate outcome reports on demand.

• If you see Medicare beneficiaries, review how the Quality Payment Program (MIPS or an Alternative Payment Model) applies to your practice.

Common Billing Challenges and How to Avoid Them

Challenge 1: Claim Denials Due to Incorrect Coding

Why it happens: Billing the wrong CPT code (e.g., 90837 for a 50-minute session), missing modifiers, or using outdated codes.

How to prevent it:

• Document actual session length and match the CPT code to that length.

• Use the modifiers each payer requires (e.g., for telehealth).

• Stay updated on annual CPT code changes.

• Have a billing staff member or software verify codes before submission.

Challenge 2: Underpayment for Services

Why it happens: Payer is paying below contract rate, or you don’t know what the contract rate actually is.

How to prevent it:

• Keep a spreadsheet of your contracted rates with each payer for each CPT code.

• Compare actual payments to contract rate monthly.

• Set up alerts in your billing software if payment falls below expected amount.

• Appeal underpayments; many are due to billing system errors.

Challenge 3: Prior Authorization Denials

Why it happens: Some payers require prior authorization for ongoing therapy; running out of authorized visits without requesting an extension.

How to prevent it:

• Check each payer’s prior authorization requirements upfront.

• Track authorization windows and request extensions 1–2 weeks before expiration.

• Use an EHR or billing software that flags upcoming authorization expirations.

Challenge 4: Telehealth Rate Issues

Why it happens: Billing telehealth with the wrong place-of-service code or modifier for that payer, or forgetting the telehealth modifier.

How to prevent it:

• Apply the telehealth modifier and place-of-service code each payer requires to every telehealth claim.

• Verify each payer’s telehealth reimbursement policy before you bill.

• Document that the session was delivered via telehealth in your notes.

Challenge 5: Group Therapy Coding Errors

Why it happens: Billing group codes incorrectly (e.g., billing multiple group codes for one patient in one group session, or billing group therapy when it was educational).

How to prevent it:

• Bill one CPT code per patient per group session, not multiple codes for the same session.

• Use 90853 (group psychotherapy) only for therapeutic group interventions, not for psychoeducation or support groups.

• Ensure documentation clearly describes the therapeutic group focus.

Tools and Technology to Optimize Reimbursement

An EHR or practice management system designed for mental health billing can materially improve your reimbursement outcomes. Key features to look for:

Billing and Claims:

• Automated claims submission with built-in compliance checks (correct codes, modifiers, payer requirements)

• Real-time eligibility verification

• Claim status tracking and denial management

Rate Management:

• Contract rate storage and comparison across payers

• Automated alerts for underpayment vs. contract rate

• Reporting on average allowed amounts by code and payer

Authorization Tracking:

• Authorization window tracking with renewal alerts

• Prior authorization request templates pre-populated by payer rules

• Concurrent review management for ongoing care

Documentation and Coding:

• CPT code libraries with payer-specific rules and billing guidance

• Outcome tracking tools (PHQ-9, GAD-7, etc.) integrated into notes

• Session length auto-calculation to suggest correct CPT code

Reporting:

• Payer mix analysis (what % of revenue comes from each payer)

• Revenue by code, diagnosis, and provider

• Trends in denial reasons and rates

Behave Health EHR includes these features, helping behavioral health providers streamline billing, track rates across payers, and catch underpayments before they cost you revenue.

FAQ: Mental Health Reimbursement

• What is the Medicare reimbursement rate for CPT 90837?

  Medicare sets the amount each year in the Physician Fee Schedule. It varies by locality, place of service, and provider type. Look up the current amount for your locality with the CMS Physician Fee Schedule lookup tool ↗.

• Which insurance companies pay the most for mental health therapy?

  There is no single answer: commercial rates are set by contract and vary by region, plan, credential and code. Compare each payer’s contracted rates as a percentage of Medicare for your locality, and check the in-network rate files health plans publish under federal price transparency rules.

• Can LMFTs and LMHCs bill Medicare?

  Yes. Licensed Marriage and Family Therapists and Licensed Mental Health Counselors have been able to enroll as independent Medicare providers since January 1, 2024. Medicare Part B pays them 75% of what a clinical psychologist is paid under the Physician Fee Schedule. Eligibility and enrollment details are available on CMS’s website.

• How much does Medicaid pay for mental health therapy compared to Medicare?

  Medicaid fees are set by each state and average below Medicare’s, with wide variation by state (KFF Medicaid-to-Medicare Fee Index ↗). Medicaid managed care plans may negotiate above or below the state fee schedule. Check your state Medicaid fee schedule for current amounts.

• Are telehealth therapy sessions reimbursed at the same rate as in-person sessions?

  It depends on the payer and the date of service. Medicare’s telehealth rules for mental health are set by law and the annual fee schedule rule, and Congress has changed some of them several times; check CMS’s telehealth page ↗. Commercial plans and state Medicaid programs set their own telehealth payment and authorization rules, so verify with the specific plan and apply the place-of-service code and modifier it requires.

• What’s the average reimbursement for a 45-minute therapy session (90834)?

  For Medicare, look up the current amount for your locality with the CMS Physician Fee Schedule lookup tool. Commercial insurance varies widely depending on payer and market, and Medicaid fees are set by each state.

• How do I know if I’m being underpaid by my insurance panels?

  Compare your actual payments to your contracted rates. Use a billing tool or EHR with rate tracking and underpayment alerts. Create a spreadsheet of your contracted 90837 rate with each payer, and flag any payment below that amount. Many underpayments are due to system errors and can be appealed.

• Should I stay in-network or go out-of-network for mental health insurance?

  This depends on your goals and market. In-network providers trade higher rates for patient volume and streamlined billing. Out-of-network providers may cite higher chargemaster rates but face greater patient responsibility and administrative burden. Many practices maintain a mix: in-network with their best-paying payers and selectively out-of-network. Analyze your payer mix and revenue quarterly to inform this decision.

How Behave EHR Helps You Maximize Mental Health Reimbursement

Navigating Medicare, Medicaid, and commercial insurance rates while ensuring accurate coding and avoiding denials is time-consuming. An EHR built for behavioral health can automate much of this work and help you capture more revenue.

Behave EHR helps you:

• Automate code selection: Built-in CPT code libraries apply the correct code based on session length, automatically flagging upcoding risks.

• Track contracted rates: Store your rates with each payer by CPT code, and compare actual payments against contract in real-time.

• Catch underpayments: Automated alerts flag payments below your contract rate, so you can appeal before the window closes.

• Manage authorizations: Track prior authorization windows and send renewal requests automatically when expiration approaches.

• Reduce denials: Pre-claim compliance checks verify that all required information (codes, modifiers, documentation) is present before submission.

• Monitor payer performance: Dashboards show your revenue mix by payer, denial rates by reason, and average allowed amounts by code.

• Track outcomes: Integrated PHQ-9, GAD-7, and custom outcome measures help you prepare for value-based contracting and demonstrate quality to payers.

With Behave EHR, you spend less time on billing administration and more time on patient care—while maximizing the reimbursement you’ve already earned.

Request a 15-minute demo to see Behave EHR in action →

Conclusion

Mental health reimbursement is complex, but the rules behind it are published. By understanding how each payer sets what it pays, tracking your rates systematically, and implementing best practices in coding and documentation, you can materially improve your practice’s financial sustainability while maintaining access to care for uninsured and underinsured patients.

Key takeaways:

• Medicare rates change every year with the Physician Fee Schedule; look up current amounts for your locality with the CMS lookup tool.

• LMFT and LMHC Medicare billing opens opportunities for independent practitioners (75% of the clinical psychologist amount).

• Commercial insurance varies widely; benchmark each contract against Medicare and negotiate.

• Medicaid remains essential despite lower average fees; prioritize accurate billing to maximize collections.

• Value-based care is growing; start tracking outcomes now to position yourself for outcome-based contracts.

• Telehealth rules differ by payer; check each payer’s policy and apply the place-of-service code and modifier it requires.

• Systematic rate tracking and denial management can recover lost revenue.

Mental health reimbursement will keep changing. Monitor your payer mix and rates quarterly, and invest in tools and training that help your team maximize revenue while maintaining compliance. Your patients—and your bottom line—will thank you.