How to Bill Insurance as a Therapist: A Step-by-Step Guide

To bill insurance as a therapist: verify the patient’s mental health benefits before the first session, document each session with its start and stop time, code it with a CPT code (such as 90834) and an ICD-10 diagnosis, and send the claim electronically on the CMS-1500 (837P) through your EHR or a clearinghouse. Then post the payment, bill the patient their share, and work any denial quickly, before the payer’s filing deadline runs out.

This is the full cycle most therapy practices run for every session. Each step below includes the mistake that most often costs therapists money at that step.

Step 1: Verify benefits before the first session

Call the payer or check the payer portal, and record:

• Whether you are in-network for this patient’s specific plan
• Who administers the mental health benefit. Many plans hand it to a separate behavioral health company with its own phone number, claims address and rules.
• Copay or coinsurance, and how much of the deductible is left
• Whether prior authorization is needed, and any visit limits
• Whether telehealth is covered, if you see the patient by video

The mistake: checking the medical benefit instead of the behavioral health benefit. The answer can be completely different.

Step 2: Collect the right patient information

A copy of the insurance card (front and back), the subscriber’s name and date of birth if the patient is a dependent, and a signed financial policy that explains what the patient owes.

Step 3: Document the session

Each note should show the start and stop time, the type of therapy provided, what was addressed and the patient’s response. For telehealth, note that it was by video or phone and where the patient was.

The mistake: notes without times. The time is what supports the CPT code.

Step 4: Code the session

What you did	Common CPT code
Intake / diagnostic evaluation	90791
Individual psychotherapy, 16 to 37 min	90832
Individual psychotherapy, 38 to 52 min	90834
Individual psychotherapy, 53+ min	90837
Family therapy with / without patient	90847 / 90846
Group therapy	90853

Add an ICD-10 diagnosis code (mental health diagnoses are F-codes, such as F41.1 for generalized anxiety disorder) that matches your assessment. For the time rules and common add-ons, see 90837 vs 90834 vs 90832.

Step 5: Submit the claim

Send it electronically on the 837P (the electronic CMS-1500) through your EHR or clearinghouse. Check these fields, because they cause most rejections:

• Rendering NPI (you) and billing NPI (you, or your group)
• Taxonomy code that matches how you are credentialed
• Place of service: 11 for the office, 10 or 02 for telehealth (see our telehealth billing guide)
• Modifiers the payer requires, such as 95 for video visits
• Patient and subscriber details exactly as they appear on the card

A rejection from the clearinghouse means the claim never reached the payer. Fix and resend it the same day.

Step 6: Post the payment and bill the patient

The payer sends an ERA (electronic remittance advice) showing what it paid and why. Post the payment against the claim, write off the contractual adjustment, and bill the patient only the amount the ERA lists as patient responsibility (copay, coinsurance or deductible).

Step 7: Work denials fast

Every payer has a timely filing limit for original claims and a shorter or separate limit for appeals and corrected claims. Medicare allows 12 months from the date of service; commercial and Medicaid plans are often much shorter. A denial that sits in a pile can become money you can never collect.

Common therapy denial	Usual cause
Provider out of network	Credentialed with the medical plan, not the behavioral health network, or no effective date yet
Eligibility / coverage terminated	Benefits not re-checked when the plan changed
Missing or invalid information	Wrong subscriber ID, date of birth or taxonomy
Authorization required	Visit limit reached, or authorization never obtained
Service not covered for this place of service	Telehealth POS or modifier wrong for this payer

Our guide to claim denial reasons covers denials in more depth.

Doing it yourself vs. outsourcing

Solo therapists with one or two payers often bill themselves. It becomes harder with more payers, a group, or a growing stack of old unpaid claims. Our billing for therapists service handles every step above, with claims sent within 24 hours and every denial worked within 5 business days, from 2.5% of collections.

Frequently asked questions