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Billing and Coding

 
 

Billing Codes

MedFTs practice in a variety of settings, and it is important to know how to bill for services across these sites. Current Procedural Terminology or CPT codes are used by MedFTs and other mental health professionals to bill for their services. It is becoming more common to see behavioral health practitioners (MedFTs included) integrated within medical settings, particularly primary care. In response to this, different models of integrated or collaborative care and payment structures are increasing rapidly. Billing for Medical Family Therapy services will vary across states, so it is imperative that the MedFT check state statutes and with their organization’s coding and billing team to determine how to apply the codes outlined below. Each will require the documentation of specific elements to bill insurance. New codes are released nearly annually.

As of 2021, the following codes have been used for integrated care. See the full fact sheet here.

When determining the appropriate billing codes, it is important to consider location (state regulations), model practiced (CoCM, SBIRT, etc.), and billing provider and license (behavioral health provider or medical provider).

*Note that codes 90832, 90834, 90837, 90846, and 90847 are now appropriate for teletherapy/telemedicine.

Billing Practices

States, settings, and insurance companies will have different rules around how often a certain code can be billed. Below are some logistics to take into consideration. 

  • Proper documentation is key.

  • Know how frequently the insurance company will over the therapy visits.

  • Some insurance plans, especially state insurance (e.g. Medicaid) will expect a treatment plan.

  • A diagnostic assessment can be billed annually.

  • The first appointment does not have to be a diagnostic assessment.

  • Billing add-ons is done most successfully with proper documentation for the necessity to bill the add on.

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Integrated Care

Different payment structures are available when MedFTs are working in medical or healthcare facilities.  Four of the most common are:

  1. Fee-for-service

  2. Per Member/ Per Month (PMPM) billing

  3. Grants

  4. Incident-to-billing (specific to Medicare)

Other Possible Billing Codes

The following CPT codes are becoming more available to MedFTs. Please check with the state to determine whether it allows LMFTs to for bill these services. Most of these codes are intended for Medicaid and/or Medicare only and may be used differently based on the setting (e.g., Community Health Center (CHC) vs. Community Mental Health Center (CMHC) vs. Federally Qualified Health Center (FQHC)). A helpful resource is SAMHSA Center of Excellence for Integrated Health Solutions which offers information and training opportunities for integrated care, including billing practices.

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