Behavioral health provider billing

Billable behavioral health services are reimbursed fee-for-service. Standard Behavioral Health fees are listed on our Fee schedules page (login required).

In general, follow billing rules for all practitioners using a CMS-1500 claim form.

See CMS-1500 billing guidelines.

Practitioners must be credentialed by Priority Health in order for services to be covered as an in-network benefit.

Behavioral health practitioner credentialing requirements

These providers must be credentialed to bill Priority Health:

HMO/EPO/POS/PPO plans: MD/DO psychiatrists/addictionologists, licensed psychologists, LMSWs, LPCs and LLPs

Medicaid plans: MD/DO psychiatrists/addictionologists, licensed psychologists, LMSWs, LPCs and LLPs

Medicare Advantage plans: MDs/DOs, licensed psychologists and LMSWs

Limited license practitioners

LLMSWs, LLPCs and TLLPs cannot be credentialed. They cannot bill for out-of-network PPO or POS services.

Behavioral health services directly rendered by another practitioner

With the exceptions noted below, the field 24J (rendering provider) on the CMS-1500 claim form must show the individual NPI number of the practitioner who directly provides the service being billed. For example, a licensed psychologist cannot be shown as the rendering provider for services directly provided by a limited license psychologist (LLP) whom they are supervising.

Exceptions to the credentialing and supervision requirements

Exceptions to the credentialing and supervision/rendering provider billing rules are:

  • Psychotropic medication management services:
    Psychiatric advanced practice providers, e.g., CNS, NP, PA, directly providing these services, do not require credentialing by Priority Health. Bill with their supervising/collaborating psychiatrist as the rendering provider.
  • Psychological testing:
    When testing is directly provided by an LLP, bill with the supervising licensed psychologist as the rendering provider.
  • Organizational providers: See below

Organizational providers

Credentialing exception: When working in an accredited organization that is credentialed as an Organizational Provider by Priority Health, appropriately licensed behavioral health practitioners do not require individual credentialing by us.

Before a new provider who meets our criteria can see a Priority Health member (and before the organization bills us for that provider's services), you must notify us in writing that the provider has been added to your contract. 

We notify you when we have added the provider. Claims with dates of service before the notification date will deny.

Bill with their own individual NPI number as the rendering provider for any services they provide directly.

Contracted billable codes, outpatient mental health providers

+ = Services must be billed under a participating Master's-level clinician

Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
Evaluation and Management (E&M) codes X
90785 Psychotherapy, complex interactive X X X
90791 Psychiatric diagnostic evaluation X X X
90792 Psychiatric diagnostic evaluation w/medical services X
90832 Psychotherapy, patient and/or family, 30 min. X X X
90833 Psychotherapy, patient and/or family w/E&M, 30 min. X
90834 Psychotherapy, patient and/or family, 45 min. X X X
90836 Psychotherapy, patient and/or family w/ E&M, 45 min. X
90837 Psychotherapy, patient and/or family, 60 min. X X X
90838 Psychotherapy, patient and/or family w/E&M, 60 min. X
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
90839 Psychotherapy for crisis; first 60 min. X X X
90840 Psychotherapy for crisis; each additional 30 min. (list separately in addition to code for primary service) X X X
90845 Psychoanalysis X
90846 Family psychotherapy w/o patient X X X
90847 Family psychotherapy w/patient X X X
90849 Multiple family group psychotherapy X X X
90853 Group psychotherapy X X X
90863 Pharmacologic management w/psychotherapy X
90867 Transcranial magnetic stimulation, initial -TMS X
90868 Transcranial magnetic stimulation, subsequent treatment, delivery & management X
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
90869 Transcranial magnetic stimulation, redetemination motor threshold, delivery & management X
90870 Electroconvulsive therapy X
96101 Psychological testing, psychologist X
96102 Psychological testing, technician X
96103 Psychological testing, computer X
96150 Health & behavioral initial evaluation X X
96151 Health & behavioral re-assessment X X
96152 Health & behavioral intervention, individual X X
96153 Health & behavioral intervention, group X X
96154 Health & behavioral intervention, family and patient X X
96155 Health & behavioral intervention, family X X
Special credentialing is required to provide the services below:
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
H0031+ Mental health assessment, non-physician, autism X X
H0032+ Mental health service plan, non-physician, autism X X
H2014+ Skills training, 15 min., for autism  
H2019+ Therapy, behavioral health services, 15 min., for autism X X
S5108+ Supervision, 15 min., for autism   X
S5111+ Parent training, 15 min., for autism  
96116 Neurobehavioral status exam X
96118 Neuropsychological testing X
96119 Neuropsychological testing, technician X
96120 Neuropsycholgical testing, computer X