When it comes to getting your clients reimbursed for therapy sessions, a well-prepared superbill is essential. Accurate coding not only ensures your clients’ superbills get processed promptly but also minimizes the chances of rejection from insurance companies. This article will guide you through different ways to code your superbill effectively, as well as highlight three common mistakes to avoid.

Understanding Superbill Basics

A superbill is a detailed receipt provided by therapists to their clients, which the client can submit to their insurance company for reimbursement. It typically includes:

• Provider’s information
• Client’s information
• Description of services rendered
• CPT codes (Current Procedural Terminology)
• ICD-10 codes (International Classification of Diseases)
• Session dates and costs

Types of Coding for Superbills

1. CPT Codes

CPT codes are an essential component of superbills. They describe the services provided during therapy sessions. Here are some commonly used CPT codes for mental / behavioral health therapy:

• 90834: 45-minute individual therapy session
• 90837: 60-minute individual therapy session
• 90846: Family therapy without the client present
• 90847: Family therapy with the client present
• Curious about how to bill for extended sessions?

Accurately selecting the appropriate CPT code for each session ensures that insurance companies understand the services rendered, improving the chances of reimbursement.

2. ICD-10 Codes

ICD-10 codes are used to indicate the diagnosis of the client. Accurate diagnosis coding is crucial because it justifies the medical necessity of the therapy sessions. Some common ICD-10 codes in mental health include:

• F32.0: Major depressive disorder, single episode, mild
• F41.1: Generalized anxiety disorder
• F43.10: Post-traumatic stress disorder, unspecified

Using precise ICD-10 codes that reflect the client’s condition can significantly enhance the approval process.

3. Modifiers

Modifiers provide additional information about the services provided and can influence the reimbursement process. Common modifiers in therapy sessions include:

• GT: Indicates services delivered via telehealth
• 95: Also used for telehealth services, often interchangeable with GT depending on the insurance company
• 59: Distinct procedural service

Applying appropriate modifiers can ensure clarity in the services provided and help in getting the claim processed smoothly.

Tips for Successful Superbill Submission

1. Double-Check client and Provider Information: Ensure that all personal details are accurate and up to date.
2. Itemize Each Session: List each therapy session separately with corresponding dates, CPT codes, ICD-10 codes, and costs.
3. Include Provider’s Credentials: Make sure the provider’s license number, NPI (National Provider Identifier), and contact information are included.

3 Mistakes to Avoid

1. Incorrect or Missing Codes

Using incorrect CPT or ICD-10 codes or omitting necessary modifiers can lead to claim denial. Always verify codes against the latest coding manuals and databases. 

2. Missing the Timely Filing Limit

Many insurance companies uphold a timely filing limit of 180 days after the date of service, also called the session date. If superbills are submitted after the timely filing limit, they will likely be rejected.

Ensure your clients understand that if they sit on their superbills for too long, they are at risk of losing out on their reimbursement.

3. Ignoring Payer-Specific Requirements

Different insurance companies may have specific requirements for superbill submissions. Failing to adhere to these requirements can result in delays or denials. Familiarize yourself with the guidelines of each payer to avoid common pitfalls.

Let Mentaya Handle Your Superbills

Mentaya offers a comprehensive suite of tools designed to simplify and expedite the billing process for therapists. We understand that creating superbills can be time-consuming and complex. If handling superbills on your own seems daunting, consider letting Mentaya manage the process for you.

Benefits of Using Mentaya for Superbill Submission:

• Effortless Superbill Creation & Submission: Our user-friendly platform allows you to create and submit superbills in a matter of seconds.
• Expert Claim Management: Our team of insurance experts will ensure your clients’ claims are submitted accurately and followed up on to guarantee successful processing.
• Focus on Client Care: By eliminating the burden of billing tasks, Mentaya empowers you to focus on providing quality care to your clients.
• Risk-Free Guarantee: We offer a risk-free guarantee for claim submissions. If a claim is not successfully processed, we provide a full refund of our processing fees.

Mentaya ensures peace of mind, allowing you to get back to what matters most – your clients.

Conclusion

Creating a precise and detailed superbill is crucial for the successful processing of therapy session reimbursements. By using accurate CPT and ICD-10 codes, appropriate modifiers, and avoiding common mistakes, you can streamline the reimbursement process and ensure timely payments. Stay informed about the latest coding updates and payer requirements to maintain a smooth billing process for your therapy practice.

Consider leveraging a platform like Mentaya to further optimize your billing workflow, automate the superbill process, and free up valuable time to focus on your clients.