Billing for Mental Health Services: A Therapist’s Guide

• Each insurance session becomes a claim with a CPT code for the service and an ICD-10 code for the diagnosis. Medicare’s 2026 national rate for a 60-minute session (90837) is $167.00 for a psychologist and $125.25 for a master’s-level clinician, who is paid 75%.¹
• You can bill yourself in an EHR (SimplePractice has charged $0.39 per claim since October 1, 2026), hire a billing company that takes 4 to 10% of collections, or join a platform that bills for you.¹
• Alma bills insurance for its members for $95 a month billed yearly or $125 monthly, credentials you under its own tax ID and pays weekly. It doesn’t publish what it keeps from each insurance payment.

Billing insurance as a therapist includes two components: getting into the payer’s network, called credentialing, and the actual billing of services by sending claims to the insurer and receiving a remittance that shows what was paid and why. Both jobs can be done by the therapist through an EHR or by a third party. Alma, for example, is a membership platform that can perform both.

See how Alma handles insurance billing for therapists

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How billing for mental health services works

Billing for mental health services starts once you’re in network. Credentialing gets you a contract with a payer, and billing, which involves checking benefits, sending the claim, posting the payment, and collecting the client’s share for each session. Our guide to insurance credentialing for therapists covers the first step, which clinicians report typically takes three to five months per commercial panel.

Medical billing for mental health uses the standard professional claim: the CMS-1500 on paper or the 837 transaction electronically. It carries the CPT code, the ICD-10 diagnosis, the place of service and your individual (Type 1) NPI as the rendering provider.

Therapist billing codes and their 2026 Medicare rates

There are six billing, or CPT, codes that are common for therapists to use. The table shows these with Medicare’s 2026 national amounts for an office session or telehealth to a client at home, before adjustment for your area. Medicare pays clinical social workers, marriage and family therapists and mental health counselors 75% of the psychologist amount.¹

Non-facility amounts at the non-QPP conversion factor, from the CMS file released August 26, 2026. Commercial rates are set by each contract.

Sessions under 16 minutes aren’t billable, and Medicare wants start and stop times or total time documented. Family therapy without the client (90846) has restricted Medicare coverage in 2026. Our guide to CPT codes for psychotherapy explains when to use each code.

Pairing the code with an ICD-10 diagnosis

Every claim needs a diagnosis, coded as specifically as the record allows, such as F41.1 for generalized anxiety disorder or F33.1 for recurrent moderate depression. A suspected diagnosis or a “rule out” stays off an outpatient claim until it’s confirmed. The code set updates every October 1, and DSM-5 wording doesn’t always match the ICD-10 descriptor.

Telehealth: POS 02, POS 10 and modifiers

Telehealth claims use POS 10 when the client is at home and POS 02 when they’re elsewhere, and Medicare has paid home telehealth at the non-facility rate since January 1, 2024.² CMS’s claims manual says to pair the POS code with modifier 95 for video or 93 for audio-only, neither of which changes the rate.³ Its December 2025 telehealth booklet asks for just the POS code on a standard professional claim, so ask your Medicare contractor which it wants.⁴ UnitedHealthcare’s 2026 guide doesn’t require a telehealth modifier on its Individual Exchange plans and accepts one as informational, while behavioral health claims follow Optum’s telemental health policy.⁵

Sending claims through a clearinghouse

A clearinghouse sends electronic claims from your software to the payer and receives the responses back using the 837 claim, 270 and 271 eligibility checks, 276 and 277 status checks, and the 835 electronic remittance advice (ERA), the electronic form of the explanation of benefits (EOB).⁵ Enrolling in ERA with each payer lets payments post to sessions automatically, simplifying the billing process.

Insurance claims can take up to 45 days to process. One major insurer, UnitedHealthcare, decides most claims within 15 days. It is important to not resend a claim that shows as in process to avoid billing errors.⁵ SimplePractice and TherapyNotes build in the clearinghouse connection, and many self-billers use Availity, a free multi-payer portal.

Superbills and out-of-network tools

A superbill lists the CPT and diagnosis codes so a client can claim out-of-network reimbursement; our superbill guide covers the client’s side. Alma and SimplePractice both generate them. Thrizer handles out-of-network payments and reimbursement for clients, with no monthly fee on its Basic plan and 3% on online card payments, and Mentaya is free for therapists.

Denials and filing deadlines

A denial’s reason appears on the ERA or EOB as a claim adjustment reason code. Code 16 means missing information or a billing error, 27 means coverage had ended, 29 means the filing deadline passed, 50 means the payer judged the service not medically necessary, and 197 means a required authorization was missing.

Aetna applies a 180-day standard for provider disputes, with longer state exceptions for fully insured plans.⁶ UnitedHealthcare allows 12 months from the original decision, and a rejected claim doesn’t prove you filed on time.⁵ First-claim deadlines, counted from the date of service, vary more:

• Medicare: one calendar year.⁷
• Medicaid: 12 months under federal rules.⁸
• Cigna: 90 days in network, 180 days out of network.⁹
• UnitedHealthcare: set by your participation agreement.⁵
• Aetna: check your contract, since we found no current national window.
• Alma members: 30 days, Alma’s own rule.

Medicare, Medicaid and good faith estimates

Medicare’s billing rules and Medicaid’s filing and payment deadlines are set in federal regulation, and the No Surprises Act requires a good faith estimate for clients who pay out of pocket.

Medicare and Medicaid

Marriage and family therapists and mental health counselors have been able to enroll in Medicare and bill it since January 1, 2024. They must accept assignment and are paid 75% of the psychologist rate.¹⁰ Opting out instead is a formal two-year status that needs an affidavit and a private contract with each Medicare client.

Federal rules give Medicaid claims 12 months, and states must pay 90% of clean claims within 30 days.⁸ Enrollment and authorization rules vary by state. Alma’s help center lists Medicare and Medicaid plans as not accepted, while Headway takes select Medicare Advantage and Medicaid managed care plans.

Good faith estimates

Uninsured and self-pay clients must receive a good faith estimate when they book a service or inquire into the cost of services.¹¹ A session booked 3 to 9 business days out needs one within one business day, and one booked 10 or more business days out, or at client’s request, needs one within three business days. One estimate can cover up to 12 months of weekly sessions. It lists your NPI and tax ID, and a client can dispute a bill at least $400 over it within 120 days.¹²

What do mental health billing companies charge?

Mental health billing companies charge 4 to 10% of collections, and most practices pay 5 to 7%, according to a 2026 pricing guide from Carepatron, which sells billing.¹ Two companies publish their prices:

• TheraThink charges 6.5 to 8% of the allowed amount, with no setup or per-claim fees and free eligibility checks.
• Carepatron charges $99 per provider a month ($79 billed yearly) plus 3.9% of collections, $0.25 per claim and $0.15 per eligibility check, working under your own NPI.

Alma members report a median rate of $110 for 90837 on a community rate tracker. On a $110 allowed amount, a biller charging 6.5 to 8% takes $7.15 to $8.80 per session. That figure adds up to $6,864 to $8,448 per year for a therapist billing 20 sessions per week for approximately 1 year. Alma’s membership is $1,140 a year, but it doesn’t publish its share of each claim.

How Alma bills insurance for therapists

Alma’s membership includes insurance billing. It runs eligibility checks and cost estimates, generates claims, invoices and superbills, stores client cards for autopay and tracks reimbursement. To join Alma:

1. Fill in the “Get in touch” form or request a demo on Alma’s provider page. Only fully licensed clinicians can join.
2. Get credentialed under Alma’s tax ID with at least one of Aetna, Cigna or Optum, which Alma says takes 45 days or less. Existing panels don’t carry over.
3. Add clients, including ones who found you on other platforms.
4. Enter the session codes in the portal and submit each claim within 30 days.
5. Alma invoices the client, collects the copay and pays you within two weeks, on a weekly or every-other-week schedule.

Membership costs $95 a month billed yearly ($1,140) or $125 if paying month to month. Alma takes no cut of cash-pay sessions and doesn’t publish what it keeps from insurance payments. If a client leaves an invoice unpaid for 60 days, Alma deducts it from your next payout. Our Alma for therapists review covers referrals and the rest of the platform.

Join Alma’s insurance program

Comparison of billing routes for therapists

Therapist billing services come in three models: your own EHR, a billing company, or a platform such as Alma or Headway. The main difference is who holds the payer contract. Figures are as of October 12, 2026, and Headway’s as of September 2026.

Billing yourself keeps your whole contracted rate. SimplePractice includes electronic claims and ERA posting on every plan, charges a $20 yearly CPT code fee, and offers new customers free credentialing with up to two payers. TherapyNotes starts at $69 a month with electronic claims and ERAs built in. Heard sells bookkeeping and tax plans to practices and doesn’t submit claims.

Once set up, billing can be a manageable part of running a therapy practice. Though stress does come from billing issues like clawbacks, audits and payer rate cuts, therapists report spending around only 20 minutes per day on billing. And although some platform users resent not knowing the platform’s share, others are glad of the reliable pay.

When Alma isn’t the right fit

Pre-licensed associates can’t join Alma. Headway charges no membership and takes some Medicare Advantage plans, though it doesn’t handle out-of-network benefits. Contracts you hold yourself can’t be billed through either platform, so therapists keeping their own panels need an EHR or a billing company.

Compare Alma’s membership options