A Beginner’s Guide to Insurance Billing for Therapists
Let’s be honest: insurance billing is not the reason you became a therapist. You signed up to help people, not to decipher the cryptic language of CPT codes, deductibles, and reimbursement rates. Yet, if you want to accept insurance in your private practice, mastering billing is a necessary evil.
The good news? It’s totally doable. With a little patience (and maybe some deep breathing exercises), you can navigate insurance billing like a pro. And if you don’t want to go it alone, I’m here to help. Let’s break it down.
Step 1: Get Credentialed (AKA The Waiting Game)
Before you can bill insurance, you need to be credentialed with insurance companies. This process involves submitting an application, proving your qualifications, and waiting. And waiting. And sometimes waiting some more.
What You Need to Apply:
Your National Provider Identifier (NPI) Number
A Tax ID (EIN) or Social Security Number (if you’re a sole proprietor)
Proof of malpractice insurance
Your license information
A completed CAQH profile (a universal credentialing database many insurers use)
Credentialing can take anywhere from a few weeks to a few months, so be patient—and follow up if needed!
Step 2: Verify Client Benefits (Because Surprises Are for Birthdays, Not Billing)
Before seeing a new client, always verify their insurance benefits. Otherwise, you might find out after the session that they have a sky-high deductible or that you’re not actually in-network (oops).
How to Verify Benefits:
Call the insurance company’s provider line.
Check eligibility through your EHR (Electronic Health Record) system if it has an integrated insurance tool.
Ask the client to check their own benefits (but always double-check yourself).
When verifying benefits, ask about:
Deductibles and co-pays
Session limits
Whether prior authorization is required
Step 3: Know Your CPT Codes (No Coded Messages Here)
Current Procedural Terminology (CPT) codes are how you tell insurance companies what services you provided. Here are some common ones for therapists:
90791 – Initial Intake Session
90837 – 60-minute therapy session
90834 – 45-minute therapy session
90832 – 30-minute therapy session
Make sure you’re using the correct code and modifier (if needed) to avoid claim denials.
Step 4: Submit Claims (a.k.a. Cross Your Fingers and Hit Send)
Claims can be submitted:
Directly through the insurance company’s provider portal
Through your EHR billing system
Via a clearinghouse (a third-party service that processes claims)
You’ll need:
Client details (name, DOB, insurance ID number)
Your information (NPI, Tax ID, address)
Session details (date of service, CPT code, diagnosis code, fee)
Most insurance companies require claims to be submitted within 90 days of the session, but some have even tighter deadlines, so don’t procrastinate!
Step 5: Handle Rejections and Denials (Because Nothing is Ever Simple)
Even when you do everything right, claims can still get denied. Fun, right? Common reasons for claim rejections include:
Incorrect client information (even a tiny typo can cause a denial)
Expired eligibility (the client’s insurance changed, and no one told you)
Coding errors (wrong CPT or diagnosis code)
If a claim is denied, don’t panic. Call the insurance company, find out why, and resubmit if possible.
Step 6: Get Paid! (Finally)
Once a claim is approved, you’ll receive an Explanation of Benefits (EOB) that outlines how much was paid and what the client owes. You may need to:
Collect a co-pay or remaining balance from the client.
Follow up on unpaid claims (insurance companies are not always quick to pay).
Adjust your records in your EHR or accounting system.
Feeling Overwhelmed? I Can Help!
Insurance billing can feel like learning a foreign language while juggling flaming swords, but you don’t have to do it alone. I specialize in helping therapists navigate the world of insurance billing, from credentialing to claims submission to troubleshooting denials.
My philosophy is to empower therapists to feel confident in managing their own insurance billing. With the right knowledge and support, you can take control of your practice’s financial health without unnecessary stress.
If you need help setting up your billing system or just want someone to explain things in plain English, contact me today to schedule a consultation. I can provide many tips and tricks, as well as personalized support. Let’s make insurance billing just a little less painful so you can focus on what you do best—helping your clients!
