Quick reference

Behavioral Health Billing Code Reference

Search CPT codes, denial and remark codes, time rules, code pairings, telehealth guidance, and common claim issues.

Common behavioral health denial reasons

Start with the ERA/EOB codes, then use the matching category below to decide whether the claim needs a correction, reprocessing request, appeal, or contractual adjustment.

No authorization or referralCO-197 · CO-15
  • Check: Authorization number, approved CPT, units, provider, level of care, and effective dates.
  • Next step: Correct an omitted authorization, request retro authorization when allowed, or appeal with proof that authorization was obtained.
Benefit exclusion or carve-outPR-204 · CO-96 · N130
  • Check: Exact CPT, diagnosis, provider type, place of service, plan exclusions, and whether behavioral health is handled by another payer.
  • Next step: Route to the carve-out payer, appeal incorrect benefit information, or follow valid patient-responsibility and contract rules.
Provider not eligible or credentialedCO-170 · N95
  • Check: Rendering NPI, taxonomy, specialty, license, credentialing effective date, network status, and supervision requirements.
  • Next step: Correct provider data or appeal/reprocess with enrollment and credentialing proof.
Frequency or unit limit exceededCO-119 · benefit limit
  • Check: Visits or units already used, same-day services, annual limits, authorization units, and prior claims.
  • Next step: Correct duplicate units, request additional authorized visits, or appeal with medical necessity when the plan permits exceptions.
Bundled or incompatible servicesCO-97 · M15 · CO-4
  • Check: Same-day code combinations, psychotherapy add-on rules, NCCI/payer edits, and whether documentation supports distinct services.
  • Next step: Correct the code combination or modifier only when supported; otherwise post the contractual adjustment.
Diagnosis or medical necessityCO-11 · CO-50
  • Check: Diagnosis linkage, covered diagnoses, session length, level of E/M, treatment plan, symptoms, risk, and progress documentation.
  • Next step: Correct a true coding/linkage error or appeal with records showing why the service was necessary.
Telehealth billing mismatchCO-4 · CO-5 · CO-58
  • Check: POS 10 versus 02, modifier 95/GT, patient and provider locations, eligible provider, modality, consent, and payer-specific coverage.
  • Next step: Correct the POS or modifier when originally billed incorrectly, or appeal with telehealth documentation and payer policy.
Eligibility or coordination of benefitsPR-27 · CO-22
  • Check: Coverage dates, member ID, COB order, primary EOB, retroactive eligibility, and behavioral-health payer.
  • Next step: Update COB, bill the correct primary payer, attach the primary EOB, or request reprocessing with eligibility proof.
Duplicate or timely filingCO-18 · CO-29
  • Check: Original claim status, claim-control number, corrected-claim indicator, clearinghouse acceptance, and filing deadline.
  • Next step: Request reprocessing instead of rebilling an unchanged claim, or appeal timely filing with dated submission evidence.
Missing or invalid claim informationCO-16 + RARC
  • Check: Every accompanying N/M remark code, member and provider identifiers, taxonomy, diagnosis pointers, modifiers, and required attachments.
  • Next step: Fix the specific field identified by the remark code and submit as corrected or replacement claim according to payer rules.

Fast billing checks

Psychotherapy time90832/33: 16–37 min · 90834/36: 38–52 min · 90837/38: 53+ min. Document total or start/stop psychotherapy time.
Telehealth POSPOS 10 when the patient is at home; POS 02 when the patient is elsewhere. Modifier 95 rules vary by payer—verify the plan.
E/M + therapyUse 90833/36/38 with an eligible E/M—not 90832/34/37. Keep E/M work and psychotherapy time/documentation distinct.

Reference aid only. Payer contracts, state scope rules, NCCI edits, authorization, and current-year code guidance control payment. CPT labels are summarized, not official descriptors.