Understanding Billing Restrictions for Behavioral Health Providers

Authors: Teresa Halliday, MA | Megan Dormand, MPH | Xavior Robinson, MHSA | Jake Bowling, MSW

Topics: Behavioral Health

Research Center: Behavioral Health Workforce Research Center

November 1, 2016

Balancing the disequilibrium between the demand for mental health and substance use disorder services and the supply of qualified behavioral health professionals compels an examination of the billing and reimbursement practices and payer policies impacting behavioral health service access. One strategy to enhance workforce capacity is to ensure that behavioral health professionals can receive reimbursement for common procedures in behavioral health, especially when those services fall well within their expertise and scope of practice.

In this report, researchers investigate the use of current procedural terminology (CPT) codes used in behavioral health practice; identify restrictions and limitations around each commonly used CPT; and interview behavioral health providers about CPT code restrictions that may limit scopes of practice.

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