SpecialtiesMedical specialties
How we see psychiatry billing.
Reviewed by the VisMed medical specialties billing team
A psychiatric visit is usually an E/M service with a psychotherapy add-on chosen by time. The E/M is leveled on decision-making; the psychotherapy is selected by minutes spent, documented separately from the medical management. Practices that write one narrative for the whole visit lose the add-on or the level, and those that document time loosely invite audits.
Around that core sit parity rules that payers still apply unevenly, telehealth conventions that differ by plan and have shifted repeatedly, prior authorization for newer treatments such as TMS and esketamine, and a patient population where eligibility, particularly Medicaid, changes often.
VisMed gives psychiatry practices templates that separate the medical and therapy portions and capture time, coders who apply the add-on rules per payer, and a telehealth rule set held per plan and updated as policies move.
Where psychiatry practices lose money
The patterns we find in the aging and denial history before anything else changes.
Psychotherapy add-on unsupported
The add-on needs its own documented time and content, distinct from the E/M. A single narrative with no minutes loses the add-on on review.E/M leveled low
Medication management across multiple agents with side-effect monitoring is moderate to high complexity. Notes that record the plan without the reasoning level down.Telehealth place-of-service and modifiers
Audio-video and audio-only rules, place-of-service codes and modifiers differ by payer and have changed several times. Applying last year’s rule is a denial.Interactive complexity and crisis codes missed
Interactive complexity add-ons and crisis psychotherapy codes apply in defined situations and are rarely billed.TMS and esketamine outside authorization
Both need authorization with specific failed-therapy criteria, and each session or dose must fall within it.
What we do differently for psychiatry
Specialty-matched coders and a denials specialist, working inside your own system.
We give you two-part documentation
Templates that hold medical management and psychotherapy in distinct sections with time recorded for the therapy portion.We review the add-on and the level
Our coders apply the E/M level and the time-based add-on per payer, and flag notes where the add-on is unsupported.We hold telehealth rules per plan
Place-of-service, modifier and audio-only rules held per payer and applied at charge entry, updated as policies change.We authorize advanced treatments per session
TMS and esketamine courses are authorized against the plan’s criteria and tracked per session.
What we bill
The procedure and code families your account team already works in.
Psychiatry billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How do we document to support the psychotherapy add-on?
With a separate section for the therapy portion that records its time and content, distinct from the medical management. The E/M then levels on decision-making. VisMed’s templates make the split natural rather than a second note.
Are telehealth visits still paid the same as in person?
It depends on the payer and has changed several times. VisMed holds each plan’s current rule for place-of-service, modifiers and audio-only coverage, and updates it as policies shift, so claims match what the payer expects that month.
Can VisMed handle TMS authorization?
VisMed assembles the failed-therapy criteria and documentation each plan requires before the request, and tracks sessions against the approval so none are delivered outside it.
What about collaborative care with primary care practices?
The psychiatric collaborative care codes are billed by the primary care practice, with your consultation time inside them. VisMed helps structure the arrangement and the documentation so the primary care side can bill it and you are paid for your part.
How does VisMed handle Medicaid eligibility changes in a psychiatric practice?
We re-verify Medicaid and managed-Medicaid patients before every visit rather than monthly, because coverage in this population lapses and returns often. A lapsed patient is flagged before the session so the practice can decide, rather than after the claim is denied.
Also in medical specialties
Cardiology
Diagnostics, device checks and cath-lab professional fees.
Endocrinology
CGM, infusion and chronic-condition management codes.
Gastroenterology
Endoscopy, ASC splits and screening-vs-diagnostic rules.
Hepatology
Infusions, specialty drugs and prior authorization.
Nephrology
Dialysis MCP, monthly capitation and transplant follow-up.
Pulmonology
PFTs, sleep crossover and DME orders.
Rheumatology
Biologic infusions, J-codes and buy-and-bill.
Neurology
EEG/EMG, infusion and long-visit E/M.
Oncology
Chemotherapy administration, drugs and NDC reporting.
Hematology
Infusion and lab-linked visits.
Immunology & allergy
Testing panels and immunotherapy series.
Infectious disease
Inpatient rounds, long-term therapy and telehealth.
Dermatology
Lesion coding, pathology and cosmetic separation.
Pain management
Injections, ablations and strict authorization trails.
All specialties
The full list, in six groups
See where your psychiatry practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med