BH Billing FAQ — 2026 Top 25 Questions
Q1: What’s a normal denial rate for BH?
Best-in-class 5-7%. Median 12-15%. See denial mgmt playbook.
Q2: What does BH billing outsource cost?
4-8% of collections is market. See cost benchmark.
Q3: Can I appeal MHPAEA parity violations?
Yes — 12-18% of BH commercial denials are parity-appealable. See parity guide.
Q4: 90837 vs 90834?
60-min vs 45-min psychotherapy. Payers auto-downcode. See 90837 recovery.
Q5: Modifier 95 vs 93?
Synchronous vs audio-only telehealth. See telepsych guide.
Q6: 97153 vs 97155?
ABA treatment by protocol vs treatment with protocol modification. See 97153 + 97155.
Q7: Can RBTs bill?
Yes, 97153 with BCBA supervision documented. See BCBA hierarchy.
Q8: BCBA credentialing timeline?
60-120 days per payer. See BCBA credentialing.
Q9: TMS billing codes?
90867 initial, 90868 subsequent, 90869 re-mapping. See TMS guide.
Q10: IOP hour minimums?
Commercial 9 hrs/wk, Medicare 6 hrs/wk. See S9480.
Q11: PHP hour minimums?
CMS 5 hrs/day. See H0035.
Q12: CO-16 vs CO-197?
Missing info vs missing PA. See CO-16 + CO-197.
Q13: ASAM 3.7 vs 3.5 residential?
Medically monitored vs clinically managed. See ASAM guide.
Q14: MAT J-codes?
J0570-J0575 buprenorphine, J0592 methadone. See MAT guide.
Q15: CCBHC PPS-1 vs PPS-2?
Daily per-visit vs monthly per-consumer. See CCBHC PPS.
Q16: H0004 units?
15-min increments. See H0004.
Q17: H0019 youth residential?
PRTF + EPSDT rules. See H0019.
Q18: Same-day peer-to-peer?
60-70% approval rate. See P2P playbook.
Q19: Days-in-AR target?
Under 40 days. See DAR guide.
Q20: TRICARE ABA (ACD)?
Autism Care Demonstration. See TRICARE.
Q21: Buy software vs outsource?
Depends on scale + RCM leadership. See buy vs outsource.
Q22: ROI on outsourcing?
15-40x typical on cash. See ROI calculator.
Q23: How to get on payer panels?
Parallel submission + top 8-10 payers. See panels guide.
Q24: Aetna vs UHC vs Cigna BH?
Different edit-rules. See Aetna + UHC + Cigna.
Q25: How do I start?
Book free 30-day denial audit. No cost, no contract.
– KD, Revenant Care