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May 06, 2025
5:09 AM
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Knowledge of the various types of authorization in medical billing is crucial in order to provide proper coverage and reimbursement of healthcare services—particularly in mental health. Authorization refers to the act of seeking insurance payer approval prior to rendering specific medical services. In the absence of it, claims can be rejected, regardless of whether the service was medically necessary.
There are a number of typical types of authorizations: pre-authorization, prior authorization, and concurrent authorization. Pre-authorization is usually needed prior to the patient's receipt of the service, whereas concurrent authorization is utilized for services that extend over time, like inpatient mental health treatment. Retroactive authorization may also be required by some payers in emergencies, although approval is not assured.
In billing for mental health, utilizing the appropriate CPT code mental health is directly related to authorization. Take, for instance, if you're billing for a 60-minute session of therapy using CPT code 90837. You might need prior authorization by the insurance company. Certain payers restrict the number of sessions covered annually, and exceeding that without approval may lead to claims denials.
Mental health services have different kinds of authorizations. Psychiatric assessments (CPT code 90791) may be initially approved, but some follow-up sessions with a much shorter duration (such as 90832) might be eligible without advance notice, subject to the plan. It is important to study each insurance company's rules and provide the required documentation in advance.
In summary, understanding the categories of authorization in medical billing and applying the proper cpt code mental health is paramount to avoiding denied claims and ensuring a consistent revenue stream. Mental health practitioners and billing staff need to monitor payer requirements, monitor authorization statuses, and have documentation available to substantiate all services billed.
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