Working through the medical billing process can be a daunting experience, particularly in mental health care. With various codes, authorizations, and classifications, providers, patients, and billers alike need to know the rudimentary factors that govern the reimbursement process. This article breaks down three essential pieces of mental health billing: TOS in medical billing, the procedures for authorization, and the mental health assessment CPT code.

What Is TOS in Medical Billing?

TOS is an acronym for Type of Service, a code that identifies the type of medical service that has been delivered. For mental health billing purposes, TOS codes assist in determining whether a service was therapy, evaluation, consultation, or some other mental health-related activity.

Knowledge of TOS in medical billing is important since insurance payers or billing systems use these identifiers to pay claims correctly. The wrong TOS code may result in claim denial, payment delay, or compliance. Psychotherapy sessions, for instance, might be coded under a particular TOS code, but medication management under another.

What Is Authorization in Medical Billing?

Prior to rendering mental health services, numerous practices have to secure authorization—but what is authorization in medical billing, precisely?

Authorization is the pre-approval that a provider needs to obtain before rendering some services. It's a process where the payer reviews whether or not the treatment that's being put forward is medically necessary. In mental health treatment, authorizations are typically needed for services such as therapy, psychological testing, or treatment plans of long duration.

If a mental health service is not checked for prior authorization, it can be rejected or denied payment. Hence, checking if a mental health service needs prior authorization is an imperative step in the billing process to safeguard both provider reimbursement and patient affordability.

Learning the Mental Health Assessment CPT Code

When the patient is first being evaluated psychologically, the billing staff will use a particular CPT code for a mental health assessment to best describe the service. The two most frequently used codes are 90791 and 90792.

• 90791 is when there is an initial diagnostic evaluation with no medical services. It is most often used by therapists or psychologists.

• 90792 is with medical services and is usually used by psychiatrists who might evaluate the condition of the patient and prescribe them medication.

Proper application of these CPT codes helps to ensure that providers are reimbursed in an equitable manner for their time and skill, as well as preserves billing compliance.

Final Thoughts: Bridging Billing Accuracy and Patient Care

Knowing the specifics of TOS in medical billing, authorizations, and CPT codes for mental health evaluations is not a technical nicety—it's a foundation of sound, ethical, and effective practice management. By collaborating on accurate application of these regulations, providers and billing staff can reduce denied claims, prevent delays, and provide improved care without aggravation.