Psychiatry Billing and Credentialing for Private Practices

Medtransic bills insurance and handles credentialing for psychiatrists and psychiatric nurse practitioners (PMHNPs) in private practice. We bill evaluations, medication management visits and therapy added to those visits, in person or by telehealth, inside the software you already use. Billing is 4-8% of what we collect for you. Credentialing is $150 per application, per provider, and usually takes 60 to 90 days with each payer. There is no long-term contract.

Last reviewed 2026-10-03.

Where psychiatry practices lose money

Psychiatric visits mix medical and therapy billing in one appointment, and each payer treats that mix a little differently.

  1. Therapy added to a medication visit goes unpaid

    A prescriber can bill a medication visit and therapy on the same day, but Medicare requires the two to be clearly separate in the note. The therapy time cannot include the time spent on the medical visit, and the medical visit level is chosen by medical decision making, not by time. If the note blurs the two, the therapy is usually what gets dropped.

  2. Nurse practitioner claims billed the wrong way

    Medicare pays a nurse practitioner who bills under their own number 85% of the physician rate. Billing "incident to" a psychiatrist pays the physician rate, but only when strict supervision and billing rules are met. Choosing the wrong route means either underpayment or a claim that should not have been sent that way.

  3. Telehealth billed to the wrong rules

    Each payer sets its own telehealth rules, and Medicare's rules for mental health differ from its rules for other care. A telehealth claim sent without the details a payer wants comes back denied or paid low.

  4. New patients seen before credentialing is finished

    Until a payer confirms your effective date, you are not yet in its network. With credentialing usually taking 60 to 90 days per payer, it has to start well before the schedule fills.

What we run, and what stays with you

What we run

What stays with you

Your EHR shows what you billed. Your portal shows what we are doing about it.

Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.

Did that claim get paid?

Every claim with its stage and amount, the denials we're working, and your receivables by age.

Where is my application with Aetna?

Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.

What do you still need from me?

One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

Medicare rules psychiatry practices should know in 2026

These are current as of October 2026. Telehealth and prescribing rules have end dates, so we re-check them before they change.

Telehealth for mental health at home is permanent. Medicare covers mental and behavioral health telehealth in the patient's home, anywhere in the U.S., on a permanent basis. For most other services, the home and any-location rules end after December 31, 2027.

The in-person visit rule starts in 2028. The requirement for an in-person visit is delayed until January 1, 2028. Patients who start telehealth before then are treated as established and will need one in-person visit every 12 months after that date.

Audio-only visits. Audio-only telehealth is allowed through December 31, 2027. After that, audio-only stays allowed for behavioral health at home when the patient cannot or will not use video and the clinician can use video.

Supervision by live video. Since January 1, 2026, Medicare lets a supervising practitioner be present by live audio and video for services that need direct supervision. Audio-only does not count. Behavioral health services billed incident to a practitioner only need general supervision.

Prescribing controlled medications after a telehealth visit. Through December 31, 2026, DEA rules let prescribers prescribe controlled medications after a telehealth visit without a prior in-person visit. DEA is working on a permanent rule, so check for updates before 2027.

The 2026 Medicare cut did not apply to behavioral health. Medicare's 2026 fee schedule applied a 2.5% efficiency adjustment to many services, but it excluded time-based services such as office visits and behavioral health services.

Credentialing for psychiatrists and PMHNPs

Every payer wants the same core documents, then runs its own review. We assemble the file once and track each application until you have an effective date.

  1. License, DEA and NPI in order

    An active state license, and a DEA registration in each state where you practice if you prescribe controlled medications. Some states also require their own controlled substance license. Your NPI, plus a group NPI and tax ID if you bill as a practice.

  2. CAQH profile complete and attested

    Most commercial payers read your profile in the CAQH Provider Data Portal (formerly CAQH ProView). We complete it, upload documents and re-attest every 120 days so applications do not stall.

  3. Medicare enrollment, if you take Medicare

    Medicare enrollment is done online in PECOS, Medicare's enrollment system. It is separate from joining commercial networks, so we file it alongside the commercial applications.

  4. Payer applications filed and followed up

    We submit each application, follow up until it is approved, and record the effective date in your client portal so you know when to start seeing that payer's members.

Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer. Payers themselves quote about 45 to 90 days after they receive a complete application.

Payer notes for psychiatry

Behavioral health networks run separately

Many health plans hand mental health to a separate behavioral health network. The insurance card may say one company while claims and credentialing go to another, so we check which one applies before the first visit.

Medicare

Medicare pays for psychiatric evaluations, medication management and psychotherapy. Its Part D drug plans must cover certain protected drug classes, including antipsychotics, antidepressants and anticonvulsants.

Medicaid

Medicaid rules for psychiatry vary by state and by managed care plan, including which providers can enroll and what needs approval first. We check the plan, not just the state.

When we are not the right fit

If your practice is cash-pay only and does not plan to take insurance, you do not need a billing company. You may still want credentialing later, if you decide to join panels.

If you are on a platform that bills for you, such as Headway or Alma, and the rates work for you, staying there can be simpler. We help when you want your own contracts.

Questions psychiatry practices ask us

How much does psychiatry billing cost with Medtransic?

Billing is 4-8% of what we collect for you, with no long-term contract. Credentialing is $150 per application, per provider. The revenue audit before you sign is free.

Do you credential psychiatric nurse practitioners?

Yes. We credential PMHNPs with Medicare, Medicaid and commercial payers. With each payer we set up whether claims go under the nurse practitioner's own number or incident to a psychiatrist, based on that payer's rules.

Can you bill a medication visit and therapy on the same day?

Yes, when the note shows both as separate services and the therapy time does not include the medical visit time. We check that both are supported before the claim goes out.

Does Medicare still pay for telepsychiatry at home?

Yes. Medicare's coverage of mental health telehealth in the patient's home is permanent. An in-person visit rule starts on January 1, 2028, as of October 2026.

Which systems do you work in?

We work inside your existing software, including SimplePractice, TherapyNotes, AdvancedMD, athenahealth, Tebra and DrChrono, so you do not change systems to work with us.

Sources

Outside facts on this page were checked against these sources on the date shown.

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