BEHAVIORAL & MENTAL HEALTH BILLING

AI-Powered Behavioral Health & Psychiatric Billing

Session-based coding, prior auth tracking, and CoCM billing built for how behavioral health practices actually get paid.

THE PROBLEM

Behavioral health gets billed like it's generic medicine. It isn't.

✕Prior authorizations expire mid-treatment and nobody catches it until the claim is denied
✕Session-based billing means high claim volume — one error repeats across dozens of sessions
✕Medical necessity documentation requirements vary by payer and change without notice
✕ABA, SUD, group therapy, and individual psychiatry each need different coding — generalist billers flatten them into one process

Sterling scrubs it before it's a denial.

Our AI is tuned to behavioral health's specific patterns, not a generic claims filter.

✓ Prior auth expiration tracked per session block, per patient
✓ CoCM and BHI add-on codes (G0568-G0570) applied correctly alongside APCM billing
✓ Telehealth POS and modifier rules checked against current CMS policy before submission
✓ Coders assigned by service type — ABA, SUD, group, and individual handled distinctly
2026 CODE CHANGES

What actually changed this year.

CMS finalized new Collaborative Care Model add-on codes in the CY 2026 Physician Fee Schedule.

📋

G0568 — Initial CoCM Month

Add-on code based on CPT 99492, for patients also receiving Advanced Primary Care Management (APCM) services.

new for 2026
🔄

G0569 — Subsequent CoCM

Add-on code based on CPT 99493, billed alongside APCM base codes G0556-G0558.

new for 2026
🧠

G0570 — General BHI

Add-on code based on CPT 99484, for general behavioral health integration services delivered with APCM.

new for 2026
📞

Telehealth Audio-Only

Behavioral health retains audio-only telehealth billing through December 31, 2027 under current CMS policy.

policy note
HOW WE WORK YOUR CLAIMS

Built around the session, not a generic claim.

01
✅

Verify

Eligibility and remaining authorized sessions confirmed before the appointment.

02
🔍

Scrub

Time-based E/M, add-on psychotherapy codes, H-codes, and modifiers validated against payer rules.

03
⏱️

Track Auth

Prior authorization expiration tracked per session block so renewal happens before care is interrupted.

04
💰

Collect

Clean claims submit same-day; denials get root-cause analysis instead of generic resubmission.

FAQ

What behavioral health practices ask first.

What are the new CoCM billing codes for 2026?
CMS finalized three new HCPCS add-on codes in the CY 2026 Physician Fee Schedule: G0568 (based on CPT 99492), G0569 (based on CPT 99493), and G0570 (based on CPT 99484), billed as add-ons alongside APCM base codes G0556-G0558.
Is audio-only telehealth still billable for behavioral health in 2026?
Yes — non-behavioral/mental telehealth audio-only billing runs through December 31, 2027 under current CMS and HHS policy.
Why are behavioral health denial rates higher than other specialties?
Session-based coding, frequent prior auth renewals, and inconsistent payer documentation requirements drive it. Industry analyses put behavioral health denials around 16-20%, versus roughly 5-10% for general medical billing.
Do you bill ABA, SUD, and group therapy separately from psychiatry?
Yes. Each carries its own code set, modifiers, and payer logic.
What EHR systems do you work with for behavioral health practices?
We work inside the EHR and practice management system you already use.
How does Sterling reduce prior authorization denials?
Our AI flags claims likely to need prior auth before submission and tracks authorization expiration by session block.

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