Mental health billing looks simple from the outside. One clinician, one code, one 53 minute session. The part that is not simple is everything wrapped around it.
Psychotherapy codes are timed and payers audit the timing. CPT 90832 covers 16 to 37 minutes, 90834 covers 38 to 52 minutes, and 90837 covers 53 minutes or more. Bill 90837 across most of your caseload and you should expect a records request. Downcode to 90834 to stay quiet and you give away revenue on sessions you actually delivered. A general medical biller who handles orthopedics and dermatology usually has no opinion on this. A mental health biller should.
The rules around the session moved twice in the first five weeks of 2026. Medicare telehealth flexibilities were scheduled to lapse on January 30, then the Consolidated Appropriations Act, 2026 (H.R. 7148), signed February 3, extended them through December 31, 2027, including the waiver of the in person visit requirement for behavioral health telehealth. Credentialing decides which claims you can file at all. Good faith estimates apply to every self pay client whether or not you take insurance.
We compared seven billing companies that work with solo and small group therapy practices, and added the network model that competes with all of them. Pricing is listed where the company publishes it and marked “quote only” where it does not, because a comparison table full of prices nobody will confirm is worth nothing to you.
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| Company | Location | Best for | Pricing | Credentialing | Focus |
|---|---|---|---|---|---|
| SwiftCare Billing | Marlton, NJ, remote-first, all 50 states | Best overall for solo and small group therapy practices | From 3% of collections, published | Yes, included as a service | 50+ specialties including mental health |
| TheraThink | Seattle, WA | Solo therapists who want a mental health only biller | Percentage of the allowed amount on paid claims, plus $35 per month per tax ID and rendering NPI | Yes, $130 commercial, $270 Medicare or Medicaid | Mental health only, since March 2014 |
Sawgrass Behavioral Resources | Fort Lauderdale, FL | New practices that need heavy credentialing help | 6% of monthly collections, onboarding from $99, minimums apply | Yes, credentialing and payer enrollment | Mental health only |
Practice Solutions | United States, remote | Owners who want billing plus training on how billing works | Quote only | Not documented on their site | Mental and behavioral health only, founded 2017 |
Psychiatric Billing Associates | New York, NY | Prescriber practices and the longest track record on this list | Quote only | Listed, not detailed | Psychiatry, psychology, therapy, since 1994 |
Ensora Health RCM | Remote | Practices already running TheraNest or Fusion | Essentials: set monthly rate for 1 to 5 clinicians. Advanced: percentage of posted payments | Payer setup assistance | Behavioral health and rehab therapy |
| Coronis Health | Multiple US locations | Practices adding IOP, PHP, or facility levels of care | Quote only | Facility credentialing | Behavioral health division of a general RCM firm |
1. SwiftCare Billing
SwiftCare Billing publishes its pricing, which almost nobody else on this list does. Rates start at 3% of collections, and the site works the math out loud: a practice collecting $500,000 a year pays about $15,000 for full service billing. You can compare that against your own numbers before you ever get on a call.
The company is based at 525 NJ-73 Suite 104, Marlton, New Jersey, and works remotely with practices in all 50 states. Mental health is one of more than 50 specialties they bill, and the service covers coding, credentialing, prior authorization, patient billing, telehealth billing, and accounts receivable follow up. They report a 98.4% clean claim rate and a 99% credentialing success rate, and say most practices finish onboarding in 7 to 14 business days.
The trade off is honest to name. SwiftCare billing is a multi specialty firm, not a therapy only shop. If your entire book is 90834 and 90837 with three commercial payers, a mental health only biller may know your payers’ quirks slightly faster out of the gate. If you have a mixed group with prescribers billing E/M plus psychotherapy add on codes (90833, 90836, 90838), or you are adding testing codes, the multi specialty depth works in your favor.
Best for: solo and small group therapy practices that want published pricing and a single vendor for billing and credentialing.
2. TheraThink
TheraThink has worked only with licensed mental health professionals and groups since March 2014, out of Seattle. That focus shows up in the details. They bill Medicare, Medicaid, TriCare, EAP plans, and out of network claims, and the service includes daily claim filing, EOB processing, eligibility verification, denials and appeals, and coding help.
Pricing is a percentage of the allowed amount or contracted rate, charged only on claims that get paid, plus a $35 per month fee per unique tax ID and rendering NPI that their clearinghouse requires. There is no startup fee and no per claim submission fee. Credentialing is priced separately at $130 for commercial payers and $270 for Medicare or Medicaid. They offer a free 30 day trial and month to month terms.
Two things to know before you sign. They do not do collections, so chasing a client who stops paying stays with you. And the percentage is on the allowed amount rather than what lands in your bank account, so run the math on a month where you have a high deductible caseload and the difference is real.
Best for: solo therapists and small groups that want a biller who touches nothing but mental health claims.
3. Sawgrass Behavioral Resources
Sawgrass is a Fort Lauderdale firm that bills only for mental health practices, and its published rate is 6% of total monthly collections with an onboarding fee starting at $99 that varies by provider type and credentialing needs. Minimums apply. They say plainly that no mental health practice is too big or too small for them, which reads as an invitation to solo practices that other vendors turn away.
Credentialing is a real service here rather than a checkbox. They handle contracting with state, federal, and commercial plans, plus practice updates for panel maintenance and payer enrollments covering EFT, ERA, and portal access. For a therapist who has never been paneled, that combination matters more than a point of percentage.
The published 6% sits above SwiftCare’s published floor of 3%. Whether that is worth it depends on how much credentialing work you need in year one and how much of your caseload runs through plans you are not yet contracted with.
Best for: newly licensed clinicians and new practices where getting on panels is the bottleneck, not claim volume.
4. Practice Solutions
Practice Solutions has billed for mental and behavioral health practices since 2017, serving everyone from solo therapists to group practices. Their billers are US based and clients work with a named account specialist rather than a call center queue. They sign business associate agreements and run a free practice health check before you commit.
What sets them apart is the teaching. They publish insurance billing education, run a podcast, and offer consulting alongside the done for you billing. For an owner who wants to understand their revenue cycle rather than hand it off blind, that is worth something. For an owner who wants to never think about a claim again, it is beside the point.
Pricing is not published. Their site does not document credentialing either, so ask about it directly on the first call if you need panels.
Best for: practice owners who want the billing handled and want to learn enough to spot problems themselves.
5. Psychiatric Billing Associates
Psychiatric Billing Associates started in 1994 as a billing service built around mental health providers, which makes it the longest running firm on this list. They work with psychiatrists, psychologists, and therapists, and cover claims processing, patient billing, payment posting, verification of benefits, follow up and appeals, financial reports, and online access to your data.
They are flexible about software. If you already run TherapyNotes or TheraNest, they can often bill directly from your system or export your data into theirs, so you are not forced to migrate to start. They also offer their own web based platform if you would rather not keep one.
Pricing is quote only. Thirty years of mental health billing is a real asset, and it is also the kind of asset that shows up as a higher quote, so get the number early.
Best for: psychiatry and mixed prescriber practices that want a firm with three decades of behavioral health claims behind it.
6. Ensora Health RCM
Ensora Health, the company behind TheraNest and Fusion, sells billing as an add on to its own software. That is the constraint and the appeal: RCM is available only to practices already on TheraNest or Fusion, and in exchange the billing team is working inside the same system where your notes and schedule live.
There are two tiers. RCM Essentials is a set monthly rate aimed at practices with 1 to 5 clinicians, and covers daily claim submission, ERA posting within 3 business days, rejected claim correction, payer setup assistance, and monthly education sessions. RCM Advanced is priced as a percentage of posted payments and adds a dedicated performance manager, appeals, A/R monitoring and cleanup, and KPI reporting. Ensora points practices collecting more than $15,000 a month from payers toward Advanced, and Advanced requires six months on Essentials first.
A flat monthly rate is unusual in this market and worth modeling. Below a certain collections volume it beats any percentage. Above it, you are paying for capacity you are not using, which is presumably why the Advanced tier exists.
Best for: TheraNest and Fusion practices with 1 to 5 clinicians who want one vendor for software and billing.
7. Coronis Health
Coronis is a general revenue cycle firm with a behavioral health division, and the scale is different from everyone else here: 35 years in business, more than 2,000 team members, more than $2.7 billion in payments processed, and more than $20 billion in charges managed. The behavioral health service covers billing, coding, denial management, full A/R support, utilization review, benefits verification, facility credentialing, and staffing.
Utilization review and facility credentialing are the tell. Those are services an outpatient therapy practice does not need and a residential, PHP, or IOP program cannot function without. If you are a solo therapist, this is not your vendor. If you are a group that is opening an intensive outpatient program next year, this is the one on the list built for where you are going.
Pricing is quote only, and enterprise firms usually carry minimums that make small practices uneconomic on both sides.
Best for: behavioral health organizations moving into higher levels of care, not solo or small outpatient practices.
The network alternative: Headway, Alma, and Grow Therapy
Most therapists comparing billing companies are also, quietly, comparing them against joining a network. It is a different deal, not a cheaper version of the same deal, and it is worth being clear about the difference.
Alma charges $95 per month billed annually, which is $1,140 a year, regardless of how many sessions you bill. That fee covers credentialing they describe as taking less than 45 days, multi state credentialing, automated eligibility checks, and rate negotiation on your behalf, across partnerships they say cover more than 112 million eligible people. Alma does not take a cut of cash pay clients. Headway does not publish provider economics on its provider page at all, and offers a free EHR built around insurance billing. Grow Therapy also works on a percentage basis and does not publish it.
The structural difference is contract ownership. In a network model, the payer contract belongs to the network, and your reimbursement is the network’s negotiated rate minus whatever the network keeps. That is genuinely simpler, and for a clinician filling a caseload from scratch it can be the right call for two or three years. But you are renting access. If you leave, you start credentialing from zero, because the panel relationship was never yours. A billing company works the other way: you own the contracts, you carry the administrative weight, and you keep the full contracted rate minus the biller’s fee.
How to choose a mental health billing company
Session length codes are where the audits start
The timed psychotherapy codes are the single biggest difference between mental health billing and general medical billing. 90832 is 16 to 37 minutes, 90834 is 38 to 52 minutes, and 90837 is 53 minutes or more. The add on codes paired with an E/M service follow the same thresholds: 90833, 90836, and 90838. Around those sit 90791 and 90792 for diagnostic evaluations, 90846 and 90847 for family sessions without and with the client present, 90853 for group, 90785 for interactive complexity, and 90839 with 90840 for crisis work, where the first unit covers 30 to 74 minutes.
Ask a prospective biller what they do when a payer opens a review of your 90837 volume. If the answer is “we would downcode going forward,” keep interviewing. The correct answer involves your documentation supporting the time you billed.
Ask who owns the payer contract
This is the question that separates a billing company from a network, and it is worth asking even of billing companies. Some vendors credential you under their own group tax ID for convenience. That is fine until you leave.
Get the 2026 telehealth position in writing
Telehealth is not a side channel in mental health, it is a large share of delivered care, so a biller’s telehealth handling is not a minor line item. Get their position on modifier 95 for audio video and modifier 93 for audio only, and on place of service 10 when the client is at home versus 02 when they are somewhere else, since POS 10 pays the non facility rate and 02 pays the facility rate.
Then ask what they did in the first week of February 2026, when Medicare telehealth flexibilities lapsed on January 30 and were restored on February 3 by the Consolidated Appropriations Act, 2026. A biller who held claims through the gap and released them clean has a process. A biller who filed into the lapse and let the denials sort themselves out does not.
Credentialing is the long pole
Nothing else on this list stops revenue the way credentialing does. You can have perfect notes and a great biller and still collect nothing from a payer you are not contracted with. Alma advertises less than 45 days. SwiftCare reports a 99% credentialing success rate and 7 to 14 business day onboarding. TheraThink prices credentialing per payer at $130 commercial and $270 for Medicare or Medicaid. Sawgrass folds it into onboarding starting at $99.
Those are the published numbers. What you want from a vendor is their real average, by payer, for providers like you.
Price the model, not the percentage
A percentage of collections, a percentage of the allowed amount, and a flat monthly fee are three different products. On this list you can see all three: SwiftCare from 3% of collections, Sawgrass at 6% of monthly collections, TheraThink on a percentage of the allowed amount plus $35 a month per tax ID and NPI, and Ensora Essentials at a set monthly rate.
Percentage of the allowed amount and percentage of collections diverge whenever patient responsibility is high, because the allowed amount includes the part the client owes and may never pay. Flat monthly wins at low volume and loses at high volume. Run all three against one real month of your own remittances before you decide.
Good faith estimates stay your job
The No Surprises Act requires a good faith estimate for uninsured and self pay clients. If services are scheduled at least 3 business days out, the estimate is due within 1 business day of scheduling; if scheduled at least 10 business days out, within 3 business days; and within 3 business days of any client request. It has to be an itemized list in clear language. If the final bill exceeds the estimate by $400 or more, the client can dispute it.
Some billers generate these, most do not. Confirm which, because the obligation follows your NPI, not your vendor’s.
Parity is still law, even with the 2024 rule paused
On May 15, 2025, the Departments of Labor, Health and Human Services, and the Treasury announced they will not enforce the portions of the 2024 MHPAEA final rule that are new relative to the 2013 rule, until a final decision in the pending litigation plus 18 months. The statutory parity obligations under MHPAEA as amended by the Consolidated Appropriations Act, 2021, still apply.
The practical read for a practice: the comparative analysis paperwork pressure on plans has eased, so do not expect parity arguments to carry as much weight in a 2026 appeal as they might have in 2024. Build appeals on medical necessity and documentation.
Mental health billing FAQs
Published rates on this list run from 3% of collections at SwiftCare to 6% of monthly collections at Sawgrass, with TheraThink charging a percentage of the allowed amount plus $35 per month per tax ID and rendering NPI. Several firms quote only. Flat monthly pricing exists at the small end, such as Ensora’s RCM Essentials for practices with 1 to 5 clinicians. Ask what the fee is charged against, not just what the number is.
It depends on volume and on what your time is worth. A therapist billing 20 sessions a week to two commercial payers with clean eligibility can often handle it inside their EHR. The math changes with more payers, Medicare or Medicaid in the mix, EAP work, high deductible clients, or any aging A/R you have not worked in 60 days.
Timed session codes that payers audit, add on codes for interactive complexity and crisis work, tighter authorization rules for higher levels of care, EAP claims that follow their own process, and a telehealth share far above most specialties. A biller who has never questioned a 90837 ratio has not done this work.
It varies by payer and by state, and it is the item most likely to delay your revenue. Alma publishes a target of less than 45 days for its own network. Direct commercial credentialing usually runs longer, and Medicare and Medicaid longer still. Ask any vendor for their median time to effective date by payer type rather than a general estimate.
Some do and some do not. SwiftCare includes credentialing as a service. TheraThink prices it per payer at $130 commercial and $270 for Medicare or Medicaid. Sawgrass builds it into onboarding from $99. Practice Solutions does not document it on their site. Confirm before you sign.
It is safe when the session actually ran 53 minutes or more and your note supports it. The risk is not the code, it is the pattern with documentation that does not back it up. Do not let a biller downcode you into 90834 to avoid attention, and do not bill 90837 by default on 45 minute sessions.
Medicare telehealth flexibilities were scheduled to expire January 30, 2026. The Consolidated Appropriations Act, 2026 (H.R. 7148), signed February 3, 2026, extended them through December 31, 2027, including the waiver of the in person visit requirement for behavioral health telehealth. CPT 90849, multiple family group psychotherapy, was added to the Medicare telehealth list effective January 1, 2026. Commercial payers set their own rules, so check each contract.
Yes, for uninsured and self pay clients, including insured clients who choose not to use their benefits with you. Deadlines are 1 business day after scheduling when the appointment is at least 3 business days out, 3 business days after scheduling when it is at least 10 business days out, or 3 business days after a client asks. The dispute threshold is $400 above the estimate.
SwiftCare publishes 98.4%. Treat any vendor number as a claim to verify, and ask how they define it, because first pass acceptance by a clearinghouse and first pass payment by a payer are not the same measurement. Ask for your own rate monthly once you are live.
Plan for a full claim cycle. The moving parts are clearinghouse enrollment, ERA and EFT re-routing per payer, portal access, and the handoff of claims already in flight. SwiftCare says most practices complete onboarding in 7 to 14 business days, but ERA re-routing at some payers takes longer than onboarding does. Do not terminate your old vendor until aged claims are resolved or formally transferred.
The network does. That is what makes the model simple and what makes leaving expensive. If you exit, you credential from the start as an independent practice. Ask any billing company the same question, because a few credential clients under their own group tax ID.
Usually collections. TheraThink states plainly that they do not handle collections. Most vendors also will not write your notes, fix documentation that does not support the code, or negotiate your commercial rates, though Alma does negotiate rates inside its own network.
Look at days in A/R, the percentage of A/R over 90 days, first pass denial rate, and net collection rate. If nobody can produce those four numbers for last month, that is the answer. Also check whether denials are being appealed or just resubmitted, since resubmission of a correctly denied claim is activity without revenue.
Not usually. SwiftCare states it integrates with existing EHR and practice management systems. Psychiatric Billing Associates can often bill directly out of TherapyNotes or TheraNest. TheraThink offers its own EHR or will work with yours. Ensora RCM is the exception on this list: it is available only to TheraNest and Fusion practices.
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