The appointment type is not the billed service. Foresight checks provider eligibility, separately documented psychotherapy, telehealth rules, and testing or collaborative-care requirements against each payer before claims are released.
Match the rendering NPI, taxonomy, license, supervision, and enrollment to the service. A psychiatrist, psychologist, PMHNP, therapist, MFT, or counselor may have different billing permissions under the same plan. Check behavioral-health carve-outs and visit limits as well as active coverage.
Distinguish diagnostic evaluation, psychotherapy, medication-management E/M, crisis, family or group therapy, and testing. Check the diagnosis, treatment plan, and time supporting the selected code; an appointment label alone cannot establish what was delivered.
Check for a primary E/M service and separately identifiable psychotherapy documentation before using an add-on code. Reconcile the recorded psychotherapy time with the code rather than carrying forward the previous visit's charges.
Check patient location, consent, modality, POS, modifiers, and state licensure against the payer's rules. Surface audio-only restrictions or a behavioral-health benefit administered by a different payer.
For testing, retain the order, scoring, interpretation, and supervision record. For CoCM/BHI, check consent, the registry, care-manager time, psychiatric consultant review, and monthly thresholds. Keep 99484 and CoCM billing paths distinct.
Verify the behavioral-health benefit and the rendering provider's enrollment before the visit.
Match the documented service, time, modality, and diagnosis to the charge. Apply payer-specific edits.
Route uncertain coding or clinical findings to your team. Every required PA goes through clinician sign-off.
Separate enrollment, authorization, modifier, and documentation denials. Track corrections and posted payments.