When you’re starting or running a mental health practice, how you bill for your services can have a major impact—not just on your bottom line, but on what your patients are able to get reimbursed for.

In this episode of the Sit and Stay Podcast, we explored why time-based billing might feel like the simplest option—but often leaves money on the table, especially for prescribers. We also covered how complexity-based billing can lead to higher reimbursement and better reflect the clinical work you’re doing.

Whether you’re a solo prescriber running a cash practice or a therapist navigating interactive complexity codes, this episode is packed with essential insights. Below, we break down key takeaways from our conversation.

The Three Types of Billing in Mental Health

There are three primary billing models clinicians might use:

1. Time-Based Billing

This approach bills strictly based on session length. For example, a 40-minute session might be billed using code 99215, regardless of what actually occurred during the visit. It’s commonly used in cash-based practices, but it doesn’t account for clinical complexity, meaning providers often miss out on higher reimbursement or useful add-ons.

2. Complexity-Based Billing

This method relies on Evaluation and Management (E/M) codes that reflect the complexity of the patient’s case—not just how long the session lasted. If a visit involves multiple diagnoses, high emotional intensity, or complex decision-making, a higher E/M code may be appropriate.

Prescribers can also add psychotherapy codes based on the therapy time delivered, and include interactive complexity codes when relevant. This method often leads to higher total reimbursement and better documentation of clinical work.

3. Procedure-Based Billing

More relevant for medical specialties, this method applies to defined procedures like neuropsych testing or TMS. For most therapy or med management visits, procedure-based billing is less applicable than time or complexity coding.

Why Time-Based Billing Seems Appealing—But Isn’t

Time-based billing feels intuitive. You set an hourly rate, track your session time, and charge accordingly. Many providers look at local rates, choose something competitive, and skip learning the complexity of coding.

But this simplicity often comes from a knowledge gap. Most prescribers aren’t taught about billing in school or residency, and they rarely get guidance from academic mentors. Even those who take insurance may unknowingly bill using time-based codes and miss out on valid psychotherapy or interactive complexity add-ons.

And the consequences?

Lower reimbursement
Limited patient insurance reimbursement
Lost revenue when sessions are more complex than the billing suggests

The billing system was designed to reward complexity, but if you’re not aware of that—or if no one taught you how to navigate it—you might be billing in a way that undervalues your work.

Real-World Example: Time vs. Complexity-Based Billing

Let’s say you’re a prescriber who just spent 44 minutes with a child who has anxiety. You:

Adjust their SSRI dosage
Discuss a recent family fight
Bring in the parent mid-session
Navigate intense emotions, including yelling and tears

It’s tempting to bill 99215 based on time alone, which might pay around $250. But consider this alternative:

99214 based on complexity – ~$200
Psychotherapy add-on (38–52 min) – ~$150
Interactive complexity code (90785) – ~$25
Total: $375

By documenting what actually happened in the session and billing accordingly, you earn $125 more, and your patient may get better reimbursement when submitting a superbill.

What About Therapists?

For therapists, time-based billing is standard and appropriate. CPT codes are structured around 30, 45, and 60-minute sessions, and those can be billed directly.

However, many therapists overlook the interactive complexity add-on. If your session includes:

Intense emotional content
Family involvement or conflict
Language interpretation
Special therapy tools or techniques

…you may be able to add code 90785 to your billing. That could mean charging an additional $25–$50—and helping your patient get a more accurate insurance reimbursement.

The key? Be transparent with your clients. Let them know that some sessions may include an additional charge due to session complexity. It’s a fair practice, and it ensures you’re billing in a way that reflects the real work you’re doing.

If You’ve Been Billing by Time, Where Should You Start?

If you’re halfway through this post and thinking, “Oh no, I’ve been doing this wrong,” you’re not alone.

Here’s how to begin shifting your approach:

Learn the Codes

Get familiar with E/M codes, psychotherapy add-ons, and interactive complexity.

Review Your Current Billing

Identify where you’ve been underbilling sessions with high complexity.

Compare Your Rates

Map your current rates against what you could earn billing by complexity.

Set a Transition Date

Give yourself time. 90 days is a good rule to educate and notify your patients.

Communicate the Change

Emphasize how this helps patients get more back from insurance.

Ask for Help

If you’re a RipsyTech client, we’re happy to help you make the transition. Many EHRs can guide you, too.

This isn’t about being in trouble. It’s about getting paid fairly—and helping your patients benefit more from the system that already exists.

In this week’s mental health business moment…

Tom shared a real-life example about the importance of reading your lease carefully—especially when it includes a right of first opportunity clause. After noticing someone being shown office space in their building, he followed up with the landlord and discovered that the space was available—despite not being notified as required by his lease. Because he acted quickly, he was able to secure the new offices, which were both affordable and conveniently located. The takeaway? Keep an eye on your surroundings, and don’t assume landlords will always follow the fine print for you.

Final Thoughts

Time-based billing may seem easier—but for prescribers, it often results in lower revenue, less accurate documentation, and limited insurance reimbursement for your patients. Complexity-based billing may take more effort upfront, but it’s designed to reflect your actual work and reward you accordingly.

Whether you’re a new provider or just revisiting your billing strategy, now’s the time to make sure your model aligns with your value.

Need help figuring it out? That’s what we’re here for.

Have a question or topic you’d like us to explore? Contact us at sitandstay@ripsytech.com.

And don’t forget to subscribe to the Sit and Stay Podcast for more insights on running a thriving mental health practice.

Looking for a health record solution that simplifies your workflows and supports your practice’s business needs?

RipsyTech has your back. Schedule a demo with us today.

Why You Should Avoid Time-Based Billing (Even in a Cash Practice)