Benefits Verification Built for Therapy Practices
Last reviewed July 18, 2026 · Reviewed by the TurboVOB team
General medical eligibility tools answer a general medical question. A therapy practice has four specific ones: what does the client owe for an outpatient behavioral-health session, does this particular code need prior authorization, how many visits are left, and how is telehealth covered. TurboVOB is built around those four.
The codes we model
You tell us the codes you plan to bill, and the verification comes back with a prior-authorization flag against each one rather than a single yes or no for the whole visit. The “prior authorization” column below says which codes payers commonly gate. It is a starting expectation, not a plan rule — what the check returns is the payer's own answer for that member, on that plan, for that code.
Psychotherapy CPT codes
90834
Individual psychotherapy, 45 minutes with the patient
- Prior authorization
- Commonly not gated
90837
Individual psychotherapy, 60 minutes with the patient
- Prior authorization
- Commonly gated
90847
Family psychotherapy (conjoint), with the patient present, 50 minutes
- Prior authorization
- Commonly gated
90853
Group psychotherapy, other than a multiple-family group
- Prior authorization
- Commonly gated
Substance-use and behavioral HCPCS codes
H0001
Alcohol and/or drug assessment
- Prior authorization
- Commonly gated
H0010
Alcohol and/or drug services; sub-acute detoxification, residential
- Prior authorization
- Commonly gated
H0011
Alcohol and/or drug services; acute detoxification, residential
- Prior authorization
- Commonly gated
H0015
Alcohol and/or drug services; intensive outpatient program (IOP)
- Prior authorization
- Commonly gated
T1006
Alcohol and/or substance abuse services; family or couple counseling
- Prior authorization
- Commonly gated
T1007
Alcohol and/or substance abuse services; treatment plan development
- Prior authorization
- Commonly gated
H2019
Therapeutic behavioral services, per 15 minutes
- Prior authorization
- Commonly gated
H2035
Alcohol and/or other drug treatment program, per hour
- Prior authorization
- Commonly gated
Why 90837 is treated differently from 90834
Clinically the two codes differ by session length: 90834 is the 45-minute individual session, 90837 the 60-minute one. Administratively they are treated as different animals. Many payers pay 90834 without asking anything and put 90837 behind prior authorization, a medical-necessity review, or a utilisation-management program that watches how often a clinician bills it.
The reason is straightforward: 90837 reimburses more, so it is the code plans watch. That makes it the code most likely to be denied for a reason that had nothing to do with the client's coverage.
What it costs when it's missed
A blanket answer — “yes, outpatient behavioral health is covered” — is accurate and useless here. You deliver the 60-minute session, bill 90837, and the claim denies for no authorisation on file. Authorisation generally cannot be obtained after the fact, so the appeal is uphill. Your options narrow to writing the session off, or billing the client for a surprise they did not agree to — which is the worse of the two for a therapeutic relationship you were trying to protect.
The whole problem is one question asked at the right moment. Ask about authorisation per code, and note the answer per code, because that is how the payer will adjudicate it.
Visit limits, and why they bite harder here
Most medical specialties are episodic. Behavioral health is not — a client may be seen weekly for a year, which puts therapy caseloads against annual visit caps that other specialties never approach. A 20-visit annual limit is invisible in March and decisive in September.
Two numbers matter, and one of them is usually the one nobody asks for. The limit is the easy number. Visits used is the one that tells you where the client actually stands — and it includes sessions with any other provider under the same plan, which is exactly the history you cannot see. A client who saw someone else for six months earlier this year arrives at your intake with a cap that is already most of the way gone.
Sessions past the cap deny outright. So the useful thing to know at intake is not whether a limit exists, but how much of it is left, and whether an extension can be requested before you get there rather than after.
Telehealth coverage and parity
Telehealth is a large share of behavioral-health delivery, and it is the area where “covered” hides the most detail. Whether a telehealth session is covered, whether it pays at the same rate as an in-person session, and what has to appear on the claim for it to pay at all — these vary by state and by plan. Ask, per plan, rather than assuming the answer carries over from the last client.
Three questions cover most of it. Is the service covered when delivered by telehealth? Does it pay at parity with the in-person rate, or at a reduced one? And which place-of-service code and modifier does this payer expect? The last one is the quiet money-loser — a covered telehealth session still denies when the place-of-service code is not what the payer wanted, and the denial reads like a coverage problem rather than a formatting one.
TurboVOB returns telehealth coverage as its own field, so it is answered before the session rather than discovered in a remittance.
Behavioral health carve-outs
A carve-out is when the payer printed on the insurance card does not administer behavioral health at all. A separate managed-care organisation does — Magellan, Carelon, and Optum are the ones you will meet most often. The client has one card, and behind it, two companies.
Every answer from the wrong company is the wrong answer
Determine the carve-out before you ask anything else, and confirm the rendering clinician's network status with the carve-out company under their own NPI — being in network with the medical plan does not put you in network with the behavioral-health administrator.
A verification reflects what the payer had on file at the time of the check. It is not a guarantee of payment. Coverage can change mid-year, and retroactive terminations happen. Keep your reference number.
The full step-by-step, including where the carve-out question belongs in a call, is in how to verify insurance eligibility and benefits.
What we don't cover
We support major commercial payers, including Aetna, Anthem, Cigna, UnitedHealthcare and Optum, Humana, and many regional Blues. We don't support Medicare or Medicaid yet, and we don't have direct EHR integrations. If either is central to how your practice runs, say so on the demo call and we'll tell you straight whether this is worth your time right now.
Related
Insurance verification
What verification means — eligibility vs benefits, methods, hub.
How to verify insurance eligibility and benefits
The eight steps, from reading the card to recording the reference number.
270 and 271 explained
What the X12 eligibility inquiry and response contain — and what they don't.
See it against your payer mix.
Twenty minutes. We'll run a live verification against the payers you actually bill.
TurboVOB acts as a business associate under HIPAA and signs a Business Associate Agreement with every customer that processes protected health information through the platform.