Quick Explanation
Denial code BH90 indicates that the payer has rejected the claim because the billing sequence or clinical documentation does not verify that a formal therapeutic relationship was established prior to the rendered service. This is particularly common in behavioral health and telehealth, where insurers require a documented initial diagnostic evaluation or a specific intake process before ongoing therapeutic services can be reimbursed.
Common Causes for BH90
Denials with code BH90 typically happen for the following specific reasons:
- Billing for ongoing psychotherapy sessions (e.g., CPT 90834 or 90837) without first billing or documenting an initial psychiatric diagnostic evaluation (CPT 90791 or 90792).
- Failure to comply with payer or state-specific mandates requiring an in-person visit to establish a provider-patient relationship prior to initiating telehealth services.
- Missing or incomplete intake documentation, such as signed informed consent forms, treatment plans, or patient-provider agreements in the electronic health record (EHR).
- Submitting claims for ongoing treatment when the documentation only reflects crisis intervention or sporadic, non-sequential consultations.
How to Prevent BH90 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Ensure a comprehensive psychiatric diagnostic evaluation (CPT 90791/90792) is completed, documented, and billed prior to scheduling subsequent therapeutic sessions.
- Verify payer-specific policy guidelines and state regulations regarding telehealth requirements, including whether an in-person visit is mandated to establish a valid relationship.
- Develop a mandatory intake checklist within the EHR to confirm that all consent-to-treat forms and treatment plans are executed before the first therapy session is submitted for billing.
- Incorporate clear statements within the clinical notes of the initial visits that explicitly outline the establishment of the therapeutic alliance and the agreed-upon plan of care.
Appeal Letter Template for BH90
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: BH90 - Therapeutic relationship not established
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code BH90: "Therapeutic relationship not established".
We are appealing the denial of this claim billed under code BH90 (Therapeutic relationship not established). In accordance with CPT guidelines and AMA coding standards, a formal therapeutic relationship was properly established prior to the date of service in question. A comprehensive psychiatric diagnostic evaluation (CPT 90791) was successfully performed and billed on [Insert Date of Evaluation], establishing the clinical baseline and plan of care. The accompanying medical records include a fully executed informed consent for treatment, an intake assessment, and a mutually signed individualized treatment plan, satisfying all state and federal regulations for establishing a provider-patient relationship. Accordingly, we respectfully request that this denial be overturned and the claim be processed for payment.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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