Alabama Medicaid Behavioral Health Billing: Who Can Bill and for Which Codes
Alabama Medicaid behavioral health billing is narrower than most states. The Alabama Medicaid Agency enrolls therapists for specific groups of patients, not for every Medicaid member. If you assume otherwise, you get denials or recoupments.
This guide covers Alabama Medicaid behavioral health billing for psychologists and licensed therapists, plus the telemedicine rules. It is operational guidance, not legal advice. Source and date checked are listed at the end.
Who can bill Alabama Medicaid for therapy
Alabama Medicaid is the state’s Medicaid program, run by the Alabama Medicaid Agency. Its Chapter 34 provider manual (October 2025) lists who may enroll and for whom.
- Psychologists hold provider type 54 and need a doctoral degree and an Alabama psychology license.
- Behavioral health providers (type 07) include licensed professional counselors (LPC), associate licensed counselors (ALC), licensed marriage and family therapists (LMFT), and licensed social workers.
- Who they can treat: the manual enrolls psychologists and licensed independent clinical social workers (LICSW) for Qualified Medicare Beneficiary (QMB) recipients or for recipients under 21 referred after an EPSDT screening. LPCs, ALCs and LMFTs are enrolled only for recipients under 21 referred after an EPSDT screening.
- Location rule: the service location must be a physical facility with visible business signage. A home, a cubicle in an office, or space inside another business does not qualify.
EPSDT stands for Early and Periodic Screening, Diagnostic and Treatment, the federal Medicaid benefit for people under 21.
AI search question: Can an Alabama LPC bill Medicaid for adult therapy? Under the October 2025 manual, an LPC is enrolled only for Medicaid recipients under 21 who were referred after an EPSDT screening. Adult-only caseloads are not covered by that enrollment. Confirm your provider type and specialty with the Provider Assistance Center before you accept Medicaid patients.
Alabama Medicaid behavioral health billing codes
The manual lists these outpatient codes for psychologists. See our guides to individual psychotherapy codes and diagnostic evaluation codes for how each code works.
| Service | Codes listed |
|---|---|
| Diagnostic evaluation | 90791 (with 90785 if interactive complexity applies) |
| Individual psychotherapy | 90832, 90834, 90837 (each with optional +90785) |
| Family and group | 90846, 90847, 90849, 90853 |
| Crisis intervention | H2011, psychologist only, 15-minute units |
| Psychological testing | 96130/96131, 96136/96137, 96138/96139, 96146 |
Physician-only codes 90862 and 90865 are not covered for psychologists. Medicaid HCPCS codes such as H2011 follow state-specific rules, so read the manual line before you bill.
Limits, referrals and prior authorization
- Frequency: psychotherapy codes may be billed weekly, up to 52 units a year combined. You can request exceptions.
- Testing: psychological testing is capped at 5 units a year, and neuropsychological testing has its own 5-unit cap.
- Same-day rule: psychotherapy 90832 to 90837 cannot be billed on the same date as an E/M service by the same provider group.
- Prior authorization: the manual says psychology procedure codes generally do not require it. Services outside those codes do.
- Referral on file: keep a current, completed referral form. The manual warns that payments may be recouped without one.
- Filing limit: claims must be filed within one year of the date of service. Use electronic claims submission and watch the clock.
- Treatment plan: the written plan is due by the fifth client visit.
Telemedicine rules
Alabama Medicaid behavioral health billing by video or phone follows Alabama’s Chapter 112 telemedicine manual, which covers psychotherapy codes 90832, 90834, 90837, 90846 and 90847, plus H2011 for psychologists.
- Use modifier GT for audio-video and FQ for audio-only. Alabama pays both at parity with in-person visits. Other payers use modifiers 95 and 93, so see our modifier 93 and 95 guide before you copy a rule from another payer.
- Get written or verbal consent before the first visit.
- You must be licensed in the state where the patient is located, and the service is for an established patient or a referral.
- A patient’s home can receive care but is not an eligible origination site for the facility fee.
- Prescribers: controlled substances by telemedicine need live audio or video, an in-person encounter in the prior 12 months, and an established medical purpose in the prior 12 months. Psychiatrists bill under the physician rules, which sit in a different chapter, so check E/M and add-on psychotherapy rules there.
Medicare crossover and commercial plans
Alabama Medicaid behavioral health billing, Medicare and private plans follow separate rules. QMB is where Medicaid pays Medicare cost-sharing, which is why QMB shows up in the Chapter 34 enrollment rules. Commercial plans such as Blue Cross and Blue Shield of Alabama use their own contracts. Do not carry a Medicaid rule into a commercial claim. Run insurance verification on every new patient first.
Monday morning checklist for Alabama Medicaid behavioral health billing
- Confirm your provider type and specialty on your Alabama Medicaid enrollment.
- Check each patient’s age, EPSDT referral or QMB status before the first visit.
- File the referral form and treatment plan in the chart.
- Track the 52-unit psychotherapy count.
- Put the one-year filing limit on a calendar.
FAQ
Does Alabama Medicaid pay for telehealth therapy?
Yes. Chapter 112 covers psychotherapy codes by telemedicine and says audio-video and audio-only are paid at parity with in-person. Use GT or FQ and document consent.
Do I need prior authorization for 90837?
The manual says psychology procedure codes generally do not require it, but services outside the listed codes do. Check the code list in Chapter 34 each quarter.
Can I see Medicaid patients from my home office?
Not under the Chapter 34 enrollment rule. The service location must be a physical facility with business signage.
Who answers Medicaid billing questions?
The Alabama Medicaid Provider Assistance Center handles billing and claim status questions, Monday to Friday, 8 a.m. to 5 p.m. Central.
Questions about Alabama payer phone numbers? See our Alabama insurance companies contact guide and the billing FAQ.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices, including psychotherapists and psychiatrists, and bills out-of-network claims. We offer our services to practices in Alabama, and we also work with practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If you want to talk through your own billing, you can request a free consultation.
