DC Medicaid Behavioral Health Billing: MCOs, DBH Services and the Gainwell Portal
DC Medicaid behavioral health billing depends on who pays for the service. Managed care organizations (MCOs) pay for some. The Department of Health Care Finance (DHCF) pays fee-for-service claims for others. Since March 2, 2026, a new fiscal agent, Gainwell Technologies, runs the fee-for-service side. This guide to DC Medicaid behavioral health billing covers the structure, the portal, the rates and the telehealth rules for therapists and psychiatrists. It is DC only. Sources were checked on October 9, 2026.
How DC Medicaid pays for behavioral health
DC has two payment paths. In managed care, an MCO pays the claim. In fee-for-service, DHCF pays it directly. Behavioral health sits across both.
DHCF’s behavioral health integration page tracks a plan to fold Medicaid behavioral health into managed care. The page says the agencies paused planning for the April 1, 2024 carve-in in February 2024. A carve-in moves a service from fee-for-service into the MCOs.
What was the plan? DHCF’s February 2024 bulletin said Mental Health Rehabilitative Services (MHRS) and Adult Substance Use Rehabilitative Services (ASURS) would move to MCOs. Providers would stop sending those claims to DHCF. It also said free-standing mental health clinics were already covered by MCOs. Because the carve-in is paused, expect MHRS and ASURS to stay on the fee-for-service path until DHCF posts a new date.
How do I bill DC Medicaid for therapy?
Enroll with DC Medicaid and register in the Gainwell portal. Check whether the member is in an MCO or in fee-for-service. Bill the MCO for MCO members and DHCF through Gainwell for fee-for-service. Verify eligibility and the member’s current plan on the date of service, because plan assignments change. Our insurance verification service page shows what to confirm.
The Gainwell change in 2026 and DC Medicaid behavioral health billing
Gainwell Technologies became the DC Medicaid fiscal agent and claims payer on March 2, 2026. DHCF’s Medicaid Director Letter 26-01, dated February 3, 2026, gives the timeline:
- January 20, 2026: Gainwell provider portal went live.
- February 2, 2026: provider registration opened.
- March 2, 2026: Gainwell became fiscal agent. The prior vendor’s role ended.
- March 6, 2026: no provider payments issued.
- March 13, 2026: first payments from the Gainwell system.
The letter says providers who did not register could not submit claims or get paid after go-live. If you skipped it, register now.
The DC Medicaid portal is where you register, train and submit. Per the site, electronic claims go in as X12 837 files or on paper. Electronic claims must be transmitted by 3:00 p.m. Eastern on Fridays to make that week’s payment cycle. Old mailboxes for the prior vendor are inactive. The portal lists a contact center at (866) 752-9233 for registration and training questions.
Sending 837 files through a clearinghouse? Our electronic claims submission page explains the flow.
Rates: check the fee schedule, not a blog
DHCF’s Transmittal 25-04, posted February 14, 2025, says the DC Medicaid fee schedule was updated effective January 1, 2025. The increases cover MHRS, ASURS, free-standing mental health clinics, and supported employment. The codes and amounts sit in the attachment. Pull your own codes from the current fee schedule on the portal.
Telehealth: GT, 93 and place of service
DHCF’s telemedicine guidance from January 2023 is specific, and it differs from what many commercial payers use:
- The provider must be enrolled in Medicaid and licensed where the service is delivered.
- Psychiatric evaluation and treatment, psychotherapy and counseling can be delivered by telemedicine.
- Modifier GT goes on video-audio services. Modifier 93 goes on audio-only services. The guidance does not mention modifier 95.
- Place of service (POS) 10 means the patient’s home. POS 02 covers other eligible originating sites. POS 03 covers a school.
- Claims without the right modifier and POS can be disallowed in an audit.
Many commercial payers use 95 instead of GT. Our guide to telehealth modifiers 93 and 95 explains the difference. MCOs can have their own telehealth policies, so check each plan.
Therapist and psychiatrist differences
Therapists bill psychotherapy codes such as 90834 and 90837. Review the psychotherapy code guide before you submit. Psychiatrists bill evaluation and management (E/M) visits, and some add psychotherapy add-on codes. Confirm that each payer, MCO or fee-for-service, pays the add-on with the E/M. Unfamiliar terms are defined in our behavioral health billing glossary and Medicaid billing glossary.
DC Medicaid behavioral health billing checklist
Use this list to keep DC Medicaid behavioral health billing on track.
- Register in the Gainwell portal and confirm your enrollment record.
- Join the networks of the MCOs whose members you see. See our credentialing and network status guide.
- Verify eligibility and plan on every date of service.
- Put GT or 93, and the right POS, on telehealth claims.
- Transmit claims before the Friday 3:00 p.m. cutoff when you want the weekly cycle.
- Keep an aging report for MCO and fee-for-service claims separately.
The DC plan list changed on August 1, 2026. For Medicaid code differences between jurisdictions, see our Medicaid HCPCS guide. More guides are on our resources hub.
DC Medicaid behavioral health billing FAQ
Short answers on DC Medicaid behavioral health billing follow.
Is the DC behavioral health carve-in happening?
DHCF says planning for the April 1, 2024 carve-in was paused in February 2024. We did not find a new date on its page. Confirm with DHCF before you change anything.
Who pays fee-for-service claims now?
DHCF pays them, and Gainwell has been the fiscal agent and claims payer since March 2, 2026.
Does DC Medicaid cover telehealth psychotherapy?
Yes. DHCF’s January 2023 guidance lists psychotherapy and counseling as eligible, with GT for video, 93 for audio-only, and POS 10, 02 or 03.
Does MCM South bill DC Medicaid?
MCM South offers billing services to mental and behavioral health practices in the District of Columbia. To talk through which payers and programs fit your practice, request a free consultation. Payer phone numbers for DC are in our Maryland and DC insurance contact guide, and more answers are in our mental health 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 the District of Columbia, 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.
