State & Regional Billing Guides for Therapists and Psychiatrists
Billing rules are set state by state. Use these state billing guides to find the Medicaid, private payer and telehealth rules for your state, and the dated changes to watch in 2026 and 2027.
Last reviewed October 14, 2026
Jump to your state
What are state billing guides?
State billing guides explain how a state's insurance rules change what you bill, to whom, and how you get paid.
They cover the state Medicaid program, the Blue Cross Blue Shield plan and other private payers there, and state rules on telehealth and parity. Medicare is federal, so see the CPT & E/M Code Guide for that.
Two things make state rules hard to track. Medicaid is run by each state, often through managed care plans that each have their own manuals. And Blue Cross Blue Shield is a group of independent companies, so one state's plan is not a guide to the next.
Each of the state billing guides says which rule is private payer, which is Medicare or Medicaid, and which is state law.
State billing changes to know in October 2026 and after
Florida moves its Children's Medical Services Plan to Molina on October 1, 2026. Illinois now rejects CPT 96127 claims that lack a U1 or U2 modifier. And every state with Medicaid expansion must have the federal work requirement in place by January 1, 2027.
In effect or pending now (October 2026)
| Date | State or scope | What changes | Who it affects | Source |
|---|---|---|---|---|
| 10/1/2026 This month | Florida | The Children's Medical Services (CMS) Plan moves from Sunshine State Health Plan to Molina Healthcare. Existing authorizations are honored. | Providers who treat CMS Plan children | AHCA |
| In effect since 8/1/2026 | Illinois | CPT 96127 claims need modifier U1 (negative screen) or U2 (positive screen with follow-up plan), or the claim is rejected. Fee-for-service and HealthChoice Illinois. | Providers billing 96127 | HFS notice, 7/7/2026 |
| Pending | Federal, Medicare | CMS proposed the CY2027 Physician Fee Schedule on 7/14/2026. The proposed conversion factor falls 1.19% (qualifying APM) and 1.68% (non-qualifying). Comments closed 9/14/2026. The final rule is still to come. | Practices billing Medicare, and payers that key rates to it | Federal Register proposed rule |
Coming up (January 2027)
| Date | State or scope | What changes | Who it affects | Source |
|---|---|---|---|---|
| 1/1/2027 | Federal, Medicaid | States must have the work requirement in place. Adults must show 80 hours a month of work, service, a work program or half-time school. Exemptions include medically frail individuals and people in drug or alcohol treatment. | Expansion-state Medicaid adults; eligibility and coverage gaps | Federal Register, 6/3/2026 |
| 1/1/2027 | New York | Old ACT rate codes (4508, 4509, 4511, 4513, 4514, 4515) stop for dates of service on or after this date. New ACT rate, procedure and modifier codes replace them. | ACT teams billing Medicaid managed care, HARPs and HIV SNPs | NY OMH memo |
Took effect this summer
| Date | State or scope | What changed | Source |
|---|---|---|---|
| 7/1/2026 | New York | ACT rate enhancements begin (includes the SFY 2026-27 targeted inflationary increase of 2.7%). | NY OMH memo |
| 7/1/2026 | Colorado | Regional Accountable Entities (RAEs) begin paying for youth residential services (PRTF, QRTP) for members involved with child welfare. Providers must contract with the RAE. | HCPF fact sheet |
| 7/31/2026 | Federal, Medicaid | CMS interim final rule on Medicaid community engagement (work) requirements takes effect. | Federal Register, 6/3/2026 |
Checked 10/14/2026. Confirm each date with the source before you rely on it. See the full update log (coming soon). Coming soon
Find your state's billing guide
Start with the ten states we serve. Each of our state billing guides will cover the Medicaid program, the Blue Cross plan, state rules and the dated changes for that state. Need a phone number or enrollment link instead? Use the Insurance Companies Contact by State directory.
Georgia
Massachusetts
Connecticut
Texas
Florida
New York
Colorado
Tennessee
North Carolina
Illinois
Each card jumps to that state's section below until its dedicated guide is published.
All states by region
Every state has a row here. The ten states we serve are highlighted and get a dedicated guide. Other states fill in as we research them, from official state sources. We never assume a state works like its neighbor.
Northeast
| State | Latest change | Links |
|---|---|---|
| Connecticut | In research | Medicaid billing · Insurer contacts · Blue Cross guide |
| Massachusetts | In research | Medicaid billing · Insurer contacts · Blue Cross guide |
| Maine | In research | Blue Cross guide |
| New Hampshire | In research | Blue Cross guide |
| New Jersey | In research | — |
| New York | 1/1/2027: old ACT rate codes end | Medicaid billing · Insurer contacts · Blue Cross guide |
| Pennsylvania | In research | Insurer contacts · Blue Cross guide |
| Rhode Island | In research | Blue Cross guide |
| Vermont | In research | Blue Cross guide |
Midwest
| State | Latest change | Links |
|---|---|---|
| Iowa | In research | Blue Cross guide |
| Illinois | 8/1/2026: modifier U1 or U2 required on CPT 96127 | Medicaid billing · Insurer contacts · Blue Cross guide |
| Indiana | In research | — |
| Kansas | In research | — |
| Michigan | In research | Blue Cross guide |
| Minnesota | In research | Blue Cross guide |
| Missouri | In research | — |
| North Dakota | In research | Blue Cross guide |
| Nebraska | In research | — |
| Ohio | In research | Blue Cross guide |
| South Dakota | In research | Blue Cross guide |
| Wisconsin | In research | Blue Cross guide |
South
| State | Latest change | Links |
|---|---|---|
| Alabama | In research | Insurer contacts · Blue Cross guide |
| Arkansas | In research | Blue Cross guide |
| District of Columbia | In research | Insurer contacts |
| Delaware | In research | — |
| Florida | 10/1/2026: Children's Medical Services Plan moves to Molina | Medicaid billing · Insurer contacts · Blue Cross guide |
| Georgia | In research | Medicaid billing · Insurer contacts · Blue Cross guide |
| Kentucky | In research | Blue Cross guide |
| Louisiana | In research | Blue Cross guide |
| Maryland | In research | Insurer contacts |
| Mississippi | In research | Blue Cross guide |
| North Carolina | In research | Medicaid billing · Insurer contacts · Blue Cross guide |
| Oklahoma | In research | — |
| South Carolina | In research | Blue Cross guide |
| Tennessee | In research | Medicaid billing · Insurer contacts · Blue Cross guide |
| Texas | In research | Medicaid billing · Insurer contacts · Blue Cross guide |
| Virginia | In research | Blue Cross guide |
| West Virginia | In research | Blue Cross guide |
West
| State | Latest change | Links |
|---|---|---|
| Alaska | In research | — |
| Arizona | In research | Blue Cross guide |
| California | In research | Medi-Cal billing · Insurer contacts · Blue Cross guide |
| Colorado | 7/1/2026: RAEs begin paying youth residential services | Medicaid billing · Insurer contacts · Blue Cross guide |
| Hawaii | In research | — |
| Idaho | In research | — |
| Montana | In research | — |
| New Mexico | In research | — |
| Nevada | In research | — |
| Oregon | In research | — |
| Utah | In research | — |
| Washington | In research | Insurer contacts · Blue Cross guide |
| Wyoming | In research | — |
Topics that apply across states
Medicaid managed care by state
Which plans and carve-outs run behavioral health, and who you contract with. Start with Medicaid Managed Care.
Medicaid work requirements
What the federal rule requires and what changes for your patients' coverage checks.
Coming soonParity and state insurance law
What federal and state parity laws require of payers. Start with Mental Health Parity.
Telehealth billing by state
Place of service, modifiers and payer differences.
Coming soonCredentialing by state
Medicaid enrollment and plan credentialing steps. See Credentialing & Network Status.
Medicare by locality
How Medicare pays by locality. See the CPT & E/M Code Guide.
Payer policy updates
Dated changes in a six-part format.
Coming soonUpdate log and calendar
Every change, by date and state.
Coming soonHow every state guide is built
The same eight parts on every one of our state billing guides, so you can compare states side by side.
- 1. OverviewWho pays for outpatient mental health in the state, and how.
- 2. MedicaidFee-for-service or managed care, plans, carve-outs, manuals, fee schedule, portal.
- 3. Blue Cross Blue ShieldThe one licensee in that state, linked to its guide.
- 4. Other private payers and EAPThe main commercial plans there.
- 5. State lawParity, telehealth and anything state-specific that changes billing.
- 6. Codes and ratesState-specific codes and modifiers.
- 7. What changedA dated list, newest first.
- 8. Sources and last review dateOfficial links, each with the date checked.
How we keep these state billing guides current
Each of the state billing guides shows the date we last reviewed it. We re-check the guides after any state or federal notice that affects them, and review all of them on a set schedule.
Every change uses six parts: what changed, when it takes effect, who it affects, the practical impact, what to do next, and questions to ask the payer.
Written for both psychotherapists and psychiatrists
Our state billing guides call out where prescribers differ: E/M visits, add-on codes, and prescribing paperwork such as DEA and EPCS rules. Where both follow the same rule, the guide says so.
Looking for the business side? See Private Practice Management.
Where do I start?
Start with your own state's Medicaid and Blue Cross pages in these state billing guides, because that is where most claim rules differ. Then read the dated changes for your state. If you work in more than one state, keep a one-page list per state.
For the basics, see the Billing Terms Glossary, Claim Denials & Appeals and In-Network vs Out-of-Network.
Official sources by state
- Georgia DCH · Florida AHCA · New York OMH
- Colorado HCPF · Illinois HFS · NC Medicaid · TennCare
- Medicaid.gov · CMS.gov
We are not affiliated with these agencies. They are public resources.
Frequently asked questions
Do billing rules really differ by state?
What billing changes take effect in October 2026?
How current are these state billing guides?
Is this legal or compliance advice?
What is the federal Medicaid work requirement?
Want billing off your plate?
MCM South serves mental health practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Our state billing guides start with the ten states we serve, and our founder has worked in all 50 states. See who we serve.