California Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in California, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This California billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
California billing guide: how California pays for outpatient care
California splits Medi-Cal mental health between two systems. Medi-Cal managed care plans cover non-specialty mental health services for mild-to-moderate needs, and county Mental Health Plans cover specialty mental health services. Bill the plan or county that matches the member's level of need.
Commercial plans fall under the Department of Managed Health Care or the Department of Insurance, and SB 855 requires coverage of medically necessary mental health and substance use treatment on the same terms as other medical conditions. California has no single Blue plan, so check which licensee covers the member.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid (Medi-Cal) | Department of Health Care Services (DHCS); managed care plans and county Mental Health Plans | DHCS provider enrollment |
| Medicare Part B | Noridian Healthcare Solutions, Jurisdiction E | Noridian JE site |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield of California (two independent companies) | See the Blue Cross section below |
California Medicaid: Medi-Cal
This California billing guide starts with Medicaid, because it decides who pays and how you file.
Medi-Cal managed care plans are organized by county. They deliver non-specialty mental health services to adults 21 and over with mild-to-moderate distress or impairment, and to members under 21 as EPSDT requires. County Mental Health Plans deliver specialty services to members who meet the access criteria in BHIN 26-002, and claim them through the Short-Doyle/Medi-Cal system. Under the No Wrong Door policy, members are referred to the right system.
Members can get an initial mental health assessment from an in-network licensed provider without a referral or prior authorization. DHCS All Plan Letter 26-002, dated February 2, 2026, sets out managed care plan duties for non-specialty services and replaces APL 22-006.
| Item | What to know |
|---|---|
| Agency | California Department of Health Care Services |
| Provider enrollment | DHCS Provider Enrollment Division through the PAVE portal |
| Specialty mental health billing manual | SMHS Billing Manual, May 2024 |
| Filing window | Medi-Cal fee-for-service and specialty mental health original claims must be submitted within 12 months of the month of service. Source |
| Telehealth modifiers | For medical benefits, 95 is synchronous video, 93 is audio-only and GQ is store-and-forward. Specialty mental health and substance use systems use GT, SC and GQ. Source |
| Work requirement | DHCS says the federal work and community engagement requirement starts January 1, 2027 for adults 19 to 64 in the expansion group, and lists an exemption for people with serious mental health conditions. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Anthem Blue Cross Partnership Plan | Medi-Cal managed care plan in many counties per the DHCS 2026 county table. |
| Health Net Community Solutions | Managed care plan in counties including Los Angeles and Sacramento. |
| Kaiser Permanente | Appears in many counties in the DHCS table. |
| Molina Healthcare of California | Managed care plan in Riverside, Sacramento, San Bernardino and San Diego. |
| Other county plans | Includes L.A. Care, CalOptima, Partnership HealthPlan and Inland Empire Health Plan. See the DHCS table. |
Check the DHCS plan and county table for the plans that serve your members' counties.
Prescribers: a Los Angeles County DMH bulletin revised August 11, 2026 says DHCS reported that the June 26, 2026 PAVE enrollment deadline for prescribers is no longer active and a new date will be shared. Check DHCS for the current date.
Medicare Part B in California
For Medicare, this California billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | Noridian Healthcare Solutions, LLC |
| Jurisdiction | Jurisdiction E: California, Hawaii, Nevada and Pacific territories |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in California
This part of the California billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. California has two independent Blue licensees: Anthem Blue Cross (the trade name of Blue Cross of California) and Blue Shield of California. Anthem's California provider news says the two are separate and independent companies. Send claims with the right payer ID: a claim for an Anthem member sent with the Blue Shield of California payer ID processes as out-of-network.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross (Blue Cross of California) | Independent of Blue Shield of California | California | Anthem California provider news |
| Blue Shield of California | Independent of Anthem Blue Cross | California | Blue Shield claims page |
Other private payers and EAPs in California
The California billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in California. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Anthem Blue Cross claims | Commercial claims go through Availity. In overlapping Blue service areas, use the Anthem Blue Cross payer ID for Anthem members. | Official page |
| Blue Shield of California claims | Claims go by EDI, SympliSend or mail through the Provider Connection portal. The claims page says county behavioral health providers must begin submitting claims to Blue Shield of California on July 1, 2026, with the keyword "county submission". Ask Blue Shield what that covers. | Official page |
California billing guide: state law that changes billing
Use this section of the California billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in California. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
SB 855 (2020) requires plans and insurers with hospital, medical or surgical coverage to cover medically necessary treatment of mental health and substance use conditions on the same terms as other medical conditions, and not limited to short-term treatment. It applies to contracts issued, amended or renewed on or after January 1, 2021, and exempts Medi-Cal managed care contracts. SB 855 text
Telehealth coverage and payment parity
AB 744 (2019) requires commercial plans to reimburse telehealth on the same basis as in-person care for the same service, and bars telehealth copays above in-person amounts. Medi-Cal managed care plans are excluded from that section. AB 744 text
Prompt payment
Health and Safety Code 1371, as rewritten by AB 3275 and operative January 1, 2026, requires a plan to pay or contest a complete claim within 30 calendar days of receipt, with 15% annual interest after day 30. DMHC says it applies to commercial and Medi-Cal health care service plans. DMHC guidance
Practitioner scope: therapists and prescribers
Clinicians regulated by the Board of Behavioral Sciences who provide telehealth to clients in California must hold a current California license or registration and document consent and client location. In Medi-Cal specialty mental health, MFTs and LPCCs who do not meet Medicare requirements bill with modifier HL. BBS telehealth guidance
Not legal advice. Confirm statute details with counsel.
California billing guide: codes and rates
This California billing guide lists only codes and rates confirmed on official pages.
These are the California-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Telehealth place of service | In specialty mental health, if a telehealth modifier is used, the place of service must be 02 or 10 unless the service is mobile crisis. Source |
| 90834 and 90791 time rules | Specialty mental health midpoint rule: bill 90834 when 38 to 52 minutes are provided. 90791 is billable at 31 minutes. T1013 interpretation cannot be billed with 90785. Source |
| Modifier HL | MFTs and LPCCs who do not meet Medicare requirements bill Short-Doyle/Medi-Cal directly with HL. Source |
| Payment reform (July 1, 2023) | Rates for licensed practitioner assessments differ from rates for non-licensed staff. See the DHCS fee schedule page. Source |
California billing guide: what changed, newest first
Check this California billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | Medi-Cal work and community engagement requirements start for adults 19 to 64 in the expansion group. | Source |
| 2026-08-11 | Los Angeles County DMH revised bulletin 26-02R on PAVE enrollment for prescribers. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-07-01 | Blue Shield of California page says county behavioral health providers must begin submitting claims to Blue Shield. | Source |
| 2026-02-02 | DHCS APL 26-002 on managed care plan responsibilities for non-specialty mental health services. | Source |
| 2026-01-01 | AB 3275 claim reimbursement rules apply to claims received on or after this date. | Source(4_1_2025).pdf) |
How do I bill mental health claims in California?
These answers come from the same sources as the rest of this California billing guide.
Start with the member's payer type. For Medi-Cal, bill the managed care plan for non-specialty mental health services and the county Mental Health Plan for specialty services. Medicare Part B goes to Noridian in Jurisdiction E. California has two independent Blue licensees: Anthem Blue Cross and Blue Shield of California.
Questions about billing in California
Who do I bill for Medi-Cal mental health claims?
Bill the member's Medi-Cal managed care plan for non-specialty mental health services and the county Mental Health Plan for specialty services. DHCS APL 26-002 explains which system covers which members.
How many Blue plans are there in California?
Two independent licensees: Anthem Blue Cross (Blue Cross of California) and Blue Shield of California. Use the payer ID that matches the member's card.
What is the Medi-Cal timely filing limit?
For fee-for-service and specialty mental health claims, 12 months from the month of service. Managed care plans set their own limits, so check each plan.
When does the Medi-Cal work requirement start?
DHCS says January 1, 2027 for adults 19 to 64 in the expansion group, with an exemption for people with serious mental health conditions.
Does MCM South bill for practices in California?
MCM South currently serves ten states; request a quote to ask about California.
Sources for the California billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- DHCS, checked October 25, 2026
- DHCS Provider Enrollment Division, checked October 25, 2026
- DHCS APL 26-002, checked October 25, 2026
- DHCS SMHS Billing Manual, May 2024, checked October 25, 2026
- DHCS telehealth modifier reference sheet, checked October 25, 2026
- DHCS Medi-Cal changes, checked October 25, 2026
- DHCS 2026 plan and county table, checked October 25, 2026
- Noridian JE Part B, checked October 25, 2026
- Anthem California provider news, checked October 25, 2026
- Blue Shield of California claims, checked October 25, 2026
- DMHC APL 25-007 on AB 3275, checked October 25, 2026
- SB 855 text, checked October 25, 2026
- AB 744 text, checked October 25, 2026
- Board of Behavioral Sciences telehealth guidance, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- California insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for California
- California Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Washington insurance companies contact guide
Billing in California? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about California.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.