Washington Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Washington, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Washington billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Washington billing guide: how Washington pays for outpatient care
Apple Health, Washington's Medicaid program, is run by the Health Care Authority (HCA). Most members are in integrated managed care, where five managed care organizations cover physical and behavioral health by region, so you bill the member's plan. Fee-for-service claims go through ProviderOne.
Behavioral health Administrative Services Organizations cover crisis services and some services for people who are not eligible for Apple Health. Starting January 1, 2027, most Apple Health for Adults enrollees must meet a work requirement or qualify for an exemption.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid (Apple Health) | Health Care Authority; five managed care organizations; ProviderOne for fee-for-service | HCA provider enrollment |
| Medicare Part B | Noridian Healthcare Solutions, Jurisdiction F | CMS MAC page |
| Blue Cross Blue Shield | Premera Blue Cross and Regence BlueShield | See the Blue Cross section below |
Washington Medicaid: Apple Health
This Washington billing guide starts with Medicaid, because it decides who pays and how you file.
Apple Health behavioral health is not carved out. State law required fully integrated managed care covering physical health, mental health and substance use treatment statewide by January 1, 2020. HCA's mental health billing guide says to send claims for managed care clients to the client's managed care organization.
Apple Health Foster Care is statewide through Coordinated Care (Apple Health Core Connections).
| Item | What to know |
|---|---|
| Agency | Washington State Health Care Authority |
| Provider enrollment | HCA: enroll as a provider |
| Mental health billing guide | HCA Mental Health Services billing guide, effective April 1, 2026 |
| Provider requirements | Providers must be independently licensed by the Department of Health, with a core provider agreement and an NPI. Associate taxonomy and claim-note rules apply to dates of service on and after January 1, 2026. Source |
| Service area map | HCA Apple Health service area map, January 2026 |
| Work requirement | Starting January 1, 2027, most adults 19 to 64 applying for or renewing Apple Health for Adults must show $580 a month in income or 80 hours a month of work, community service, a work program or half-time school, or qualify for an exemption. Medically frail people and people in substance use treatment are among the exemptions. Coverage periods move from 12 to 6 months. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Coordinated Care of Washington | Apple Health managed care organization. |
| Community Health Plan of Washington | Apple Health managed care organization. |
| Molina Healthcare of Washington | Apple Health managed care organization. |
| UnitedHealthcare Community Plan of Washington | Apple Health managed care organization. |
| Wellpoint Washington | Apple Health managed care organization, previously Amerigroup. |
Plans vary by region. Check the HCA service area map for the plans that serve each member's region.
Medicare Part B in Washington
For Medicare, this Washington 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 F: Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Washington
This part of the Washington 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. Washington has two independent Blue licensees, Premera Blue Cross and Regence BlueShield. Regence's Washington newsroom describes it as an independent licensee of the Blue Cross and Blue Shield Association. Check the member's card to see which plan applies, and do not apply one plan's rules to the other.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Premera Blue Cross | Independent Blue licensee | Alaska and Washington, as the Premera provider page describes it. Confirm counties with Premera. | Premera behavioral health provider page |
| Regence BlueShield | Independent licensee of the Blue Cross and Blue Shield Association | Select Washington counties. Confirm counties with Regence. | Regence behavioral health |
Other private payers and EAPs in Washington
The Washington billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Washington. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Premera Blue Cross | Premera says professional and facility claims go through Availity. | Official page |
| Regence BlueShield | See the Regence behavioral health page for member and provider information. | Official page |
| Apple Health managed care organizations | Bill the client's managed care organization for Apple Health managed care clients. | Official page |
Washington billing guide: state law that changes billing
Use this section of the Washington billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Washington. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
E2SHB 1432 (2025) replaced the separate parity statutes with RCW 48.43.766, which applies to all health carriers and incorporates the federal parity final rules. The Office of the Insurance Commissioner (OIC) filed a CR-102 for rulemaking R 2025-13 on October 20, 2026, with comments open from October 22 to December 2, 2026. OIC rulemaking page
Telehealth coverage and payment parity
RCW 48.43.735 and OIC rule WAC 284-170-130 require carriers to reimburse telemedicine at the same allowed amount as in-person care unless a different amount is negotiated. Audio-only telemedicine is covered with prior patient consent, and an established relationship is required from January 1, 2023. Rule
Prompt payment
WAC 284-170-431, as described in an OIC letter dated April 4, 2024, requires carriers to pay at least 95% of clean claims within 30 days and pay or deny at least 95% of all claims within 60 days. OIC letter
Practitioner scope: therapists and prescribers
The Department of Health lists physicians, osteopathic physicians, ARNPs and PAs among prescribers. HCA billing rules for associates changed for dates of service from January 1, 2026. DOH prescriber page
Not legal advice. Confirm statute details with counsel.
Washington billing guide: codes and rates
This Washington billing guide lists only codes and rates confirmed on official pages.
These are the Washington-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 |
|---|---|
| 90791 and 90792 | One per client per provider per calendar year without a limitation extension. Source |
| 90833, 90836 and 90838 add-ons | Add-on codes must be billed with an E/M on the same claim. 90846, 90847 and 90849 are not covered for marriage counseling. Source |
| Associate taxonomy and claim notes | LICSW and associates use 104100000X, LMFT and associates 106H00000X, LMHC and associates 101YM0800X, and psychiatric ARNPs 363LP0808X. Medicaid-only and dual-eligible clients need a claim note such as "LMHP associate" for dates of service from January 1, 2026. Source |
| Psychological testing 96130 to 96139 | Twelve units per client per lifetime without prior authorization. Source |
Washington billing guide: what changed, newest first
Check this Washington billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | Apple Health work requirements and 6-month coverage periods begin for Apple Health for Adults. | Source |
| 2026-10-20 | OIC filed CR-102 for mental health parity rules R 2025-13. Comments open October 22 to December 2, 2026. | 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 |
| 2026-06-01 | HCA published its H.R. 1 work requirements and renewals fact sheet. | Source |
| 2026-04-01 | HCA Mental Health Services billing guide edition takes effect. | Source |
| 2026-01-01 | HCA associate taxonomy and claim-note rules take effect for Medicaid-only and dual-eligible clients. | Source |
How do I bill mental health claims in Washington?
These answers come from the same sources as the rest of this Washington billing guide.
Start with the member's payer type. For Apple Health managed care, bill the client's managed care organization. For fee-for-service, use ProviderOne and the HCA billing guide. Medicare Part B goes to Noridian in Jurisdiction F. Washington has two Blue licensees, Premera Blue Cross and Regence BlueShield.
Questions about billing in Washington
Who do I bill for Apple Health mental health claims?
For managed care clients, bill the client's managed care organization. For fee-for-service clients, use ProviderOne and the HCA mental health billing guide.
How many Blue plans are there in Washington?
Two independent licensees: Premera Blue Cross and Regence BlueShield. Check the member's card.
When does the Apple Health work requirement start?
HCA says January 1, 2027 for most adults 19 to 64 applying for or renewing Apple Health for Adults, with exemptions for groups such as medically frail people.
Does Washington require telehealth payment parity?
Yes for state-regulated carriers. RCW 48.43.735 and WAC 284-170-130 require the same allowed amount as in person unless a different amount is negotiated.
Does MCM South bill for practices in Washington?
MCM South currently serves ten states; request a quote to ask about Washington.
Sources for the Washington billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- Washington Health Care Authority, checked October 25, 2026
- HCA: enroll as a provider, checked October 25, 2026
- HCA Mental Health Services billing guide, checked October 25, 2026
- HCA H.R. 1 work requirements fact sheet, checked October 25, 2026
- HCA Apple Health service area map, checked October 25, 2026
- CMS: MAC Jurisdiction F, checked October 25, 2026
- OIC mental health parity rulemaking R 2025-13, checked October 25, 2026
- WSR 21-24-029, audio-only telemedicine rule, checked October 25, 2026
- OIC prompt payment letter, checked October 25, 2026
- Premera behavioral health provider page, checked October 25, 2026
- Regence behavioral health, checked October 25, 2026
- Department of Health: who may prescribe, 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
- Washington insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Washington
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- California insurance companies contact guide
- Colorado insurance companies contact guide
Billing in Washington? 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 Washington.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.