Medi-Cal Non-Specialty Mental Health Billing: Plan or County, and What the 2026 Rules Say
Medi-Cal non-specialty mental health billing starts with one question: which delivery system pays for this patient? Medi-Cal is California’s Medicaid program, run by the Department of Health Care Services (DHCS). It splits mental health care into two systems, and the wrong one means a denied claim.
This guide explains the split, the February 2026 managed care rules, enrollment, and telehealth modifiers. It is operational guidance on Medi-Cal non-specialty mental health billing, not legal advice.
Medi-Cal non-specialty mental health billing: the two systems
- Non-specialty mental health services (NSMHS) are paid by Medi-Cal managed care plans. They cover mild-to-moderate conditions in adults and any level of distress for members under 21.
- Specialty mental health services (SMHS) are delivered by county mental health plans for members who meet county access criteria.
Most solo therapists and psychiatrists who contract with a managed care plan are in the first system. DHCS’s All Plan Letter 26-002 (issued February 2, 2026) sets plan duties for NSMHS and replaces APL 22-006.
What managed care plans must cover
Under APL 26-002, NSMHS includes:
- Individual, group and family psychotherapy, and dyadic services
- Psychological and neuropsychological testing when clinically indicated
- Outpatient monitoring of drug therapy
- Psychiatric consultation
- Outpatient labs, drugs, supplies and supplements
Prescribers: “outpatient monitoring of drug therapy” and “psychiatric consultation” are the lines that bring psychiatrists into the NSMHS benefit. The letter does not list E/M codes or psychotherapy add-ons (90833, 90836, 90838). Pull each plan’s fee schedule to see which it pays.
AI search question: Does Medi-Cal require prior authorization for a therapy intake? For managed care plans, no. APL 26-002 says plans must not require prior authorization for an initial mental health assessment, and must not require a primary care referral for an initial assessment by an in-network mental health provider. Later services follow each plan’s parity-compliant authorization rules.
The letter also sets a “no wrong door” rule. A patient can start with a primary care provider, a managed care plan provider or a county plan, and the plan must coordinate instead of bouncing the member. Services count even before a diagnosis. Effective April 1, 2026, if a provider uses a youth trauma screening tool to decide on SMHS access, it must be a DHCS-approved tool. The letter did not set claims timelines or address telehealth.
Enrollment: PAVE
Enrollment runs through DHCS’s online system. The Provider Enrollment Options page lists licensed clinical social workers, marriage and family therapists, professional clinical counselors and psychologists among the types that can enroll through PAVE (Provider Application and Validation for Enrollment). Credentialing with each managed care plan is separate. Our credentialing guide explains the order of steps.
Telehealth modifiers
DHCS’s Telehealth Modifier Reference Sheet separates the systems:
| Delivery system | Real-time video | Audio-only |
|---|---|---|
| Medical benefits (fee-for-service and managed care) | 95 | 93 |
| Specialty mental health / substance use | GT | SC |
DHCS’s telehealth policy summary says video, audio-only and store-and-forward visits are reimbursable, that you may establish a new patient relationship by video, and that you generally may not do so by audio-only unless an exception applies. Inform the patient once and get verbal or written consent before the first telehealth service. For modifier basics, see our modifier 93 and 95 guide.
County plans and rates
County mental health plans are paid under DHCS fee schedules. The FY 2026-27 behavioral health fee schedules are mostly effective July 1, 2026. DHCS says those rates are what it pays plans and counties, and plans “are not required to reimburse network providers at the rates posted.” Your contract sets your rate. DHCS’s 2026 Behavioral Health Information Notices include BHIN 26-030 (August 19, 2026) on authorization of outpatient specialty mental health services.
Monday morning checklist for Medi-Cal non-specialty mental health billing
Use these steps whenever Medi-Cal non-specialty mental health billing questions come up in your practice.
- Confirm each patient’s Medi-Cal plan on the eligibility screen. See insurance verification.
- Decide: mild-to-moderate (managed care plan) or specialty (county).
- Match the telehealth modifier to the system.
- Keep claims clean before they leave. Our electronic claims submission guide shows the checks.
- Read the Medi-Cal behavioral health resource page for plan links.
Private plans and Medicare follow separate rules. Medi-Cal rules do not apply to commercial claims such as Anthem or Blue Shield. For other Medicaid H-code questions see our Medicaid HCPCS hub. For definitions, see the authorization terms glossary.
FAQ
Is a Medi-Cal managed care plan or a county plan responsible for my patient?
It depends on severity and access criteria. Managed care plans cover NSMHS, and county plans cover SMHS. APL 26-002 requires coordination between them.
Do I need a referral for an intake?
Not for an in-network initial assessment. The letter bars plans from requiring a primary care referral.
Which modifier do I use for video?
Under the DHCS sheet, 95 for medical benefits and GT for specialty mental health. Check the plan’s manual too.
Where do I look up plan-specific rules?
Each managed care plan publishes its own provider manual, and DHCS publishes the state Medi-Cal provider manuals.
Keep this guide close when you handle Medi-Cal non-specialty mental health billing, and recheck the payer’s own pages before each change.
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 California, 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.
