New York Medicaid Billing for LCSW, LMHC and LMFT: Enrollment and Rules
New York Medicaid billing for LCSW, LMHC and LMFT clinicians starts with enrollment. Licensed clinical social workers (LCSWs), licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs) can bill New York Medicaid in private or group practice once they enroll. The rules differ between fee-for-service Medicaid and Medicaid managed care. This guide to New York Medicaid billing LCSW LMHC LMFT clinicians need sorts out which is which. It covers New York only. Sources were checked on October 9, 2026.
Who can enroll and bill
This section covers who can enroll for New York Medicaid billing LCSW LMHC LMFT clinicians handle.
The state’s LCSW, LMHC and LMFT Policy Manual (July 2025 edition) sets the ground rules:
- You must be licensed and registered with the New York State Education Department (NYSED).
- You must enroll in NYS Medicaid fee-for-service (FFS) to be reimbursed for FFS members. The manual also mentions Medicaid managed care (MMC) enrollees.
- Licensed master social workers (LMSWs) cannot enroll or participate independently. They may work only under supervision by an LCSW, licensed psychologist or psychiatrist.
- Limited permit holders cannot enroll. Their services can be billed under a supervising clinician’s NPI.
- Enrolled providers must revalidate every five years.
Where can you practice? The manual says enrolled LCSWs, LMHCs and LMFTs in private or group practice may bill directly for their own services and for supervised limited permit holders’ services. Clinic settings work differently. In an Article 28 hospital outpatient department or clinic, the practitioner enrolls as an OPRA provider, and the clinic gets a payment that includes the professional component. You cannot send a separate professional claim.
How do I enroll in New York Medicaid as a therapist?
Enroll through eMedNY. Choose the individual billing path if you will bill FFS Medicaid directly. Choose the non-billing path if you will only serve members through managed care plans and will not bill FFS. Revalidate every five years. eMedNY’s LMHC enrollment page lists three routes: individual billing, non-billing (ordering, prescribing, referring or attending, or managed care network provider), and switching from non-billing to billing. That page covers LMHCs, so confirm the LCSW and LMFT pages offer the same options.
For a refresher on plan enrollment more broadly, read our credentialing and network status guide and the credentialing terms glossary.
Which CPT codes fit New York Medicaid billing for LCSW, LMHC and LMFT?
The manual’s Section IV lists codes by license. They are not identical.
| Code group | LCSW | LMHC | LMFT |
|---|---|---|---|
| 90791 (diagnostic evaluation) | Yes | No | No |
| 90832, 90834, 90837 (psychotherapy) | Yes | Yes | Yes |
| 90785 (interactive complexity), 90839, 90840 (crisis) | Yes | Yes | Yes |
| 90846, 90847, 90849 (family), 90853 (group) | Yes | Yes | Yes |
| 98970 to 98972 (eVisits only) | Yes | No | No |
| H2017 (psychosocial rehabilitation) | Yes | No | No |
| T1013 (interpreter services) | Yes | Yes | Yes |
Review the psychotherapy code guide before you submit. Evaluation rules for 90791 are in our diagnostic evaluation guide. The manual does not describe prior authorization or telehealth, so confirm those with the payer.
Managed care is a different rulebook
Most New York Medicaid members are in managed care. For them, the state’s Office of Mental Health (OMH) keeps a Medicaid managed care billing page. It lists the NYS Medicaid Managed Care Behavioral Health Billing and Coding Manual (October 2025) and its Summary of Edits. The edits cover the Mainstream, HARP and HIV-SNP product lines, according to OMH’s summary of changes. HARPs are Health and Recovery Plans, which serve members with serious mental illness.
Most of the October 2025 edits touch clinic, crisis and rehabilitation services, not routine outpatient therapy. Still, read the edits that apply to your license. Each plan also publishes its own manual, and it can be stricter than the state’s. Plan phone numbers are in our New York insurance contact guide. The state’s Medicaid Update tells providers that questions about reimbursement, billing or documentation go to the member’s plan (June 2024 Medicaid Update). Our own New York Medicaid billing page lists the manuals and payers. For how Medicaid codes differ by state, see our Medicaid HCPCS guide.
Psychiatrists: a different manual
Psychiatrists do not use the LCSW, LMHC and LMFT manual. Prescribers bill under physician rules, with evaluation and management (E/M) codes and, in some cases, psychotherapy add-on codes. Confirm the add-on policy with each plan. Our Medicaid billing glossary defines the terms.
Five common mistakes in New York Medicaid billing LCSW LMHC LMFT practices make
Avoid these slips in New York Medicaid billing LCSW LMHC LMFT enrollment and claims.
- Billing LMSW sessions under the LMSW’s own number. LMSWs cannot enroll independently.
- Using 90791 as an LMHC or LMFT. It is not on their lists.
- Billing a clinic service twice. In an Article 28 clinic, the clinic is paid for the professional component.
- Letting revalidation slip. The cycle is five years.
- Applying FFS rules to managed care. Send MMC billing questions to the plan.
Check eligibility before every first visit. Our insurance verification service page shows what to confirm, and our electronic claims submission page shows how clean claims move.
New York Medicaid billing LCSW LMHC LMFT FAQ
Short answers on New York Medicaid billing LCSW LMHC LMFT follow.
Can an LMSW bill New York Medicaid on their own?
No. The manual says LMSWs cannot enroll or participate independently.
Do I need to bill Medicaid FFS to see Medicaid managed care members?
eMedNY offers a non-billing path for managed care network providers. Pick the path that fits how you will be paid.
Can an LMHC bill 90837?
Yes. Psychotherapy codes 90832, 90834 and 90837 appear on the LMHC list.
Does MCM South work with New York practices?
Yes. New York is one of the ten states listed below.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service works with mental and behavioral health practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims. If you run a New York practice and want help sorting out Medicaid and commercial billing, see who we serve or request a free consultation.
