Texas Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Texas, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Texas billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Texas billing guide: how Texas pays for outpatient care
Texas Medicaid is run by the Health and Human Services Commission (HHSC). Most members are in managed care (STAR, STAR Kids, STAR+PLUS and CHIP), so you bill the member's health plan. The Texas Medicaid & Healthcare Partnership (TMHP) handles enrollment and fee-for-service claims.
Texas outpatient psychotherapy under Medicaid is open to physicians, physician assistants, advanced practice registered nurses, LCSWs, LMFTs, LPCs and psychologists. Psychotherapy is limited to 30 visits per calendar year before prior authorization.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Texas HHSC; managed care plans by service area; TMHP for fee-for-service | TMHP |
| Medicare Part B | Novitas Solutions, Jurisdiction H | CMS MAC page |
| Blue Cross Blue Shield | Blue Cross and Blue Shield of Texas (HCSC) | See the Blue Cross section below |
Texas Medicaid: Texas Medicaid and CHIP
This Texas billing guide starts with Medicaid, because it decides who pays and how you file.
Texas Medicaid is mixed but mostly managed care. HHSC publishes a service-area map showing which health plans serve STAR, STAR+PLUS, STAR Kids and CHIP members in each area. Fee-for-service providers follow the Texas Medicaid Provider Procedures Manual (TMPPM), which TMHP updates monthly.
Behavioral health was not shown as a separate carve-out in the sources we reviewed. For example, UnitedHealthcare Community Plan of Texas routes behavioral health claims through Optum and needs no primary care referral.
| Item | What to know |
|---|---|
| Agency | Texas Health and Human Services Commission |
| Claims and enrollment | Texas Medicaid & Healthcare Partnership (TMHP), with the TexMedConnect portal |
| Behavioral health handbook | TMPPM Behavioral Health and Case Management Services, January 2026 |
| Telehealth handbook | TMPPM Telecommunication Services, September 2026 |
| Filing window | TMHP's August 2026 manual says newly enrolled providers must file claims within 95 days of the date enrollment is complete. Check the handbook for your provider type. Source |
| Service-area map | HHSC managed care service areas, revised January 2026 |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| UnitedHealthcare Community Plan of Texas | Provider manual dated October 7, 2026. Behavioral health is managed by Optum. |
| Other STAR, STAR+PLUS, STAR Kids and CHIP plans | Listed by service area on the HHSC map. Confirm the current roster there before you contract. |
Enrollment: LCSWs, LMFTs, LPCs, APRNs and psychologists generally must be enrolled in Medicare or get a pediatric practice exemption from TMHP before billing Medicaid. Interns and associates bill under the supervising provider's NPI as described in the handbook.
Medicare Part B in Texas
For Medicare, this Texas 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 | Novitas Solutions, Inc. |
| Jurisdiction | Jurisdiction H: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Texas
This part of the Texas 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. In Texas that is Blue Cross and Blue Shield of Texas (BCBSTX), a division of Health Care Service Corporation (HCSC). BCBSTX is an independent licensee of the Blue Cross and Blue Shield Association, and its rules do not apply to Blue plans in other states.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Blue Cross and Blue Shield of Texas (BCBSTX) | Health Care Service Corporation (HCSC); independent licensee | Texas | BCBSTX provider manual |
Other private payers and EAPs in Texas
The Texas billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Texas. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Blue Cross and Blue Shield of Texas | The provider manual says claims must be submitted within 180 days of the date of service unless your contract or the member's plan says otherwise. | Official page |
| UnitedHealthcare / Optum Behavioral Health | The Community Plan manual sends behavioral health claims to Optum. Initial outpatient behavioral health visits are due within 10 business days. | Official page |
Texas billing guide: state law that changes billing
Use this section of the Texas billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Texas. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Texas Insurance Code 1355.254 and 1355.255 require mental health and substance use benefits on the same terms as medical and surgical benefits. Texas Department of Insurance Bulletin B-0003-09 applies the 60-visit rule for serious mental illness. TDI parity rule proposal
Telehealth coverage and payment parity
Texas Insurance Code 1455.004 requires plans to cover telemedicine and telehealth by contracted providers on the same basis as in person, with cost-sharing no higher than in person. Plans need not cover audio-only services. Texas Medicaid allows audio-only behavioral health with informed consent and modifier FQ. Statute
Prompt payment
Texas Medical Association summarizes the rule as 30 days for electronic claims and 45 days for non-electronic claims, with late-payment penalties. Confirm the current rule text at 28 TAC 21.2815. Source
Practitioner scope: therapists and prescribers
Licensure for telepsychology is based on the patient's physical location in Texas, per Behavioral Health Executive Council guidance. For prescribers, federal DEA telemedicine controlled-substance flexibilities were extended through December 31, 2026. BHEC guidelines
Not legal advice. Confirm statute details with counsel.
Texas billing guide: codes and rates
This Texas billing guide lists only codes and rates confirmed on official pages.
These are the Texas-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 |
|---|---|
| Texas Medicaid outpatient mental health CPT codes | Covered codes include 90791, 90792, 90832 to 90838, 90846, 90847, 90853, 90870, 96116, 96121 and 96130 to 96137. Psychotherapy is limited to 30 visits per calendar year before prior authorization. Source |
| Modifiers 95, FQ and 93 | 95 is synchronous audio-video. FQ is audio-only for behavioral health codes. 93 is audio-only for non-behavioral codes. Facility fee Q3014 is not payable when the patient is at home. Source |
| Fee schedule | Use the TMHP online fee lookup for current rates. This guide does not state Texas Medicaid rates. TMHP |
Texas billing guide: what changed, newest first
Check this Texas billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-07 | UnitedHealthcare Community Plan of Texas provider manual dated October 7, 2026. | Source |
| 2026-09-01 | TMPPM Telecommunication Services handbook, September 2026 edition: audio-only behavioral health with consent and modifier FQ. | 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 |
| 2026-06-25 | CMS announced the Novitas Solutions award for Jurisdiction H, which includes Texas. Implementation is in progress. | Source |
| 2026-06-01 | CMS issued the Medicaid community engagement interim final rule. States generally implement by 1/1/2027 for covered adults. | Source |
| 2026-01-08 | HHSC revised its managed care service-area map. | Source |
How do I bill mental health claims in Texas?
These answers come from the same sources as the rest of this Texas billing guide.
Start with the member's payer type. For Texas Medicaid managed care, bill the member's health plan. For fee-for-service, use TMHP. Medicare Part B goes to Novitas Solutions in Jurisdiction H. Blue Cross and Blue Shield of Texas, a division of HCSC, is the Blue licensee for commercial members.
Questions about billing in Texas
Who do I bill for Texas Medicaid behavioral health claims?
For managed care members, bill the member's health plan from the HHSC service-area map. For fee-for-service members, bill through TMHP.
How many psychotherapy visits does Texas Medicaid cover?
Outpatient psychotherapy is limited to 30 visits per calendar year before prior authorization, according to the TMPPM Behavioral Health handbook.
Does Texas Medicaid cover audio-only therapy?
Yes for behavioral health, with informed consent and modifier FQ, according to the September 2026 Telecommunication Services handbook.
What is the BCBSTX timely filing limit?
The BCBSTX provider manual says 180 days from the date of service unless your contract or the plan says otherwise.
Does MCM South bill for practices in Texas?
MCM South serves Texas. Request a quote to talk through your practice.
Sources for the Texas billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- TMHP, checked October 25, 2026
- HHSC STAR+PLUS page, checked October 25, 2026
- HHSC managed care service-area map, checked October 25, 2026
- TMPPM Behavioral Health handbook, January 2026, checked October 25, 2026
- TMPPM Telecommunication Services handbook, September 2026, checked October 25, 2026
- TMPPM August 2026, checked October 25, 2026
- CMS: MAC Jurisdiction H, checked October 25, 2026
- BCBSTX HMO provider manual, checked October 25, 2026
- UnitedHealthcare Community Plan of Texas manual, checked October 25, 2026
- TDI parity rule proposal, checked October 25, 2026
- Texas Insurance Code 1455.004, checked October 25, 2026
- Texas Medical Association: prompt pay, checked October 25, 2026
- BHEC telepsychology guidelines, 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
- Texas insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Texas
- Texas Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Florida insurance companies contact guide
Billing in Texas? 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 serve Texas.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.