Virginia Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Virginia, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Virginia billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Virginia billing guide: how Virginia pays for outpatient care
The Virginia Department of Medical Assistance Services (DMAS) runs Virginia Medicaid. Since July 1, 2025, managed care members are in Cardinal Care, which combined CCC Plus and Medallion 4.0 and uses five health plans (Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Community Plan, UnitedHealthcare Community Plan); DMAS says providers must enroll with the state through PRSS and contract with each plan individually.
Fee-for-service (FFS) service authorizations for behavioral health go to Acentra Health, and DMAS's Psychiatric Services Manual sets a 12-month-from-date-of-service deadline for initial FFS claims. Anthem HealthKeepers, Inc. and Anthem Health Plans of Virginia, Inc. are independent licensees of the Blue Cross and Blue Shield Association for most of Virginia, and CareFirst (also an independent licensee) describes its footprint as including Northern Virginia. Medicare Part B for Virginia (except Arlington and Fairfax counties and the city of Alexandria, per CMS) is handled by Palmetto GBA in Jurisdiction M. Virginia's federal work requirement for Medicaid expansion adults is set to begin for applicants on or after January 1, 2027.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Virginia Medicaid and FAMIS, delivered through Cardinal Care (managed care) and fee-for-service: Virginia Department of Medical Assistance Services (DMAS) | Provider enrollment |
| Medicare Part B | Palmetto GBA, LLC | CMS MAC page |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield (Anthem Health Plans of Virginia, Inc.) and Anthem HealthKeepers (HealthKeepers, Inc.); CareFirst BlueCross BlueShield (CareFirst BlueChoice) | See the Blue Cross section below |
Virginia Medicaid and how to bill it
This Virginia billing guide starts with Medicaid, because it decides who pays and how you file.
Cardinal Care is Virginia's unified managed care program (combining CCC Plus and Medallion 4.0).
Behavioral health: DMAS describes behavioral health services as delivered through the managed care organizations and through a Behavioral Health Services Administrator, all contracted by DMAS. For FFS members, service authorizations go to Acentra Health (effective Nov 1, 2023).
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Aetna Better Health of Virginia | Listed on the DMAS Cardinal Care providers page. |
| Anthem HealthKeepers Plus | Listed on the DMAS Cardinal Care providers page. |
| Humana Healthy Horizons of Virginia | New to Cardinal Care 7/1/2025. |
| Sentara Health Plans (Sentara Community Plan) | Listed on the DMAS Cardinal Care providers page. |
| UnitedHealthcare of the Mid-Atlantic, Inc. (UnitedHealthcare Community Plan) | Listed on the DMAS Cardinal Care providers page. |
Timely filing (FFS): DMAS Psychiatric Services Manual Chapter V (revised 12/5/2025) says the deadline for initial submission is within 12 months from the date of service; exceptions listed for retroactive eligibility, delayed eligibility (within 12 months of the local department notice, letter attached), denied-claim resubmission (processed by 13 months from the initial denial if the original claim met timely filing), and a timely filing waiver request using the DMAS-3 attachment form.
Medicare Part B in Virginia
For Medicare, this Virginia billing guide names your contractor and the current telehealth rules.
As of 2026-10-25, per CMS Telehealth FAQ (updated 10/8/26): Medicare telehealth flexibilities run through December 31, 2027, including audio-only at home.
| Item | What to know |
|---|---|
| Contractor | Palmetto GBA, LLC |
| Jurisdiction | Jurisdiction M (JM): North Carolina, South Carolina, Virginia and West Virginia (Part A/B). |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Virginia
This part of the Virginia 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. Here is who holds the Blue license in Virginia.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield (Anthem Health Plans of Virginia, Inc.) and Anthem HealthKeepers (HealthKeepers, Inc.) | Elevance Health. | Most of Virginia, excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123, per Anthem's own site. | Source |
| CareFirst BlueCross BlueShield (CareFirst BlueChoice) | CareFirst, Inc. | CareFirst's fact sheet says it serves Maryland, the District of Columbia and Northern Virginia; its legal notice says 'portions of Virginia'. | Source |
Other private payers and EAPs in Virginia
The Virginia billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Virginia. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Aetna (commercial) | National provider contact page lists 1-888-MD Aetna (632-3862) for indemnity and PPO-based plans. Aetna Better Health of Virginia is the Medicaid plan listed above. | Official page |
| Cigna / Evernorth Behavioral Health | Cigna provider contact page lists Evernorth Behavioral Health at 800.926.2273 (national, not Virginia-specific). | Official page |
| UnitedHealthcare / Optum Behavioral Health | UHC provider contact page lists Virginia entries for All Savers, Individual Exchange and Medicare Advantage/Community Plan, and Optum behavioral health at 877-614-0484. | Official page |
| Humana | Humana Healthy Horizons in Virginia (Medicaid) page lists a 24/7 Behavioral health/ARTS crisis line. | Official page |
Virginia billing guide: state law that changes billing
Use this section of the Virginia billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Virginia. Medicare and Medicaid rules are covered in their own sections above.
Telehealth coverage and payment parity
Va. Code 38.2-3418.16 requires insurers, HMOs and subscription-contract corporations offering accident and sickness coverage to cover telemedicine services, and bars excluding a service solely because it is delivered by telemedicine. Medicare and similar federal plans are excluded. The statute's definition of telemedicine excludes audio-only telephone, but the section does not bar coverage of audio-only telephone services. Citation: Va. Code 38.2-3418.16. Source
Prompt payment and timely filing
Va. Code 38.2-3407.15 requires a carrier to pay a claim within 40 days of receipt and to notify the submitter of any defect within 30 days; interest is paid without demand at the time of payment or within 60 days thereafter (the rate is set in other sections). Carriers must give at least 30 days' advance notice of a retroactive denial or recovery. Citation: Va. Code 38.2-3407.15(B); DMAS Psychiatric Services Manual Chapter V. Source
Practitioner scope: therapists and prescribers
DMAS's 3/4/2024 bulletin refers to LPCs and LMFTs licensed in Virginia by the Board of Counseling through the Department of Health Professions, and states Medicare began covering their services on 1/1/2024 for dually eligible members (Medicare primary). Source
Not legal advice. Confirm statute details with counsel.
Virginia billing guide: codes and rates
This Virginia billing guide lists only codes and rates confirmed on official pages.
These are the Virginia-specific codes, modifiers and rate items confirmed on official pages.
| Code or item | What to know |
|---|---|
| Outpatient psychotherapy fee table (effective 1/1/2024) | DMAS bulletin lists 90785, 90791, 90792, 90832, 90834, 90837, 90833, 90836, 90838, 90839, 90840, 90845, 90846, 90847 and 90853. Source |
| 10% increase for outpatient psychotherapy and other community BH services (effective 1/1/2024) | Budget item 304.VVVV.1 per DMAS bulletin dated 12/26/2023. Source |
| Collaborative care management CPT 99492, 99493, 99494 | DMAS bulletin says reimbursement begins under budget item 304.AAAAA. Source |
| Procedure fee files and CPT codes | DMAS maintains current fee files for procedure codes. Source |
Virginia billing guide: what changed, newest first
Check this Virginia billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-08 | CMS Telehealth FAQ updated: Medicare telehealth flexibilities through 12/31/2027; in-person requirement for mental health telehealth after 12/31/2027. | Source |
| 2026-08-20 | DMAS Behavioral Health Services Redesign implementation moved to July 1, 2027 (2026 Appropriation Act item 291.TT.1). | Source |
| 2026-05-04 | DMAS bulletin titled 'Behavioral Health Services Redesign Implementation Date Change' issued (superseded in detail by the 8/20/2026 bulletin). | Source |
| 2026-01-05 | DMAS Telehealth Services Supplement updated (revision date 1/5/2026) for all providers and MCOs. | Source |
| 2025-07-01 | Cardinal Care managed care contract began: Humana Healthy Horizons of Virginia joined; Molina left; five plans active. Special enrollment period ran June 19 to September 30, 2025. | Source |
How do I bill mental health claims in Virginia?
These answers come from the same sources as the rest of this Virginia billing guide.
The Virginia Department of Medical Assistance Services (DMAS) runs Virginia Medicaid. Since July 1, 2025, managed care members are in Cardinal Care, which combined CCC Plus and Medallion 4.0 and uses five health plans (Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Community Plan, UnitedHealthcare Community Plan); DMAS says providers must enroll with the state through PRSS and contract with each plan individually. Start with the member's payer type: Medicaid plan, Medicare Part B, a Blue Cross licensee or another commercial plan.
Questions about billing in Virginia
How long do I have to file a Virginia Medicaid fee-for-service claim?
DMAS's Psychiatric Services Manual (revised 12/5/2025) says initial claims must be submitted within 12 months from the date of service. Exceptions exist for retroactive or delayed eligibility, and denied claims that met timely filing can be resubmitted so they are processed by 13 months from the initial denial. For managed care members, follow the health plan's contract.
Which health plans does Virginia Medicaid use for managed care?
Cardinal Care, which replaced CCC Plus and Medallion 4.0, uses five plans as of July 1, 2025: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Community Plan and UnitedHealthcare Community Plan. DMAS says providers enroll with the state through PRSS and contract with each plan individually.
Which Blue Cross plan covers Virginia?
Anthem Blue Cross and Blue Shield (Anthem Health Plans of Virginia, Inc.) and Anthem HealthKeepers cover most of Virginia, excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123, per Anthem's own site. CareFirst, a separate independent licensee, describes its service area as including Northern Virginia. Check which licensee the member's ID card shows before you verify benefits.
Are Medicare telehealth services still covered for therapy in Virginia?
Per the CMS Telehealth FAQ updated 10/8/26, Medicare telehealth flexibilities run through December 31, 2027, including audio-only at home. The in-person visit requirement for mental health telehealth begins after that date. Virginia Part B claims (outside Arlington, Fairfax and Alexandria) go to Palmetto GBA.
Does MCM South bill for practices in Virginia?
MCM South currently serves ten states; request a quote to ask about Virginia.
Sources for the Virginia billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- DMAS behavioral health providers page, checked October 25, 2026
- DMAS Cardinal Care providers page, checked October 25, 2026
- DMAS bulletin: July 1, 2025 Cardinal Care managed care contract, checked October 25, 2026
- DMAS bulletin: BH claims/payment process effective Nov 1, 2023, checked October 25, 2026
- CoverVA health plans page, checked October 25, 2026
- Psychiatric Services Manual Chapter V (rev. 12/5/2025), checked October 25, 2026
- Telehealth Services Supplement (rev. 1/5/2026), checked October 25, 2026
- MES Memos by Year 2026, checked October 25, 2026
- DMAS bulletin: BH Services Redesign Implementation Dates (8/20/2026), checked October 25, 2026
- DMAS bulletin: BH Service Rate Updates effective 1/1/2024, checked October 25, 2026
- DMAS bulletin: Medicare coverage of LPC/LMFT outpatient counseling (3/4/2024), checked October 25, 2026
- DMAS Work & Community Engagement Requirements, checked October 25, 2026
- DMAS Federal Work Requirements, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Georgia insurance companies contact guide
- Texas insurance companies contact guide
- Florida insurance companies contact guide
- Tennessee insurance companies contact guide
Billing in Virginia? 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 Virginia.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.