Texas Medicaid Mental Health Billing: 6 Easy Essentials
Texas Medicaid mental health billing is how a practice gets paid by the state’s Medicaid program for therapy and psychiatric visits. Most claims go to a managed care plan, not to the state, and the rules on who can bill and how often come from the Texas Medicaid Provider Procedures Manual. This guide covers six things to get right.
1. Know where Texas Medicaid mental health billing claims go
Texas Medicaid mental health billing starts with the client’s plan on the date of service. Per the Texas Medicaid and Healthcare Partnership (TMHP) managed care handbook, managed care claims go to the managed care organization (MCO) where the client is enrolled that day. Carve-out services are billed to TMHP.
| Program | Who it generally covers |
|---|---|
| STAR | Children, newborns, pregnant women and some families |
| STAR+PLUS | Adults 65 and older, and adults 21 and older with a disability |
| STAR Kids | People 20 and younger with a disability |
| STAR Health | Children in foster care (one plan) |
Plans may subcontract behavioral health to a separate organization, so confirm the claims process with each plan. Check the plan every visit, because coverage can change. Our guide to behavioral health insurance verification shows what to confirm.
2. Confirm who can bill Texas Medicaid for mental health
The Texas Medicaid behavioral health handbook lists the provider types that can bill outpatient mental health services. Clinicians must be licensed in Texas, and temporary licenses are not accepted for most counselor and social work types. Check your license status before you enroll, because the manual says a provider cannot enroll if the license expires within 30 days.
| Provider type | What the handbook says |
|---|---|
| Licensed clinical social worker (LCSW), licensed marriage and family therapist (LMFT), licensed professional counselor (LPC) | Enroll in Medicare or hold a pediatric practice exemption |
| Psychologist | Same Medicare rule; temporary licenses are accepted |
| Psychiatrist (physician) | Licensed and enrolled in Medicare first, with exceptions such as pediatric psychiatrists |
| Psychological associates, post-doctoral fellows, interns | Bill under the supervising psychologist’s National Provider Identifier (NPI) or the employer’s |
Do I have to enroll in Medicare to bill Texas Medicaid for therapy?
Yes, for LPCs, LMFTs, LCSWs and psychologists, unless you hold a pediatric practice exemption from TMHP Provider Enrollment. The handbook states this for each license type. A Blue Cross and Blue Shield of Texas Medicaid notice dated May 14, 2024 adds that the Medicare number must be on file for dates of service after January 1, 2024. Start Medicare enrollment before you apply for Medicaid.
3. Use the right codes and respect the visit limit
Texas Medicaid mental health billing relies on a defined list of psychotherapy and evaluation codes. The handbook lists psychiatric diagnostic evaluation (90791 and 90792) and psychotherapy codes 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847 and 90853. It limits those psychotherapy codes to 30 visits per calendar year and says more visits need prior authorization.
The add-on codes (90833, 90836, 90838) must go with a primary code. Prescribers bill an evaluation and management (E/M) visit with a psychotherapy add-on, not a stand-alone psychotherapy code. Some codes are limited to certain diagnoses. The manual is the fee-for-service rule, so check each plan’s authorization policy.
4. Watch the 95-day filing rule in Texas Medicaid mental health billing
For managed care claims, the TMHP handbook gives 95 days from the date of service to reach the correct plan. If you billed the wrong plan, refile with the right one within 95 days of the wrong plan’s Remittance and Status report date, and keep proof. Appeals go to the plan, not to TMHP. Read each denial with our guide to CARC and RARC codes, then compare it with the electronic remittance advice.
5. Keep Medicaid separate from commercial rules
Texas Medicaid mental health billing follows different deadlines and appeal paths than Medicare or commercial plans. Do not apply one set to another.
Private payers
Commercial plans set their own terms in your contract. Texas’s prompt pay protections apply to fully insured commercial plans, but the Texas Department of Insurance (TDI) says traditional Medicaid, Medicaid HMOs and CHIP are exempt (page updated 10/1/2025). Do not expect those penalties on a Medicaid claim.
Medicare and Medicaid
Medicaid is the payer here. Medicare matters only because enrollment is a prerequisite for the clinician types above.
State rules
These are Texas rules. Other states run Medicaid differently, so do not reuse this checklist elsewhere. Check each state’s own rules for every state you bill in.
6. What to do Monday morning
Use this short list to tighten your Texas Medicaid mental health billing this week.
- Confirm each clinician’s license type and Medicare enrollment, or the pediatric exemption.
- List Medicaid clients by plan and note the date of service for every unpaid claim.
- Count each client’s psychotherapy visits so far this calendar year against the 30-visit limit.
- Track your clean claim rate for Medicaid separately.
- Keep plan contact details together. The insurance companies contact directory helps.
The short version: Texas Medicaid mental health billing
Texas Medicaid mental health billing means billing the client’s managed care plan, using an enrolled and licensed clinician with Medicare enrollment or a pediatric exemption. Use the handbook’s codes, watch the 30-visit limit, and file within 95 days. Check each plan’s own rules.
How MCM South helps
MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims for clients. Enrollment is a separate job, covered on our credentialing page.
Keep going
Related reading
Want a second pair of eyes on your payer mix? We can talk through your practice.
FAQ
Can an LPC or LMFT bill Texas Medicaid without Medicare enrollment?
Only with a pediatric practice exemption from TMHP Provider Enrollment. Otherwise the Medicaid handbook requires Medicare enrollment first. Ask TMHP Provider Enrollment if you are unsure which applies to you.
How many therapy sessions does Texas Medicaid cover per year?
The fee-for-service handbook limits the listed psychotherapy codes to 30 visits per calendar year, with more requiring prior authorization. A managed care plan can set its own authorization steps, so confirm with the client’s plan before you schedule past that point.
Where do I send a Texas Medicaid mental health claim?
To the managed care plan the client was enrolled in on the date of service. Services carved out of managed care go to TMHP. If you picked the wrong plan, you can refile with the correct one within 95 days of the wrong plan’s report date.
Does the Texas prompt pay law apply to Medicaid claims?
No. TDI says traditional Medicaid, Medicaid HMOs and the Children’s Health Insurance Program (CHIP) are exempt from the commercial prompt pay rules. Follow the Medicaid handbook and the plan’s contract instead.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
