Texas Telehealth Billing for Therapists: 5 Easy Essentials
Texas telehealth billing for therapists is the set of modifier, consent and coverage rules for claims on sessions delivered by video or phone. Texas Medicaid and commercial plans handle these differently, so one claim habit will not fit both. This guide shows what to put on the claim and what to document.
Telemedicine, telehealth and what each one means in Texas
Texas telehealth billing for therapists starts with vocabulary, because Texas Medicaid uses two terms. The Texas Medicaid Telecommunication Services Handbook (April 2026) treats telemedicine as medical services from physicians and certain advanced practice providers. Telehealth covers services from any health professional licensed or certified to practice in Texas, which includes counselors, social workers and psychologists.
The handbook calls your location the distant site and the client’s location the patient site. The client’s home can be the patient site. The patient-site facility fee (Q3014) is not payable when the patient site is the client’s home.
Texas Medicaid modifiers for Texas telehealth billing for therapists
For Texas telehealth billing for therapists with Medicaid clients, the modifier shows how the session was delivered. The April 2026 handbook uses modifier 95 for real-time audio and video, and modifier FQ for behavioral health sessions by audio only. Modifier 93 is the general audio-only modifier for non-behavioral-health services. Codes that already describe telephone delivery do not need these.
| How the session was delivered | Modifier | Documentation to keep |
|---|---|---|
| Real-time audio and video | 95 | Informed consent; client and provider locations |
| Audio only, behavioral health | FQ | Consent; why audio only was used |
| E/M visit focused on medication management | UD with the E/M code | Visit focus in the note |
The UD modifier on the E/M code comes from a Texas Medicaid and Healthcare Partnership (TMHP) news item on behavioral health telemedicine and telehealth, effective September 1, 2022. Prescribers should bill the E/M code, not a therapy code, for a medication visit.
When can I bill audio-only therapy to Texas Medicaid?
Texas Medicaid pays for audio-only behavioral health sessions when HHSC has designated the service for audio-only reimbursement and the clinician judges it clinically appropriate. The 2022 TMHP news item says psychotherapy and psychiatric diagnostic evaluation by phone need an existing relationship with the client. That means at least one in-person or video service from the same provider in the six months before the first phone session, and another at least every rolling 12 months, unless you document why not. Document why audio-only was used each time.
Informed consent comes first in Texas telehealth billing for therapists. The handbook says verbal consent is allowed and must be documented in the record.
Rules by payer type
Each payer type follows its own rulebook for Texas telehealth billing for therapists. Keep them separate in your notes.
Private payers
Texas Insurance Code section 1455.004, as reprinted on texas.public.law, says a health benefit plan must cover a covered service delivered by telemedicine or telehealth on the same basis and to the same extent as in person. The plan cannot charge more cost sharing than for the in-person service, and it cannot add a separate deductible just for telehealth. The plan does not have to cover audio-only calls. For fully insured plans, collect the same copay or coinsurance you would for an office visit, and check the plan’s audio-only policy before a phone session.
Medicare and Medicaid
For Texas Medicaid, the modifiers and conditions above apply. The handbook does not address cost sharing, so check the client’s plan. For Medicare telehealth, rules change often; check the Centers for Medicare & Medicaid Services before billing.
State rules
These are Texas rules. A clinician must be licensed or certified in Texas to deliver mental health telehealth under the Medicaid handbook. Other states differ, so check each state where your clients live.
What modifier do I use for Texas Medicaid audio-only therapy?
Use modifier FQ for behavioral health sessions delivered by audio only, and modifier 95 for audio and video. These come from the April 2026 Texas Medicaid Telecommunication Services Handbook. Always confirm with the client’s plan, because a managed care plan can set additional claim rules.
What to do Monday morning
Use this list to tighten your Texas telehealth billing for therapists this week.
- Add telehealth consent language to your intake forms and record verbal consent in the note.
- Set your billing system to add 95, FQ or UD automatically from the session type, and track your clean claim rate by modifier.
- Flag every audio-only psychotherapy client and check the last in-person or video date.
- Verify telehealth benefits for each plan before the first session. Our guide to behavioral health insurance verification lists what to ask.
- Review denials with our guide to CARC and RARC codes and the electronic remittance advice.
The short version: Texas telehealth billing for therapists
Texas telehealth billing for therapists means the right modifier, documented consent and a check of each payer’s audio-only rule. Medicaid uses 95 for video and FQ for behavioral audio-only. Fully insured commercial plans must cover covered telehealth services on the same basis as in-person.
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. For credentialing questions, see our credentialing page.
Keep going
Related reading
Want help setting up telehealth claims? We can talk through your practice.
FAQ
Do I need a modifier on every telehealth claim in Texas?
For Texas Medicaid, procedure codes that do not describe remote delivery need modifier 95 for audio-video sessions or FQ for behavioral health audio-only sessions. Codes that already describe telephone delivery do not. Commercial plans set their own modifier rules, so check each one.
Can a Texas health plan charge a higher copay for telehealth?
Under the Insurance Code section above, cost sharing for a covered telehealth service cannot be higher than for the same service in person, and a plan cannot add a telehealth-only deductible. This applies to the health benefit plans the section covers. Check the plan type before you collect.
Is verbal consent enough for Texas Medicaid telehealth?
Yes, the Medicaid handbook says verbal consent is allowed. It must be documented in the client’s record before the service. For behavioral health audio-only sessions, the handbook allows the consent to be waived only when it is not feasible or could cause death or injury.
Can I bill the client’s home as a facility?
No facility fee is payable when the patient site is the client’s home. The handbook says the patient-site facility fee (Q3014) is limited to certain provider types and does not apply to a home. Your own professional fee is billed as usual.
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.
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