Behavioral health billing is where state Medicaid rules differ most. One state lets associate-level counselors bill under their own number; the next will not enroll them at all. One state caps therapy visits before prior authorization; another removed every visit limit in 2025. One state's Medicaid uses modifier GT for video sessions; Medicare and most commercial plans use different codes. This page collects our state guides, each built from that state's own Medicaid manual, rule or notice, and shows what to check first in each.
What changes from state to state
- Who can enroll. Which licenses can bill Medicaid on their own, and whether associates, supervised practitioners or limited permit holders bill under a supervisor.
- Visit and testing limits. Whether therapy or psychological testing needs prior authorization after a set number of visits or hours.
- Telehealth coding. Which modifier and place of service the state Medicaid program expects for video and audio-only sessions.
- Managed care. Which plans most members are in, and whether behavioral health is carved in or run by separate plans.
- Documentation. Required assessments and treatment plan deadlines that auditors check.
- Commercial filing limits. State prompt pay laws set how long you have to file with state-regulated plans; see our timely filing limits page.
Our state guides
| State | What to check first | Guide |
|---|---|---|
| New York | LCSWs, LMHCs and LMFTs must be enrolled in NYS Medicaid fee-for-service to be paid even for managed care members; LMSWs and limited permit holders bill under a supervisor's NPI. | New York |
| New Jersey | Outpatient behavioral health moved into managed care on January 1, 2025, and each MCO is ending its transition protections on its own schedule. | New Jersey |
| Illinois | LCSWs and psychologists have been paid since 2017, LCPCs and LMFTs since December 2021, each under a specific IMPACT provider type. | Illinois |
| North Carolina | Associates can bill under their own Medicaid number with a service order; no prior approval for outpatient therapy since 2025; GT and KX modifiers. | North Carolina |
| Ohio | Supervised practitioners and trainees bill through the supervisor, at a lower rate; a treatment plan is due within five sessions or one month. | Ohio |
| Texas | Texas Medicaid's psychotherapy visit limit before prior authorization, the rate for master's-level clinicians, and modifier 95 for video sessions. | Texas |
| Florida | Florida Medicaid's mental health benefits through managed care, therapist licenses and registered interns, and Florida's telehealth rules. | Florida |
Each guide links to its sources. State rules change, so we re-check them against the official source before acting on them for a client, and we date every guide's sources.
Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.
30-Day Free TrialRules that apply in every state
- Medicaid filing limit. Federal rules require state Medicaid programs to require claims within 12 months of the date of service, and states can set a shorter limit.
- Medicare first. For clients with both Medicare and Medicaid, Medicare is billed first. Counselors and marriage and family therapists can enroll in Medicare since January 1, 2024; see our Medicare enrollment for therapists guide.
- Credentialing with each plan. State Medicaid enrollment does not credential you with its managed care plans or with commercial payers. See the credentialing guides and our pages on Aetna, Cigna and Evernorth and Optum.
- Telehealth. Medicare's place of service and modifier rules are in our behavioral health telehealth billing guide; state Medicaid rules can differ, as the North Carolina and Ohio guides show.
Your state is not listed?
We bill for behavioral health practices nationwide. The questions above are the ones we work through for any state before the first claim: which licenses can enroll, what limits and authorizations apply, how telehealth is coded and which plans your clients use. Our behavioral health billing page explains how we work, and you can start with our 30-Day Free Trial.
Frequently asked questions
Do Medicaid rules for therapists differ by state?
Which state guides do you have?
What is the Medicaid timely filing limit?
Does state Medicaid enrollment credential me with managed care plans?
Sources
Each state guide lists its own official sources: state Medicaid manuals, administrative rules and provider notices.
Code of Federal Regulations, 42 CFR 447.45(d): Medicaid claims filing limit.
This summarizes official sources and is not legal advice. How we verify this guidance.
Related reading
- Behavioral health billing. Our full approach for therapy and mental health practices.
- Provider credentialing & payer enrollment. Every credentialing guide in one place.
- Behavioral health telehealth billing. Medicare place of service and modifiers.
- Timely filing limits by payer. Medicare, Medicaid and state limits.
Billing for your behavioral health practice, in any state
Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.
30-Day Free TrialNo setup fee. No long-term contract.