Behavioral Health Billing in New York

Mukesh MakwanaFounder & CEO · Hands-on medical billing & RCM across 11 specialties · Reviewed October 1, 2026

Behavioral health billing in New York starts with one rule that catches many private practices: a licensed clinical social worker, mental health counselor or marriage and family therapist must be enrolled in New York State Medicaid fee-for-service to be paid for any Medicaid client, including clients in Medicaid managed care plans. The NYS Medicaid LCSW, LMHC and LMFT Policy Manual (July 2025) sets out who can enroll, how supervised clinicians are billed, which codes each license uses, and how clinic settings differ. This page covers those rules for New York therapy practices.

Who can enroll, and who cannot

LCSW: enrolls and bills directly, once licensed and registered by the NYS Education Department (NYSED).
LMHC and LMFT: enroll and bill directly, once licensed and registered by NYSED.
LMSW: cannot enroll or participate independently. LMSW services must be supervised by an LCSW, licensed psychologist or psychiatrist, and the manual notes that an LCSW may supervise up to six LMSWs.
Limited permit holders (LCSW, LMSW, LMHC and LMFT permits) cannot enroll in Medicaid.

Licensure rules are in the Education Law: Article 154 for social work and Article 163 for mental health counseling and marriage and family therapy. Enrollment is through eMedNY provider enrollment, and enrolled providers must revalidate every five years.

Managed care plans need the Medicaid enrollment too

The manual is explicit: an LCSW, LMHC or LMFT must be enrolled with NYS Medicaid fee-for-service to receive reimbursement for services to a fee-for-service member or a Medicaid Managed Care enrollee. A contract with a managed care plan is not enough on its own. For a practice where most Medicaid clients are in managed care, this is the first thing we check, because claims without the state enrollment do not pay.

Billing for supervised clinicians

New York lets supervising clinicians in private or group practice bill for the people they supervise:

An enrolled LCSW can bill for services provided by LMSWs and by LCSW or LMSW limited permit holders under their supervision, using the supervising LCSW's NPI as the attending provider.
An enrolled LMHC or LMFT can bill for services by LMHC or LMFT limited permit holders they supervise, using the supervisor's NPI.
Student interns: individual or group therapy is reimbursable only when a licensed, registered clinician is in continuous face-to-face attendance with the intern and the client, is not treating or supervising anyone else at the same time, and writes and signs the session note.

Codes and time ranges by license

The manual lists the procedure codes each license bills, with its own time guidance. For psychotherapy, it describes 90832 as sessions typically lasting 16 to 37 minutes, 90834 as 38 to 52 minutes, and 90837 as 53 minutes or more. Differences worth knowing:

LCSWs bill the psychiatric diagnostic evaluation (90791); the LMHC and LMFT code list does not include it.
Interactive complexity (90785) is paired with different codes in the two lists, and is never reported with psychotherapy for crisis (90839, 90840).
Family psychotherapy (90846, 90847) is not reported for sessions under 26 minutes.
Group psychotherapy (90853) involves no more than 12 participants, per the manual's description.
LCSWs also bill eVisit codes (98970 to 98972) and psychosocial rehabilitation (H2017).

Fee schedules are published separately for social work and for LMHC and LMFT services on eMedNY. We check each claim's code against the right license's list before it goes out.

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Clinic settings work differently

In Article 28 hospital outpatient clinics and free-standing diagnostic and treatment centers, LCSWs, LMSWs, LMHCs and LMFTs can treat any patient population, but the clinic's payment includes the professional component, so no separate professional claim can be billed. Clinicians there enroll as Ordering, Prescribing, Referring, Attending (OPRA) providers, and the clinic must affiliate their NPI in eMedNY. Clinicians in Article 16, 29-I, 31 and 32 programs also enroll as OPRA providers under those agencies' rules. A clinician who works in a clinic and has a private practice needs both set up correctly.

Telehealth

NYS Medicaid's telehealth policy applies to all Medicaid-enrolled providers and managed care plans, and the state updated its telehealth policy manual in 2025. Programs licensed by the Office of Mental Health follow additional OMH guidance that can supersede the general rules. Because modifier and place of service rules have changed recently, we check the current manual and each plan's requirements before setting up telehealth billing for a practice.

Medicare first for dual-eligible clients

Since January 1, 2024, Medicare covers services by marriage and family therapists and mental health counselors. For New York clients with both Medicare and Medicaid, bill Medicare first; the therapist needs both enrollments. Our guide to Medicare enrollment for therapists covers the Medicare side.

What we do for New York behavioral health practices

Enroll each LCSW, LMHC and LMFT in NYS Medicaid fee-for-service, then contract with the managed care plans your clients use.
Set up supervisor billing for LMSWs and limited permit holders with the right attending NPI.
Check each code against the license's code list and time ranges.
Keep clinic (OPRA) and private practice billing separate.
Track revalidation every five years.
Work denials by reason; see why mental health claims are denied.

How Sterling Global Solution LLC works with New York practices

We work remotely inside the system you already use, under a business associate agreement. For commercial plans and New York's prompt pay rules, see our page on medical billing for New York practices. See also our behavioral health billing approach and credentialing services for therapists.

Frequently asked questions

Do New York therapists need Medicaid enrollment to bill Medicaid managed care plans?

Yes. The NYS Medicaid LCSW, LMHC and LMFT Policy Manual says these clinicians must be enrolled with NYS Medicaid fee-for-service to be reimbursed for fee-for-service members or Medicaid Managed Care enrollees.

Can an LMSW bill NYS Medicaid?

Not independently. An LMSW cannot enroll on their own; services must be supervised by an LCSW, licensed psychologist or psychiatrist, and an enrolled LCSW can bill for them using the LCSW's NPI as the attending provider.

Can LMHCs and LMFTs bill NYS Medicaid directly?

Yes. LMHCs and LMFTs in private or group practice who are enrolled in NYS Medicaid fee-for-service can bill directly, and can also bill for LMHC or LMFT limited permit holders they supervise.

How often must New York Medicaid providers revalidate?

Every five years, according to the policy manual and eMedNY.

Can a therapist in an Article 28 clinic bill a separate professional claim?

No. The clinic's payment includes the professional component for LCSW, LMSW, LMHC and LMFT services, so a professional claim cannot be billed.

Sources

New York State Department of Health, NYS Medicaid Fee-for-Service LCSW, LMHC and LMFT Policy Manual, July 2025: sections I to IV.
eMedNY, provider enrollment and revalidation; NYS Department of Health, Medicaid telehealth.
NYS Education Law Article 154 (social work) and Article 163 (mental health practitioners).

CPT® is a registered trademark of the American Medical Association. This summarizes official sources and is not legal advice. Managed care plans set their own rules; check each plan's provider manual. How we verify this guidance.

Behavioral Health Billing for New York Practices