Behavioral Health Billing in Texas

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

Behavioral health billing in Texas runs on rules that are specific to therapy and psychiatry: Texas Medicaid names exactly which license types can enroll and bill, caps psychotherapy at 30 visits per calendar year before prior authorization, pays licensed clinical social workers, marriage and family therapists and professional counselors at 70 percent of the psychologist rate, and requires modifier 95 on video sessions. Sterling Global Solution LLC bills for Texas therapy, counseling and psychiatry practices with those rules built into every claim. For Texas Medicaid enrollment and the state's prompt pay deadlines for commercial plans, see our page on medical billing for Texas practices.

Who can bill Texas Medicaid for mental health services

The October 2026 Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, lists the mental health service providers for outpatient mental health services: physicians, physician assistants, advanced practice registered nurses, licensed clinical social workers (LCSWs), licensed marriage and family therapists (LMFTs), licensed professional counselors (LPCs), psychologists, licensed psychological associates, provisionally licensed psychologists, post-doctoral fellows and pre-doctoral psychology interns.

Enrollment has conditions that catch new practices out. For LPCs, the handbook states:

An LPC must be licensed by the Texas Board of Examiners of Professional Counselors to enroll, whether as an individual or as part of a group.
LPCs must also be enrolled in Medicare or obtain a pediatric practice exemption from TMHP Provider Enrollment.
Providers that hold a temporary license are not eligible to enroll in Medicaid.
LPCs cannot be enrolled if their license is due to expire within 30 days.

Counselors, marriage and family therapists, social workers and psychologists in Texas are licensed through the boards under the Texas Behavioral Health Executive Council. A claim is only payable when the license, the Medicaid enrollment and the plan credentialing all line up on the date of service, so we check all three before the first session is billed. See credentialing services for therapists.

Texas Medicaid limits that drive denials

The handbook sets limits that turn into denials when nobody is counting. Prior authorization is required for:

Psychiatric diagnostic evaluation (procedure code 90791 or 90792) after the limit of one evaluation per person, per provider, per rolling year has been met.
Individual, family or group psychotherapy (procedure codes 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847 and 90853) after the 30 visit per calendar year limitation has been met.
Psychological or neuropsychological testing after the 8 hour per calendar year limitation has been met.

There is also a daily ceiling. Psychologists, advanced practice registered nurses, physician assistants, LCSWs, LMFTs and LPCs are limited to a maximum combined total of 12 hours per provider, per day, regardless of the number of persons seen. The handbook calls this a system limitation, so a provider with a heavy day of long sessions and groups needs the hours added up before claims go out.

These limits are in the fee-for-service manual. Members enrolled in a Medicaid managed care plan are subject to that plan's own authorization rules, so we track visit counts against the rule that applies to each client's plan. Our prior authorization services cover the request and the follow-up.

How Texas Medicaid pays therapists

Rate for master's-level clinicians: the handbook states that, according to 1 TAC 355.8091, the Texas Medicaid rate for LCSWs, LMFTs and LPCs is 70 percent of the rate paid to a psychiatrist or psychologist for a similar service.
Medicare first: providers must bill Medicare before Medicaid when a person is eligible under both programs. The handbook notes that Texas Medicaid may reimburse the full amount of the Medicare coinsurance and deductible for services rendered by psychiatrists, psychologists, LCSW, LMFT and LPC providers.
Claim format: LCSW, LMFT and LPC services must be submitted to TMHP in an approved electronic format or on the CMS-1500 paper claim form. Superbills and itemized statements are not accepted as claim supplements.

Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.

30-Day Free Trial

Telehealth sessions in Texas Medicaid

The handbook allows listed outpatient mental health services, including psychiatric diagnostic evaluations and psychotherapy, to be provided by synchronous audiovisual technology if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services. Those services must be billed using modifier 95. It also says providers must let the person's choice, not provider convenience, drive the mode of delivery, and must meet all licensure requirements when delivering by telehealth.

In billing terms: the modifier has to be on the claim, the note has to show the session was by video and that the client agreed, and audio-only sessions follow their own section of the handbook. We check each telehealth claim for all three. More detail is on our behavioral health billing page.

Commercial plans for Texas behavioral health practices

Commercial plans in Texas follow the state's prompt pay rules, which the Texas Department of Insurance explains in its Prompt Pay FAQ, including a 95-day claim filing deadline. For a therapy practice, common commercial problems are different from Medicaid's: sessions billed past an authorization's end date, a clinician billed before the plan's effective date, and a mental health benefit that is administered by a different company from the one on the insurance card. We verify the mental health benefit and its administrator before the first visit. The deadlines themselves are covered on our Texas medical billing page.

What we do for Texas therapy and psychiatry practices

Confirm license, Texas Medicaid enrollment and plan credentialing for each clinician before billing.
Verify eligibility and the mental health benefit before the first session, and again when coverage changes.
Count evaluations, psychotherapy visits and testing hours against the limits, and request authorization before the limit is reached.
Check daily provider hours against the 12-hour total.
Apply modifier 95 to video sessions and confirm the documentation supports it.
Bill Medicare first for clients eligible under both programs, then the Medicaid crossover.
Work every denial by reason. See why mental health claims are denied.

How Sterling Global Solution LLC works with Texas behavioral health practices

We work remotely inside the system you already use, including SimplePractice and TherapyNotes, under a HIPAA business associate agreement. We bill for psychiatry and ABA practices as well as counseling and therapy groups. Start with our 30-Day Free Trial.

Frequently asked questions

Which therapists can bill Texas Medicaid?

The Texas Medicaid Provider Procedures Manual lists physicians, physician assistants, advanced practice registered nurses, LCSWs, LMFTs, LPCs, psychologists, licensed psychological associates, provisionally licensed psychologists, post-doctoral fellows and pre-doctoral psychology interns as mental health service providers.

How many therapy visits does Texas Medicaid allow before prior authorization?

The handbook requires prior authorization for individual, family or group psychotherapy after the 30 visit per calendar year limitation has been met. Medicaid managed care plans publish their own authorization rules.

What does Texas Medicaid pay LPCs, LMFTs and LCSWs?

The handbook states that, according to 1 TAC 355.8091, the Texas Medicaid rate for LCSWs, LMFTs and LPCs is 70 percent of the rate paid to a psychiatrist or psychologist for a similar service.

Does an LPC need Medicare enrollment to enroll in Texas Medicaid?

The handbook states that LPCs must be enrolled in Medicare or obtain a pediatric practice exemption from TMHP Provider Enrollment, and that providers holding a temporary license are not eligible to enroll.

Which modifier does Texas Medicaid require for video therapy sessions?

Outpatient mental health services provided by synchronous audiovisual technology must be billed using modifier 95, according to the handbook.

Is there a daily limit on hours a therapist can bill Texas Medicaid?

Yes. Psychologists, advanced practice registered nurses, physician assistants, LCSWs, LMFTs and LPCs are limited to a maximum combined total of 12 hours per provider, per day.

Sources

Texas Medicaid & Healthcare Partnership, Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook, October 2026: provider types and enrollment (4.1), telehealth (4.2.1), prior authorization (4.3), twelve hour limitation (4.5), claims filing and reimbursement (4.8).
Texas Behavioral Health Executive Council: licensing of counselors, marriage and family therapists, social workers and psychologists.
Texas Medicaid & Healthcare Partnership, Provider Enrollment.
Texas Department of Insurance, Prompt Pay FAQ: claim filing deadline for HMO and PPO claims.

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 Texas Practices