Behavioral Health Billing Services in Florida
Last reviewed October 6, 2026 by the Healthcare Logic revenue cycle team.
Almost all Florida Medicaid services, including behavioral health, are delivered through Statewide Medicaid Managed Care (SMMC). The current version, SMMC 3.0, started February 1, 2025 and runs through 2030. It changed plan names, plan types and how serious mental illness is handled, so many practices are still cleaning up eligibility and authorization issues from the transition.
Healthcare Logic supports Florida therapists, group practices, psychiatry groups, community mental health centers and FQHCs with plan verification, authorizations, coding, claims, denials and credentialing across SMMC plans, Medicare and commercial payers.
Florida behavioral health billing at a glance
| Medicaid program | Statewide Medicaid Managed Care (SMMC 3.0), contracts 2025 to 2030, 9 regions |
|---|---|
| Behavioral health delivery | Covered by Managed Medical Assistance (MMA) and comprehensive plans |
| Serious mental illness | SMI specialty products inside MMA Plus and Comprehensive Plus plans (standalone specialty plans ended) |
| Safety net funding | DCF-funded behavioral health managing entities for uninsured and underinsured people |
| Enrollment | About 4 million Floridians covered by Medicaid as of October 2025 |
| Medicare contractor | First Coast Service Options, Jurisdiction N |
How Florida Medicaid pays for behavioral health
Florida Medicaid members choose or are assigned a managed care plan in their region. Managed Medical Assistance (MMA) plans and comprehensive plans cover state plan behavioral health services, including therapy, psychiatric care, targeted case management and community behavioral health services. The plan, not AHCA, is the payer for enrolled members.
SMMC 3.0 replaced the old standalone specialty plans with specialty products carried inside the regular plans. Members with a serious mental illness can enroll in an MMA Plus or Comprehensive Plus plan that carries the SMI specialty product. AHCA uses an SMI diagnosis algorithm to identify eligible members. As of October 2025, 22,394 people were enrolled in an SMI specialty plan.
When members change plans, SMMC 3.0 requires the new plan to honor ongoing treatment that was authorized before the switch for up to 90 days. That window matters for billing: authorizations need to be tracked and renewed with the new plan before it closes.
Separately, the Department of Children and Families funds regional managing entities that contract for mental health and substance use services for people who are uninsured or underinsured. These are not Medicaid claims and follow their own contract rules.
Medicare rules for Florida behavioral health providers
Medicare rules are federal, so they are the same in Florida as everywhere else. What changes is the contractor: Florida clinicians enroll and bill Part B through First Coast Service Options (Jurisdiction N).
- Counselors and MFTs can bill Medicare. Since January 1, 2024, marriage and family therapists and mental health counselors (including LPCs) can enroll in Medicare and bill for their services, paid at 75% of the physician fee schedule amount.
- Home telehealth is permanent for mental health. Patients can receive mental and behavioral health telehealth at home, anywhere in the country, and audio-only is allowed when the patient cannot or does not want to use video.
- The in-person visit rule is delayed. The requirement for an in-person visit within six months before starting tele-mental health, and every 12 months after, is waived until January 1, 2028 under the Consolidated Appropriations Act of 2026. Broader Medicare telehealth flexibilities run through December 31, 2027.
- Incident-to under general supervision. Behavioral health services by auxiliary personnel can be billed incident-to a supervising practitioner under general supervision.
- Tele-prescribing of controlled substances. DEA and HHS extended telemedicine prescribing flexibilities through December 31, 2026.
- Medicare Advantage is different. MA plans set their own networks and prior authorization rules, so we verify each MA plan before the first visit.
Florida commercial plan notes
Florida has a large Medicare Advantage population, and many seniors receive behavioral health care through MA plans with their own networks and prior authorization rules. We verify MA plan networks before the first visit.
Common behavioral health denials in Florida
These are the patterns we see most often with Florida behavioral health claims, and each one is preventable with front-end checks:
- Claims sent to the wrong plan or region after a member's SMMC plan changes.
- Authorizations not renewed before the continuity of care window ends.
- Services billed to Medicaid that should go to a managing entity contract, or the reverse.
- SMI specialty product services billed for members who are not enrolled in one.
- Medicare Advantage out-of-network or missing authorization denials.
Core behavioral health codes we bill in Florida
Psychotherapy codes are time based, so documented start and stop times or total minutes must support the code billed. State Medicaid programs and plans may also require HCPCS codes, modifiers or rate codes on top of these.
| 90791 / 90792 | Psychiatric diagnostic evaluation (without / with medical services) |
|---|---|
| 90832 / 90834 / 90837 | Individual psychotherapy, 16 to 37, 38 to 52, and 53+ minutes |
| 90833 / 90836 / 90838 | Psychotherapy add-ons with an E/M visit |
| 90785 | Interactive complexity add-on |
| 90839 / 90840 | Psychotherapy for crisis, first 60 minutes / each extra 30 |
| 90846 / 90847 / 90853 | Family psychotherapy without / with patient; group psychotherapy |
| 96127 | Brief emotional or behavioral assessment (for example PHQ-9, GAD-7) |
Behavioral health billing services for Florida providers
Healthcare Logic works inside your EHR and clearinghouse as an extension of your team. Use one service or the full revenue cycle:
Learn more about our behavioral health revenue cycle services, how we handle behavioral health coding, and credentialing for new clinicians.
Frequently asked questions
What is SMMC 3.0 in Florida?
It is the current Statewide Medicaid Managed Care program. It began February 1, 2025, runs through 2030 and operates in 9 regions. Behavioral health is covered by the member's MMA or comprehensive plan.
How does Florida Medicaid handle serious mental illness?
Through SMI specialty products inside MMA Plus and Comprehensive Plus plans. These replaced the standalone specialty plans that operated before 2025.
Do new Florida Medicaid plans honor existing authorizations?
Yes. Under SMMC 3.0, a new plan must honor ongoing treatment authorized before enrollment for up to 90 days. We track those windows so care is not interrupted.
Can counselors and MFTs in Florida bill Medicare?
Yes. Since January 1, 2024, mental health counselors and marriage and family therapists can enroll in Medicare. In Florida they enroll through First Coast Service Options, Jurisdiction N.
How does Healthcare Logic help Florida behavioral health providers?
We verify plan and region before each visit, manage authorizations across plan changes, code and bill to each plan's rules, work denials and keep clinicians credentialed with SMMC plans, Medicare and commercial payers.
Talk to a behavioral health billing specialist
Tell us your payer mix and EHR, and we will show you where Florida claims are getting stuck. Business inquiries only. Reply within 1 business day.
Behavioral health billing in other states
Sources
Payer rules change often. This page reflects official guidance as of October 6, 2026. Confirm current requirements in the state manual and your payer contracts before billing.