Behavioral Health Billing Services in Texas
Last reviewed October 6, 2026 by the Healthcare Logic revenue cycle team.
Texas has one of the largest behavioral health markets in the country and some of the tightest Medicaid margins. Behavioral health is built into Medicaid managed care, so most claims go to the member's MCO, not to the state. Each MCO, and often its behavioral health vendor, sets its own authorization and billing rules on top of the state manual.
Healthcare Logic supports Texas therapists, group practices, psychiatry groups, substance use programs and FQHCs with eligibility checks, authorizations, coding, claims, denial work and credentialing across Medicaid MCOs, Medicare and commercial plans.
Texas behavioral health billing at a glance
| Medicaid programs | STAR, STAR+PLUS, STAR Kids, STAR Health and CHIP |
|---|---|
| State agency | HHSC; claims administrator is the Texas Medicaid & Healthcare Partnership (TMHP) |
| Behavioral health delivery | Built into Medicaid managed care; most members are billed through their MCO |
| Key manual | Texas Medicaid Provider Procedures Manual (TMPPM), Behavioral Health and Case Management Services Handbook |
| Telehealth law | HB 4 (2021) made many behavioral health services permanently available by telehealth and audio-only |
| Medicare contractor | Novitas Solutions, Jurisdiction H |
How Texas Medicaid pays for behavioral health
Texas Medicaid and CHIP members are enrolled in managed care programs: STAR for most children and families, STAR+PLUS for adults with disabilities and older adults, STAR Kids for children with disabilities, and STAR Health for children in foster care. Behavioral health is a covered benefit inside each program, so the MCO is the payer for outpatient therapy, psychiatric services, substance use treatment and mental health rehabilitation for its members. Fee-for-service claims for members not in managed care go through TMHP.
The TMPPM Behavioral Health and Case Management Services Handbook sets the base rules: which provider types can bill which services, documentation requirements, and benefit limits. Mental health rehabilitation and targeted case management have their own provider qualifications and are mostly delivered by Local Mental Health Authorities and qualified community providers.
Under HB 4, many behavioral health services can be delivered by synchronous video or audio-only when clinically appropriate, and Medicaid MCOs cannot deny payment just because a service was delivered by telehealth. Audio-only behavioral health services are reported with modifier FQ in Texas Medicaid.
- Each MCO sets its own prior authorization list and behavioral health vendor, so the same service can need authorization at one plan and not another.
- Texas Medicaid MCO claims are generally due within 95 days of the date of service; late claims are hard to recover.
- LPCs, LMFTs, LCSWs and psychologists are licensed through the Behavioral Health Executive Council; chemical dependency counselors (LCDC) are licensed through HHSC and have a narrower billing scope.
- Members can move between STAR programs, so eligibility should be checked before every visit, not just at intake.
Medicare rules for Texas behavioral health providers
Medicare rules are federal, so they are the same in Texas as everywhere else. What changes is the contractor: Texas clinicians enroll and bill Part B through Novitas Solutions (Jurisdiction H).
- 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.
Texas commercial plan notes
Texas requires state-regulated plans to cover telehealth services and not deny a covered service only because it was delivered remotely. Self-funded employer plans are governed by federal law instead, so we check plan type before relying on Texas rules.
Common behavioral health denials in Texas
These are the patterns we see most often with Texas behavioral health claims, and each one is preventable with front-end checks:
- Claim sent to TMHP when the member is in an MCO, or to the wrong MCO after a plan change.
- Missing MCO or behavioral health vendor authorization for intensive or recurring services.
- Claims filed after the 95-day MCO filing window.
- Service billed under a provider type that is not eligible for that code in the TMPPM, including LCDC scope issues.
- Telehealth claims missing the correct place of service or modifier, such as FQ for audio-only.
Core behavioral health codes we bill in Texas
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 Texas 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
Who pays behavioral health claims for Texas Medicaid members?
For most members, the Medicaid managed care organization (MCO) in their STAR, STAR+PLUS, STAR Kids or STAR Health program pays. Fee-for-service claims for members not enrolled in managed care go to TMHP.
What is the timely filing limit for Texas Medicaid MCO claims?
Texas Medicaid managed care claims are generally due within 95 days from the date of service. Some MCOs publish additional rules for corrected claims and appeals, so we track each plan's deadlines.
Can I bill Texas Medicaid for audio-only therapy?
Yes, for many behavioral health services when clinically appropriate, under HB 4. Audio-only behavioral health services use modifier FQ. Coverage still depends on the service and the MCO's policy.
Can LPCs and LMFTs in Texas bill Medicare?
Yes. Since January 1, 2024, licensed professional counselors (as mental health counselors) and marriage and family therapists can enroll in Medicare. In Texas they enroll through Novitas, the Jurisdiction H contractor.
How does Healthcare Logic help Texas behavioral health practices?
We verify the member's program and MCO before each visit, secure authorizations, code to TMPPM and plan rules, submit inside filing limits, work denials and keep every clinician credentialed with the MCOs, Medicare and commercial plans you accept.
Talk to a behavioral health billing specialist
Tell us your payer mix and EHR, and we will show you where Texas 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.