What are the primary billing rules for behavioral health providers in Texas?
Mental and behavioral health billing in Texas is governed by the Texas Behavioral Health Executive Council (BHEC) licensing categories and state mental health parity regulations (Texas Insurance Code Chapter 1355). Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), and Licensed Clinical Social Workers (LCSWs) can bill commercial insurers directly and enroll in Texas Medicaid (TMHP) as independent billing practitioners. For Texas Medicaid MCOs, prior authorization is typically required for psychiatric diagnostic evaluations (90791/90792) exceeding annual limits and psychotherapy sessions (90834/90837) beyond initial benefit tiers.
1. The Texas Behavioral Health Credentialing Landscape
With the creation of the Texas Behavioral Health Executive Council (BHEC), licensing standards for LPCs, LMFTs, Social Workers, and Psychologists were unified.
Medicare now fully recognizes LPCs and LMFTs as enrolled Medicare Part B providers under recent federal expansions, opening massive new patient populations for Texas mental health practitioners.
2. Navigating Prior Authorization with Texas Medicaid MCOs
Managing Superior, Molina, Amerigroup, and Community Health Choice
Texas Medicaid STAR and STAR+PLUS plans mandate pre-authorization for extended psychological testing (CPT 96130-96137) and continuous intensive outpatient programs (IOP).
Clinicians must submit standardized Texas HHSC Behavioral Health Prior Authorization Request Forms accompanied by DSM-5 diagnostic formulations and functional impairment assessments.