Mental Health Billing Services for Florida Providers
Mental health billing in Florida requires more than just experience. It demands precision, compliance, and deep knowledge of both state-specific insurance rules and regulatory standards. Whether you are a licensed therapist in Orlando, a psychiatrist in Miami, or a behavioral health clinic in Tampa, the practice success depends on medical billing systems that are accurate, timely, and fully aligned with Florida’s payer standards. At MedStates, we specialize in mental health billing services for behavioral and mental health providers in Florida. Our end-to-end billing services are designed specifically for mental health providers operating in Florida’s diverse healthcare ecosystem. From AHCA compliance to Florida Medicaid plans like Sunshine Health and Simply Healthcare, we handle it all so you continue focusing on patient care.
We understand the challenges face by mental health providers in Florida with telehealth billing, city-specific payer requirements, and denial management. That is why we tailor every process from claim creation to use of accurate modifier and conducting prior authorization to submitting timely appeals, to meet Florida’s billing standards. With our support, providers across the state are increasing collections, reducing denials, and staying compliant to avoid billing audits.
Why Mental Health Billing in Florida is Complex
Mental health billing in Florida presents challenges that go beyond national standards. From managing Florida Medicaid Managed Care plans to complying with AHCA (Agency for Health Care Administration) audit requirements, providers must navigate a landscape shaped by both federal and state-specific complexities.
| Challenge | Florida-Specific Details |
|---|---|
| State Insurance Variability | Florida has over 15 Medicaid Managed Care plans including Sunshine Health, Simply Healthcare, and Humana Healthy Horizons — each with unique billing rules. |
| Telehealth Compliance | Under Florida’s SB 1120 and AHCA policies, telebehavioral health services require specific documentation, GT/95 modifiers, and synchronous session validation. |
| Licensing & Credentialing Requirements | All mental health professionals must meet Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling standards. |
| Prior Authorizations | Prior auths vary across Florida counties and payers. Behavioral health services, especially ABA therapy, often require extensive justification and documentation. |
| Documentation for Audits | AHCA requires strict documentation standards, including treatment plans, progress notes, and consent forms for Medicaid audits. |
| City-Level Requirements | Miami-Dade, Broward, and Hillsborough counties often have different provider enrollment protocols for Medicaid HMOs. |
These complexities make it difficult for providers to get paid accurately and on time. Without a deep understanding of Florida-specific claim handling and payer communication workflows it is inevitable to address billing delays, underpayments, and claim denials. At MedStates, we address these Florida-specific pain points with tailored processes for:
- Modifier application (e.g., 95, GT, HA)
- County-level Medicaid protocol alignment
- Multi-plan credentialing under AHCA standards
Common Billing Codes in Florida Mental Health Billing
Billing for mental health services in Florida requires familiarity with state-prevalent coding practices across CPT, ICD-10-CM, HCPCS, POS codes, and modifiers. These codes are the backbone of compliance, accuracy, and reimbursement. Below is an overview tailored for Florida-based behavioral health providers.
Most Frequently Used CPT Codes in Florida for Mental Health Services
Mental health practices in Florida commonly bill the following CPT codes:
- CPT 90791 – Psychiatric diagnostic evaluation (no medical services)
- CPT 90792 – Psychiatric diagnostic evaluation with medical services
- CPT 90832 – Psychotherapy, 30 minutes
- CPT 90834 – Psychotherapy, 45 minutes (most used)
- CPT 90837 – Psychotherapy, 60 minutes
- CPT 90846 – Family psychotherapy (without patient present)
- CPT 90847 – Family psychotherapy (with patient present)
- CPT 90853 – Group psychotherapy
- CPT 96127 – Brief emotional/behavioral assessment (often used with PHQ-9, GAD-7 in Florida Medicaid)
- CPT 99417 – Prolonged services (used for extended psychotherapy sessions)
These codes are often paired with evaluation & management (E/M) codes such as 99204, 99205, or 99214, when necessary.
ICD-10 Codes Commonly Used by Florida Mental Health Providers
Florida-based mental health professionals frequently report the following ICD-10-CM codes:
- F32.0–F33.3 – Major depressive disorder (MDD), single or recurrent
- F41.1 – Generalized anxiety disorder
- F43.23 – Adjustment disorder with mixed anxiety and depressed mood
- F84.0 – Autism spectrum disorder (especially for ABA therapy in Florida Medicaid)
- F90.0 – Attention-deficit hyperactivity disorder (ADHD)
- F31.9 – Bipolar disorder, unspecified
- F50.9 – Eating disorder, unspecified (frequent in adolescent behavioral clinics)
- F43.10 – PTSD, unspecified
These are aligned with AHCA guidelines for mental health diagnostic reporting and are commonly pre-screened during utilization review audits in Florida.
Florida-Specific HCPCS Codes for Behavioral Health Billing
Florida Medicaid Managed Care and Medicare Advantage plans rely heavily on HCPCS codes. Common examples include:
- H0031 – Mental health assessment by non-physician
- H0032 – Mental health service plan development
- H2019 – Therapeutic behavioral services (especially for youth in crisis)
- H2021 – Community-based wrap-around services (used for Florida’s SED population)
- T1015 – Clinic visit/encounter, per visit (used in FQHCs and CMHCs)
These codes are often specific to managed care and community-based programs supported by Florida’s Department of Children and Families (DCF).
Common Place of Service (POS) Codes in Florida Mental Health Billing
- POS 11 – Office (most outpatient therapy settings)
- POS 02 – Telehealth Provided Other Than in Patient’s Home (used under SB 1120)
- POS 10 – Telehealth Provided in Patient’s Home (newly reimbursed by Florida Medicaid)
- POS 03 – School (for services rendered under Medicaid School Match Program)
- POS 53 – Community Mental Health Center
- POS 99 – Other Place of Service (used cautiously when unique settings are involved)
Billing correctly under the appropriate POS is vital, especially when differentiating 02 vs. 10 for telehealth encounters.
Modifier Usage Relevant to Florida Regulations
Florida behavioral health billing often requires modifiers for reimbursement and compliance:
- Modifier GT – Synchronous telecommunication service via interactive audio and video (used under Florida Medicaid)
- Modifier 95 – Synchronous telehealth service rendered via real-time audio and video
- Modifier U1–U9 – Medicaid level of care/service indicators (required for behavioral analysis)
- Modifier HA – Child/adolescent program
- Modifier HE – Mental health program
- Modifier HQ – Group session
- Modifier TF – Intermediate level of care (used in some substance abuse programs)
Incorrect modifier usage is a top cause of denials from Florida Medicaid Managed Care Organizations (MCOs) such as Sunshine Health and Simply Healthcare. Read details on modifiers usage in mental health billing
Florida-Specific Insurance Coverage & Payer Networks for Mental Health Providers
Florida’s behavioral health billing landscape is shaped by a mix of state-funded programs, managed care organizations, and commercial payers with unique policies. For mental health providers, understanding Florida-specific insurance options and payer expectations is crucial to timely and accurate reimbursement.
Major Public Mental Health Programs in Florida
1. Florida Medicaid Behavioral Health
- Agency for Health Care Administration (AHCA) oversees Florida’s Medicaid program.
- Behavioral health is carved into Managed Medical Assistance (MMA) plans.
- Most services are delivered through managed care organizations (MCOs) like:
- Sunshine Health
- Simply Healthcare Plans
- Molina Healthcare of Florida
- Humana Healthy Horizons
- Aetna Better Health
- Medicaid covers individual, group, and family therapy, psychiatric evaluations, crisis services, and targeted case management
2. State-Funded Mental Health Programs
- Coordinated by the Florida Department of Children and Families (DCF).
- Services funded through:
- Substance Abuse and Mental Health (SAMH) Program
- Managing Entities such as Central Florida Behavioral Health Network (CFBHN), LSF Health Systems, and South Florida Behavioral Health Network.
3. Medicaid School Match Program
- Allows mental health services to be billed for eligible students in public schools.
- Often uses POS 03 and HCPCS codes like H0031, H2019.
Florida Mental Health Managed Care Plans (Commercial)
Commercial payers in Florida offer mental health benefits under both ACA-compliant plans and employer-sponsored coverage. Major insurers include:
- Florida Blue (Blue Cross Blue Shield of Florida)
- Behavioral health managed by New Directions or Lucet Health.
- Aetna
- UnitedHealthcare
- Cigna
- Humana
- Oscar Health
Each payer may subcontract behavioral health to a third-party administrator (TPA), so prior authorization and claims submission rules can differ.
Telehealth Coverage in Florida for Behavioral Health
Florida has taken proactive steps to expand telehealth mental health access:
- SB 1120 and HB 23 have broadened telehealth policy coverage.
- Florida Medicaid recognizes telehealth delivery via:
- POS 02: Not in patient’s home
- POS 10: In patient’s home
- Use of Modifier 95 or GT is required.
- Most MCOs reimburse individual therapy (90832–90837), assessments (90791), and med management (99204, 99213) via telehealth.
Tip: Always verify telehealth parity rules with the payer. Not all plans reimburse for group therapy or family sessions rendered remotely.
Out-of-Network & Prior Authorization Challenges in Florida
- Florida-based MCOs and Medicaid plans often require prior authorization for:
- Psych testing (96130, 96136)
- Prolonged therapy sessions (90837, 99417)
- ABA therapy for autism (H0032, H2019)
- Out-of-network billing is limited unless urgent/emergent or continuity-of-care provisions apply.
- Some commercial plans offer Single Case Agreements (SCAs) for out-of-network behavioral health providers.
Our Mental Health Billing Services in Florida
At MedStates, we specialize in delivering end-to-end mental health billing services designed specifically for Florida’s regulatory environment and payer landscape. Our team ensures your practice is reimbursed faster, stays compliant with state-specific rules, and focuses more on patient care—not paperwork.
Comprehensive Services We Provide for Florida Mental Health Providers
| Service | Description |
|---|---|
| Insurance Verification & Eligibility Checks | We verify patient insurance benefits for mental health coverage under Medicaid, MMA plans, and commercial carriers like Florida Blue, Aetna, and Cigna. |
| Pre-Authorization Management | Our team handles all prior authorization requirements—whether it is for individual therapy (90837), psychological testing (96130), or ABA therapy (H2019). |
| Claim Scrubbing & Submission | We prepare and scrub all CMS-1500 or UB-04 forms for accuracy before electronic submission through Florida-specific clearinghouses. |
| Denial Management & Appeals | We address denied claims (e.g., CO 197, CO 45) quickly and efficiently by analyzing payer remarks and filing precise appeals. |
| Telehealth Billing Compliance | We ensure your telehealth services comply with Florida laws and payer-specific requirements—using correct POS codes (02, 10) and modifiers (95, GT). |
| Behavioral CPT & HCPCS Coding | Our certified coders apply appropriate CPT, ICD-10, and HCPCS codes for therapy, evaluations, crisis interventions, and substance use services. |
| Patient Billing & Statements | We manage patient invoicing, co-pays, and statements while ensuring compliance with Florida debt collection and transparency regulations. |
| Credentialing & Contracting | Whether joining Medicaid or negotiating with Florida-based MCOs (like Sunshine Health or Simply), we handle credentialing from start to finish. |
Why Florida Mental Health Providers Choose MedStates
🧠 Deep knowledge of Florida Medicaid behavioral health systems and MCO policies.
🏥 Experience with billing for outpatient clinics, group therapy practices, school-based providers, and private telehealth clinicians.
📈 Consistent increase in clean claim rate and monthly revenue within 90 days.
Major Insurance Plans We Work With in Florida
Florida’s mental health coverage is broad but complex, especially with multiple layers of Medicaid, commercial plans, and ACA-compliant options. We have built direct relationships with many of the State’s top carriers, including:
- Sunshine Health (a Centene plan)
- Simply Healthcare
- Staywell Health Plan
- Molina Healthcare of Florida
- Humana Healthy Horizons
- Community Care Plan
- Florida Community Care
We help mental health providers navigate these Medicaid plans through credentialing, claim submission, encounter reporting, and prior authorizations for behavioral services.
- Florida Blue (BCBS of Florida)
- Aetna Better Health of Florida
- UnitedHealthcare of Florida
- Cigna Behavioral Health
- Oscar Health
- Ambetter from Sunshine Health
- AvMed
We ensure correct billing with accurate CPT codes, plan-specific modifiers, and compliance with network contracts and authorization guidelines.
- Traditional Medicare
- Humana Gold Plus
- WellCare Dual Complete
- UnitedHealthcare Dual Complete
- CarePlus Health Plans
Our mental health billing specialists stay updated on CMS rules, Medicare Advantage payer edits, and DSNP guidelines to minimize denials and ensure timely reimbursements.
City-by-City Mental Health Billing Support Across Florida
Florida’s healthcare landscape varies dramatically by region, making localized billing expertise essential. At MedStates, we tailor our mental health billing services to address the unique payer mixes, documentation rules, and referral protocols in each major city.
Miami & Miami-Dade County
Key Challenges: High volume of Medicaid MCO patients, bilingual documentation needs, and strict prior authorization rules for behavioral therapy.
Our Approach:
- Spanish-language EHR integration and patient statements
- Authorization support for Sunshine Health, Simply Healthcare
- Enhanced verification for undocumented patients on emergency Medicaid
Orlando
Key Challenges: Rapidly expanding provider networks, heavy use of managed care, and increased scrutiny of therapy notes.
Our Approach:
- Accurate billing for ABA therapy, group sessions, and intensive outpatient programs (IOP)
- Integration with payer portals (e.g., Florida Blue, Cigna)
- Chart audits and compliance reviews to minimize takebacks
Tampa
Key Challenges: High concentration of veterans and DSNP members, local credentialing backlogs.
Our Approach:
- Expertise in VA Community Care Network (CCN) and Medicare Advantage DSNP billing
- Expedited provider enrollment services
- Automation of dual-eligibility verifications
Jacksonville
Key Challenges: Coordination with regional health information exchanges (HIEs) and multi-specialty clinics.
Our Approach:
- Direct claim routing to providers connected with the Northeast Florida Health Information Consortium
- Multi-disciplinary mental health billing across psychiatry, therapy, and social work
- Streamlined billing for outpatient mental health centers (POS 11)
Gainesville
Key Challenges: Student mental health clinics, variable payer policies due to transient populations.
Our Approach:
- Integration with student health plans and ACA exchanges
- High accuracy with HCPCS coding for brief intervention and counseling
- Claims compliance training for small university-affiliated clinics
Looking FOR ASSISTANCE IN practice billing?
Whether you re a solo psychiatrist in Tallahassee, a therapy group in Fort Lauderdale, or a behavioral health clinic in Sarasota, we adjust our billing workflow to fit your exact payer contracts, locality rules, and clinical structure. Schedule a free consultation today and discover how our Florida-focused mental health billing services can help you:
- Eliminate claim denials
- Boost revenue cycle efficiency
- Ensure timely reimbursements
- Stay compliant with Florida mental health billing requirements
📞 Call us: +1-929-621-6059
📧 Email us: info@medstates.com
📝 Or fill out the form to request a callback. Let’s get started!
