Medical Billing for Mental Health Providers in Texas
Mental health providers across Texas face unique billing challenges — from navigating Medicaid Managed Care Organizations (MCOs) like STAR and CHIP to adhering to Texas-specific CPT, ICD-10, and modifier requirements. Our specialized billing services for mental health providers in Texas are tailored for solo practitioners, group practices, and behavioral health clinics. Whether you are in Houston, Dallas, Austin, or a rural town, we ensure compliance with Medicaid, TMHP and commercial payers in TX.
Are you a therapist, psychologist, or behavioral health clinic in Texas struggling with complex billing, denied claims, or Medicaid documentation? At MedStates, we provide end-to-end billing solutions customized for mental health professionals in TX. From Houston to Austin and El Paso, we recognize the reimbursement challenges that vary by region. That’s why our billing support is designed to align with local payer regulations, including TMHP, and leading commercial insurers like Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna, and Superior HealthPlan. We adapt to your EHR and ensure full compliance with Texas Health and Human Services (HHS) and Texas Medicaid policy manuals.
Comprehensive Mental Health Billing Services for Texas Providers
- ✅ Insurance credentialing services and re-credentialing support. Read how we support mental health providers in payer enrollment
- ✅ Prior authorization tracking for Texas Medicaid and commercial payers
- ✅ CPT and ICD-10 coding specific to Texas mental and behavioral health
- ✅ Modifier & POS code management for Texas
- ✅ Electronic claim submission with clean creation and proactive follow-up
- ✅ Expert denial management
- ✅ ERA / EOB reconciliation and transparent patient balance tracking
- ✅ End-to-end telehealth billing compliant with TMHP and Medicaid rules. Read our guide on telehealth billing
Local Billing Differences Across Major Texas Cities
Serving behavioral health providers across Houston, Dallas, Austin, San Antonio, El Paso, Fort Worth, and surrounding Texas regions. Here is how we adapt our billing support to specific regions:
Houston
Specialized knowledge of managed Medicaid payers like Molina, Amerigroup, and Superior
Dallas–Fort Worth
Complex commercial payer management, including BCBS TX and UHC plans
Austin
Emphasis on hybrid billing (telehealth + in-person) for tech-savvy and wellness-oriented providers
El Paso & Border Towns
Bilingual support and streamlined workflows for binational provider setups
Why Mental Health Providers in Texas Choose MedStates
- ✅ 97% first-pass clean claim rate. Learn what clean claim means
- 📍 Deep experience with TMHP, Medicaid MCOs, and Texas commercial insurers
- ⚖️ Support for Medicaid, Medicare, and cash-pay hybrid models
- 📞 U.S.-based support for mental health providers in Texas
- 💬 Seamless integration with mental health EHRs like TherapyNotes, SimplePractice, and TheraNest. Read our blog post on Mental Health EHRs
Our Mental Health Billing Services for Texas Providers
At MedStates, we offer full-spectrum billing services customized for Texas-based mental health professionals, whether you’re practicing in major cities like Houston and San Antonio or rural or underserved networks.
CPT/ICD-10/HCPCS Code Optimization
- Accurate use of Texas-prevalent CPT codes.
- ICD-10 codes for common diagnoses in Texas including major Depressive Disorder, generalized anxiety and ADHD.
- Texas Medicaid HCPCS codes .
Place of Service & Modifier Accuracy
- Expertise in POS codes used in Texas for office-based care, telehealth, community clinics.
- Proper application of modifiers for Texas Medicaid, PHMP and MCOs.
Payer Enrollment with TX Medicaid, MCOs
- Payer enrolment with Texas Medicaid, STAR Health, STAR Kids, and payers like BCBS TX, Cigna, and Aetna.
- TMHP credentialing support.
- Behavioral Health Organization (BHO) enrollments in TX.
Claims Management & Denial Resolution
- Electronic claims submission via TMHP or clearinghouse.
- VOB and Pre-authorizations for TX Medicaid MCOs.
- Denial management & appeals under TX payer guidelines.
Continuous Reporting & Compliance
- Monthly billing reports and analysis.
- Audit ready documentation for Texas HHSC and Medicaid MCO.
- HIPAA Compliant record handling in line with Texas HB 300.
Patient Statements & Payment Posting
- Co-pay and patient balance management.
- Prompt payment posting and reconciliation with payers.
- Support for client billing in out-of-pocket.
In-House vs. Outsourced Billing for TMHP and Medicaid MCOs
Choosing the right billing approach in Texas can dramatically affect your mental health practice revenue, efficiency, and compliance. Here’s how chossing our billing services is wise and affordable than billing in-house:
| Criteria | In-House Billing | MedStates Outsourced Billing (Texas) |
|---|---|---|
| Cost Efficient | Salaries, training, and software costs add up | Percentage model with no hidden charges |
| Texas-Specific Billing Expertise | Often limited; depends on in-house resource | Expertise in Texas PHMP, Medicaid MCOs plans |
| Claim Denial Rate | Higher due to staff turnover or missing payer updates / guidelines | 30–50% lower denial rate with proactive claim scrubbing |
| Time Spent on Admin Tasks | Up to 30% of provider’s time | Near-zero; full-cycle billing handled by our team |
| Payer enrollment with Texas MCOs | Manual and error-prone | Streamlined, monitored and continuous follow-up due to dedicated staff |
| Telehealth Compliance (Texas) | May miss evolving Medicaid and private payer guidelines | Fully compliant with current Texas telehealth policies |
| Access to Reporting | Depends on software | Real-time dashboards, monthly reports, defined KPIs |
| Scalability | Difficult with growing patient base | Easily scales across solo, group, or multi-site practices |
| Revenue Recovery | Often overlooked, delayed and lost | Aggressive and ethical AR follow-up |
Common CPT, ICD-10, HCPCS, POS, and Modifiers in Texas Mental Health Billing
Mental health billing in Texas must adhere to both federal and state-specific coding and reimbursement rules. At MedStates, we optimize claims by applying the correct codes used by providers across the state — whether you are billing Medicaid, commercial payers, or behavioral health carve-out plans. Below is a breakdown of commonly used billing codes and modifiers:
Common CPT Codes Used in Texas Mental Health Billing
Behavioral health providers in Texas rely on CPT codes such as 90791, 90834, and 90837 for psychotherapy and evaluation sessions. However, state-specific payers like TMHP, Superior, and Amerigroup may require prior authorization or modifier 95 for telehealth sessions.
👉 For a detailed CPT code reference by service type and duration, visit our complete CPT codes for mental health billing guide.
ICD-10 Codes Frequently Reported in Texas
Accurate ICD-10 coding ensures timely claim approval with Texas Medicaid and MCOs. Common examples include F32.0 (Major depressive disorder) and F41.1 (Generalized anxiety disorder).
👉 For an in-depth list and guidance on mental health ICD-10 coding, refer to our ICD-10 codes section on mental health billing services page.
HCPCS Codes Used by Texas Behavioral Health Clinics
Texas Medicaid uses HCPCS codes like H0031 and H2019 for community-based therapy and case management services. Each MCO (e.g., Molina, Superior, Amerigroup) may define its own documentation and authorization requirements.
👉 See a comprehensive explanation of HCPCS and their usage in behavioral health billing on our nationwide mental health billing services page
POS Codes Used in Texas Mental Health Settings
Correct POS assignment reduces TMHP denials and ensures accurate reimbursement under Texas-specific Medicaid and MCO plans.
👉 Learn more about POS codes and how they affect medical billing.
Most Utilized Modifiers for Texas Providers
In Texas, payers like Superior and Amerigroup often require modifiers such as HE, 95, and U2 for telehealth and behavioral services. Correct use of these modifiers ensures accurate reimbursement under TMHP and Medicaid MCO plans.
👉 Learn more about behavioral health modifiers and their billing impact.
Insurance Plans and Payers We Work With in Texas
Navigating the Texas behavioral health insurance landscape requires familiarity with both statewide programs and regional networks. At MedStates, we work directly with mental health providers to ensure their services are billable, compliant, and paid—whether they serve clients under public plans, commercial insurers, or managed care entities.
Texas Medicaid & State Behavioral Health Plans
We specialize in mental health billing for providers enrolled in:
- Texas Medicaid (Traditional & STAR/STAR+PLUS MCOs)
- NorthSTAR Behavioral Health Program (Dallas region legacy support)
- Texas Children’s Health Plan
- Community First Health Plans (San Antonio area)
- Superior HealthPlan Behavioral Health Services
- UnitedHealthcare Community Plan of Texas
- Amerigroup Texas
- Texas Health and Human Services Commission (HHSC) programs
- Mental Health Services under Texas HHSC Behavioral Health Services
These plans often require authorization, encounter reporting, and specific HCPCS/CPT combinations, which we manage proactively.
Commercial Insurance Carriers (BCBS, UHC, Aetna, Cigna)
MedStates helps Texas providers bill all major commercial payers, including:
- Blue Cross and Blue Shield of Texas (BCBSTX)
- UnitedHealthcare
- Aetna
- Cigna
- Molina Healthcare of Texas
- Magellan Health
- Optum Behavioral Health
- Beacon Health Options
- Ambetter from Superior HealthPlan
Our billing experts ensure payer-specific guidelines (like telehealth coverage, pre-auths, and session limits) are followed for clean claims submission.
Texas-Based EAPs and Behavioral Carve-Out Programs
Many mental health providers in Texas also work with Employee Assistance Programs and regional behavioral carve-outs. We support billing for:
- Deer Oaks EAP Services
- Interface EAP
- MHNet Behavioral Health (Texas-focused)
- Alliance Work Partners (AWP)
We handle visit limits, session documentation, and unique EAP billing structures efficiently.
Behavioral Health Compliance and Documentation Under Texas Medicaid
Texas has unique mental health billing requirements shaped by state regulations, Medicaid managed care contracts, and regional health authorities. At MedStates, we ensure providers stay compliant and fully reimbursed by aligning with all Texas-specific rules and payer expectations.
Key Documentation Requirements in Texas
Mental health providers billing in Texas must comply with both Texas Administrative Code (TAC) and payer-specific documentation protocols. Our team supports:
- Compliant Progress Notes: Including client ID, DSM-5 diagnosis, goals, interventions, and clinical outcomes—structured to meet Medicaid MCO audits.
- Medical Necessity Justifications: Especially critical when billing codes like H0031, H2017, or 90837 under Medicaid.
- Behavioral Health Service Logs: Including encounter timestamps, service location, and practitioner credentials.
- HIPAA-Compliant Telehealth Documentation: We adapt forms to ensure compliance with Texas Medicaid Telemedicine and Telehealth Services Handbook and commercial payers’ tele-behavioral policies.
Common Texas Medicaid & MCO Claim Filing Rules
We help you meet key rules that vary by region and MCO contract:
- Timely Filing Windows: Often 95–120 days depending on payer (e.g., Superior HealthPlan, Amerigroup).
- Provider Type Enrollment: Ensuring you’re correctly credentialed with TMHP, Texas Medicaid’s claims administrator.
- National Correct Coding Initiative (NCCI) edits: Applied more strictly in Texas Medicaid.
- Place of Service (POS) Reporting: Especially for POS 02 (telehealth) and POS 03 (school-based settings).
We maintain strict compliance with the Texas Health and Human Services Commission (HHSC) billing manual and frequently update workflows to reflect new bulletins.
Texas Managed Care Organizations (MCO) – City Level Variances
Texas operates many regional MCOs with slight documentation differences across cities. For example:
- Houston (Harris County): Molina and Community Health Choice require real-time electronic progress notes.
- Austin/Travis County: Superior HealthPlan mandates encounter-level ICD validation.
- Dallas/Fort Worth: Prior auths for ABA therapy (CPT 97151–97158) often include school-based and in-home restrictions.
- San Antonio: Community First requires additional referral notes for CPT 90846 (family therapy without patient).
Our system flags city-specific rules and payer quirks to ensure every claim is formatted, supported, and submitted correctly the first time.
How We Adapt to City-Level Mental Health Billing Needs Across Texas
Mental health billing is not one-size-fits-all in Texas. Every major metro area—including Houston, Austin, Dallas, San Antonio, and El Paso—has its own payer mix, managed care protocols, and documentation habits. At MedStates, we fine-tune our billing services based on the city-specific environment where your practice operates.
- Specialized billing for Medicaid MCOs like Community Health Choice and Molina Healthcare.
- Emphasis on electronic visit verification (EVV) and teletherapy documentation.
Dallas–Fort Worth Metroplex
- Familiarity with Blue Cross Blue Shield of Texas commercial plans and their mental health carve-outs.
- Prior authorization workflows tailored for ABA, psychotherapy, and school-based therapy claims.
Austin
- Responsive to Texas STAR Health requirements and Superior HealthPlan’s behavioral health billing edits.
- Claims tailored to meet strict timeliness and diagnosis code pairing rules.
San Antonio
- Integration with Community First and Aetna Better Health systems.
- Optimized submissions for bilingual therapy services and culturally adapted care plans.
El Paso & West Texas
- Experience with limited provider networks and rural telehealth regulations.
- Support for bilingual ICD coding and claims aligned with Texas-Mexico border initiatives.
Whether you are billing in a bustling urban center or a rural region, we localize every claim to the compliance, coding, and payer nuances of your specific city in Texas—maximizing your collections while minimizing denials.
Ready to Simplify Your Mental Health Billing in Texas?
Whether you are a solo therapist in Austin, a group practice in Dallas, or a community clinic in El Paso, MedStates has the tools, experience, and Texas-specific mental health billing expertise to elevate your practice reimbursements.
- Struggling with Medicaid MCOs or private payer rejections?
- Wasting hours on insurance follow-ups or compliance paperwork?
- Expanding to new cities or launching teletherapy services?
Let us handle the billing complexities so you can focus on patient care. Start Today
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Your practice. Your patients. Our billing expertise. Welcome to MedStates Texas.
