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 mental health billing services are tailored for solo practitioners, group practices, and behavioral health clinics in Texas. Whether you’re in Houston, Dallas, Austin, or a rural town, we ensure faster claim approvals, accurate coding, and full compliance with TMHP and commercial payers. Let us handle the paperwork, so you can focus on your patients’ well-being.
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, Medi-Cal, 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.
Our Core Services Include
Accurate CPT and ICD-10 coding specific to mental and behavioral health- Prior authorization tracking for Texas Medicaid and commercial payers
- Electronic claim submission with clean creation and proactive follow-up
- Modifier & POS code management for Texas (e.g., 95, GT, POS 02)
- Optimization for high-volume codes: 90791, 90837, 90832, 96130, 90846
- Insurance credentialing services and re-credentialing support
- Expert denial management for common denials like CO 197, and CO 45 denial code
- ERA/EOB reconciliation and transparent patient balance tracking
- Insurance verification customized for Texas payer systems
- End-to-end telehealth billing compliant with TMHP and Medicaid rules
City-Level Customization to Maximize Revenue
Texas is diverse in both geography and payer policy. Here’s 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
Trusted, Compliant, and Transparent Billing
- 🔒 HIPAA and Texas HB 300-compliant documentation and processes
- 📊 SOC 2 Type II-compliant platforms with audit trails and daily secure backups
- ✅ 40% reduction in claim denials via pre-submission quality assurance
- 👥 Dedicated account managers trained in Texas-specific billing regulations
Why Mental Health Providers in Texas Choose MedStates
- 97% first-pass clean claim rate
- 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
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
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 like 90791, 90837, 96127, H2011, and H0031.
- ICD-10 codes for common diagnoses in Texas: F32.9 (Major Depressive Disorder), F41.1 (Generalized Anxiety), F90.0 (ADHD).
- Mental health HCPCS codes used under Texas Medicaid: H0032 (treatment planning), T1015 (clinic visit).
Place of Service & Modifier Accuracy
- Expertise in POS codes for in-office (11), telehealth (02), community clinics (50), and schools (03) – frequently used in Texas.
- Proper application of modifiers: GT, 95 for telehealth; HN, HO, U1–U8 for managed care compliance.
Insurance Credentialing & Payer Enrollment
- End-to-end credentialing with Texas Medicaid, STAR+PLUS, STAR Health, STAR Kids, and private payers like BCBS TX, Cigna, and Aetna.
- PECOS, CAQH, and TMHP credentialing support.
- Behavioral Health Organization (BHO) enrollments specific to Texas.
Claims Management & Denial Resolution
- Electronic claims submission via TMHP or clearinghouse.
- Real-time eligibility checks and pre-authorizations for Medicaid managed care organizations.
- Appeal management and denial rework (CO 197, CO 45, CO 109, etc.) aligned with Texas payer rules.
Continuous Reporting & Compliance
- Customized monthly billing reports and RCM analytics.
- Audit preparation and documentation according to Texas HHSC and Medicaid MCO guidelines.
- Secure handling of mental health records per Texas HB 300 and HIPAA.
Patient Statements & Payment Posting
- Co-pay and patient balance management.
- Prompt payment posting and reconciliation per Texas prompt pay statutes.
- Support for client billing in out-of-pocket or sliding scale practices.
In-House vs. Outsourced Billing for Texas Mental Health Providers
Choosing the right billing approach in Texas can dramatically affect your mental health practice revenue, efficiency, and compliance. Here’s how our professional billing services compare to managing billing in-house:
| Criteria | In-House Billing | MedStates Outsourced Billing (Texas) |
|---|---|---|
| Cost Efficiency | Salaries, training, and software costs add up | Flat monthly rate with no hidden fees |
| Knowledge of Texas Payers | Limited; depends on in-house expertise | Experts in Texas Medicaid, MCOs, private plans |
| Claim Denial Rate | Higher due to staff turnover or payer updates missed | 30–50% lower denial rate with proactive scrubbing |
| Time Spent on Admin Tasks | Up to 30% of provider’s time | Near-zero; full-cycle billing handled by our team |
| Credentialing with Texas MCOs | Manual and error-prone | Streamlined and monitored continuously |
| 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, KPIs |
| Scalability | Difficult with growing patient base | Easily scales across solo, group, or multi-site practices |
| Revenue Recovery | Often overlooked or delayed | Aggressive and ethical AR follow-up |
Texas-Specific CPT, ICD, HCPCS, POS & Modifiers
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
- 0791 – Psychiatric diagnostic evaluation (no medical services)
- 90792 – Psychiatric diagnostic evaluation with medical services
- 90834 – 45-minute individual psychotherapy session
- 90837 – 60-minute individual psychotherapy session
- 90846 / 90847 – Family psychotherapy (without/with patient)
- 96127 – Brief emotional/behavioral assessment with scoring
- H0031 – Mental health assessment by non-physician
- H2017 – Psychosocial rehabilitation services, per 15 minutes
ICD-10 Codes Frequently Reported in Texas
- F32.9 – Major depressive disorder, single episode, unspecified
- F41.1 – Generalized anxiety disorder
- F84.0 – Autism spectrum disorder
- F90.9 – Attention-deficit hyperactivity disorder, unspecified
- F43.20 – Adjustment disorder, unspecified
- Z63.5 – Disruption of family by separation or divorce
We continuously update these codes based on Texas Medicaid Bulletins and CMS NCCI edits to minimize denials.
HCPCS Codes Used by Texas Behavioral Health Clinics
- H0004 – Behavioral health counseling and therapy, per 15 min
- H2011 – Crisis intervention service, per 15 min
- H0036 – Community psychiatric support and treatment
- T1015 – Clinic visit/encounter, all-inclusive (for FQHCs, RHCs)
These codes are essential for clinics operating under the Texas HHSC Behavioral Health Services programs.
POS Codes Used in Texas Mental Health Settings
- POS 11 – Office
- POS 02 – Telehealth provided other than in patient’s home
- POS 10 – Telehealth provided in patient’s home
- POS 03 – School (for school-based behavioral programs)
- POS 99 – Other place of service (used by mobile therapists)
Correctly assigning the Place of Service (POS) ensures alignment with payer-specific billing rules in Texas.
Most Utilized Modifiers for Texas Providers
- GT – Via interactive audio and video telecommunication systems
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video
- 25 – Significant, separately identifiable E/M service by the same provider on the same day
- 59 – Distinct procedural service
- H9 – Court-ordered services (common in juvenile justice programs)
We validate modifiers against payer guidelines to prevent rejections and reduce audit risk, especially under Texas Medicaid managed care organizations (MCOs).
Texas Mental Health Insurance Plans We Work With
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-Run 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 in Texas
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 & Behavioral Carve-Out Plans
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.
Texas-Specific Billing Requirements & Documentation Assistance
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.
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.
Trust Signals, Compliance & Credentialing Support
At MedStates, we understand that trust, compliance, and payer enrollment are non-negotiables for mental health providers in Texas. That is why we go beyond billing—offering credentialing, documentation, and legal support that earns your patients’ and payers’ trust from day one.
Credentialing & Enrollment in Texas
We assist with full credentialing and re-credentialing for:
- Texas Medicaid & MCOs (e.g., Superior HealthPlan, Amerigroup, Molina)
- Private payers (BCBS Texas, UnitedHealthcare, Aetna, Cigna)
- Behavioral health-specific plans (Magellan, Beacon, Optum)
- City-specific networks in Houston, Austin, San Antonio, Dallas, and El Paso
Compliance-First Approach
We ensure you stay aligned with:
- Texas Health and Human Services (HHS) billing requirements
- Texas Medical Board and Board of Examiners of Psychologists regulations
- HIPAA, HITECH, and CMS mandates for mental health documentation
- Medical necessity, therapy duration limits, and authorized CPT code usage
Trust Signals We Provide
- HIPAA-compliant technology & claim processing
- 97% claim accuracy rate
- U.S.-based billing experts with Texas-specific payer experience
- Proven track record with behavioral health practices
- Client portal with real-time transparency
When you work with MedStates, you are not just outsourcing billing—you’re gaining a compliant, credentialed, and credible partner trusted across Texas.
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 knowledge to elevate your mental health billing and maximize 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.
