Direct answer: The 2026 Texas Medicaid behavioral health fee schedule provides fee-for-service reimbursement information by procedure code, provider type, place of service, and effective date. Providers should verify every rate through the current TMHP Online Fee Lookup or applicable static fee schedule before submitting a claim. Medicaid managed-care plans may use different rates and billing rules.
Last reviewed: August 2026. This article provides general billing information and does not replace current TMHP, HHSC, managed-care plan, contract, coding, or legal guidance.
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What Is the Texas Medicaid Behavioral Health Fee Schedule?
The Texas Medicaid behavioral health fee schedule helps fee-for-service providers identify reimbursement information for covered behavioral health services. The applicable amount can depend on the procedure code, provider type, modifier, place of service, date of service, and other billing conditions.
Texas Medicaid uses several reimbursement methods. Some services use rates published through the TMHP Online Fee Lookup or static fee schedules. Under this methodology, reimbursement is generally limited to the lower of the provider’s billed charge or the applicable Medicaid rate.
However, the fee-for-service schedule should not automatically be applied to members enrolled in a Medicaid managed-care organization. Managed-care plans may establish different rates, authorization requirements, filing deadlines, and billing instructions.
How to Verify a Texas Medicaid Behavioral Health Rate in 2026
Do not rely on an old spreadsheet, a previous remittance, or a rate quoted on a third-party website. Complete the following review for the actual date of service:
- Confirm whether the patient has fee-for-service Medicaid or managed-care coverage.
- Verify the patient’s eligibility for the date of service.
- Identify the procedure code and any required modifier.
- Confirm the rendering provider’s enrolled provider type and specialty.
- Check the applicable place of service.
- Review the current TMHP Online Fee Lookup or relevant static fee schedule.
- Check the Behavioral Health and Case Management Services Handbook for coverage limitations.
- Verify prior authorization, referral, and managed-care requirements.
This process is important because the same code may be treated differently according to the provider, setting, benefit, and patient’s coverage arrangement.
Behavioral Health Services Covered by Texas Medicaid
Texas Medicaid behavioral health policy covers several types of services when the patient, provider, service, and documentation meet the applicable requirements. These may include:
- Psychiatric diagnostic evaluations
- Individual psychotherapy
- Family and group psychotherapy
- Evaluation and management services
- Crisis intervention services
- Mental health rehabilitative services
- Mental health targeted case management
- Substance use disorder services
- Behavioral health integration services
Coverage is not determined by the procedure code alone. Providers must also confirm medical necessity, benefit limitations, provider eligibility, authorization requirements, and the patient’s specific Medicaid program.
Common Behavioral Health Code Families
The following examples can help billing teams organize their code review. They are not a guarantee of coverage or payment:
| Code family | Common purpose | Primary billing check |
|---|---|---|
| 90791–90792 | Psychiatric diagnostic evaluation | Provider qualifications and whether medical services were included |
| 90832–90837 | Individual psychotherapy | Documented time and service requirements |
| 90846–90847 | Family psychotherapy | Whether the patient was present |
| 90853 | Group psychotherapy | Coverage, group documentation, and provider eligibility |
| 90839–90840 | Crisis psychotherapy | Crisis documentation and time requirements |
| 99202–99215 | Office or outpatient evaluation and management | Provider eligibility and current E/M coding rules |
| HCPCS H-codes | Selected community-based and rehabilitative behavioral health services | Program, provider, authorization, unit, and documentation requirements |
Always verify the current code description, coverage policy, unit limitation, modifier instructions, and rate before billing.
Provider Type Can Affect Reimbursement
Texas Medicaid reimbursement may vary according to the rendering provider’s enrollment classification. The Behavioral Health and Case Management Services Handbook includes policies for psychiatrists, psychologists, physicians, advanced practice registered nurses, physician assistants, licensed clinical social workers, licensed marriage and family therapists, licensed professional counselors, and other eligible providers.
For example, Texas Medicaid states that LCSWs, LMFTs, and LPCs are reimbursed at 70% of the rate paid to a psychiatrist or psychologist for a similar service under the applicable Texas Administrative Code methodology. The final payable amount still depends on the code, setting, program, date of service, and other claim details.
Billing under the wrong rendering provider, taxonomy, NPI, or enrollment record can cause denials or recoupment. Confirm that both the individual and organization are properly enrolled and credentialed for the service being submitted.
Fee-for-Service and Managed Care Are Different
One of the most important billing distinctions is whether the claim belongs to Texas Medicaid fee-for-service or a managed-care plan.
Fee-for-Service Claims
For fee-for-service claims, providers should follow the current Texas Medicaid Provider Procedures Manual, TMHP billing instructions, and the applicable Online Fee Lookup or static fee schedule.
Managed-Care Claims
For managed-care claims, providers should consult the patient’s health plan and their provider contract. Medicaid managed-care organizations are not necessarily required to use the Texas Medicaid fee-for-service schedule. Differences may include:
- Contracted reimbursement rates
- Prior authorization requirements
- Claim filing deadlines
- Telehealth policies
- Required modifiers
- Appeal and reconsideration procedures
- Provider credentialing requirements
Verifying the payer before the visit reduces avoidable eligibility, authorization, and reimbursement errors.
Documentation Requirements for Behavioral Health Claims
A clean claim still requires a complete clinical record. Documentation should support the service that was actually performed and demonstrate why it was medically necessary.
Depending on the service, the record may need to include:
- Patient identity and date of service
- Rendering provider identity and credentials
- Diagnosis and relevant clinical findings
- Reason for the encounter
- Assessment and treatment plan
- Interventions performed
- Patient response and progress
- Start and stop times when required
- Place and method of service delivery
- Provider signature and completion date
The documentation should support the code, units, modifier, and place of service reported on the claim. Templates should not create repetitive or inaccurate statements that fail to describe the individual encounter.
Time-Based Behavioral Health Codes
Psychotherapy and crisis codes can include time requirements. Billing teams should compare the documented time with the current code definition and payer policy before selecting a code.
Do not select a longer-session code simply because it pays more. The record must support the service and the required time. Missing, inconsistent, or copied time entries can lead to denials, audits, or overpayment recovery.
Telehealth Billing Requirements
Telehealth coverage and claim formatting can depend on the service, patient location, provider type, Medicaid delivery model, and date of service. Before billing a behavioral health telehealth encounter, verify:
- Whether the service is eligible for remote delivery
- The correct place-of-service code
- Whether a telehealth modifier is required
- Whether audio-only service is covered
- Whether prior authorization is required
- Whether the provider meets enrollment and licensure requirements
- Whether the patient’s managed-care plan has additional rules
Do not automatically apply modifier GT or another telehealth modifier to every remote claim. Use only the modifier required by the current TMHP or managed-care plan instructions.
NCCI and Medically Unlikely Edits
Texas Medicaid behavioral health claims are subject to applicable National Correct Coding Initiative relationships and Medically Unlikely Edits. These edits can restrict code combinations, units, or billing circumstances.
When Texas Medicaid policy is more restrictive than federal NCCI guidance, the Texas Medicaid limitation may control. Review code combinations before claim submission and use a modifier only when the documentation and coding rules support it.
For more coding guidance, read our guide to common medical billing modifiers.
Common Reasons Behavioral Health Claims Are Denied
- The patient was not eligible on the date of service.
- The claim was sent to the wrong payer.
- Prior authorization was missing or did not match the service.
- The rendering provider was not enrolled or credentialed correctly.
- The procedure code, modifier, units, or place of service was incorrect.
- The documented time did not support the code.
- The service exceeded a benefit or program limitation.
- The claim conflicted with an NCCI or MUE edit.
- The medical record did not support medical necessity.
- The claim was submitted after the applicable filing deadline.
Practices can reduce preventable denials by using a payer-specific claim checklist and reviewing remittance trends by code, provider, and denial reason. See our guide on reducing denied claims through eligibility verification.
Behavioral Health Billing Checklist for 2026
- Verify eligibility and the patient’s Medicaid delivery model.
- Confirm benefits and prior authorization requirements.
- Confirm that the provider is enrolled and credentialed.
- Select the code supported by the documented service.
- Verify time, units, modifiers, and place of service.
- Check NCCI and MUE restrictions.
- Use the current fee lookup for the date of service.
- Submit the claim to the correct payer.
- Review acceptance reports and remittance advice.
- Correct denials within the payer’s filing or appeal deadline.
Frequently Asked Questions
Where can providers find the 2026 Texas Medicaid behavioral health fee schedule?
Providers should use the TMHP Online Fee Lookup or the applicable static fee schedule. The Behavioral Health and Case Management Services Handbook should also be reviewed for coverage and billing requirements.
Does the Texas Medicaid fee-for-service rate apply to every managed-care plan?
No. Managed-care plans may use contract-specific reimbursement arrangements and billing rules. Verify the patient’s plan and the provider contract before billing.
Does every behavioral health provider receive the same rate?
No. Reimbursement can vary by provider type, procedure, setting, modifier, program, and date of service.
Can a provider rely on a fee schedule downloaded earlier in the year?
Providers should verify the current rate for the actual date of service because policies and reimbursement information may change.
What should a provider do if the TMHP rate differs from an MCO contract?
For a managed-care claim, review the MCO’s contract, provider manual, fee exhibit, and claim instructions. Contact the plan when the applicable rate or policy remains unclear.
Official Texas Medicaid Resources
- Texas Medicaid Provider Procedures Manual
- Behavioral Health and Case Management Services Handbook
- Texas Medicaid Fee-for-Service Reimbursement
Improve Behavioral Health Billing Accuracy
Behavioral health reimbursement depends on more than selecting a procedure code. Eligibility, authorization, provider enrollment, documentation, modifiers, edits, claim deadlines, and payer-specific rules must all align.
Med Billing and Transcription helps healthcare practices improve claim accuracy, denial prevention, accounts receivable follow-up, and revenue-cycle performance. Contact our team to discuss billing support for your practice.
