Every year, the Texas Health and Human Services Commission (HHSC) updates the Texas Medicaid program’s fee schedule, which outlines what the state will pay for healthcare services provided to patients enrolled in Texas Medicaid. This includes licensed behavioural health providers — such as Licensed Clinical Social Workers (LCSWs), Licensed Professional Counsellors (LPCs), Licensed Marriage and Family Therapists (LMFTs), and psychiatrists — who provide a wide variety of mental health services to their patients.
The Texas Medicaid 2026 Behavioural Health Fee Schedule is a state-wide fee schedule that guides what constitutes a reasonable maximum charge for billing to Texas Medicaid. The maximum payable services include:
- Psychiatric diagnostic evaluations
- Individual psychotherapy
- Group and family therapy
- Crisis intervention services
- Case management and community-based behavioural health
- Medication management visits
Licensed behavioural health provider billing has a great deal to do with:
- Correctly selecting CPT/HCPCS codes
- Using modifiers correctly (i.e., GT for telehealth, HO for master’s-level providers)
- Accurately documenting every clinical service provided, including start and stop times
- Properly reporting where services were performed (office, home, inpatient facility, telehealth, etc.)
Code Selection & Reimbursement Example
| CPT Code | Session Type | Duration | Reimbursement |
| 90834 | Individual Therapy | 45 minutes | $65.00 |
| 90837 | Individual Therapy | 60 minutes | $94.00 |
| 90791 | Psychiatric Diagnostic Evaluation | Standard | $131.00 |
| 90792 | Psychiatric Evaluation with Medical Services | With medical component | $158.00 |
Medicaid Eligibility Requirements for Behavioural Health Services
The Texas Medicaid behavioural health fee schedule applies to all Medicaid patients who are receiving mental health or substance use disorder treatment, including:
- Adults and children diagnosed with mental health conditions such as major depressive disorder, anxiety disorder, PTSD, or bipolar disorder
- Patients requiring crisis stabilization or urgent psychiatric evaluation
- Individuals enrolled in community mental health programs or rehabilitative services
- Patients receiving medication management for psychiatric conditions
Texas Medicaid serves a significant number of individuals with behavioural health needs across the state. Therefore, it is necessary for providers to accurately bill under this fee schedule to maintain compliance and strengthen revenue cycles.
Complete Behavioural Health Provider Fee Schedule (Effective 2026)
| Procedure | Modifier | Service Description | Non-Facility | Facility |
| 90791 | — | Psychiatric diagnostic evaluation | $131.00 | $105.00 |
| 90792 | — | Psychiatric evaluation with medical services | $158.00 | $131.00 |
| 90832 | — | Psychotherapy, 30 minutes | $46.00 | $36.00 |
| 90834 | — | Psychotherapy, 45 minutes | $65.00 | $52.00 |
| 90837 | — | Psychotherapy, 60 minutes | $94.00 | $75.00 |
| 90837 | GT | Telehealth individual psychotherapy, 60 min | $94.00 | — |
| 90846 | — | Family therapy without patient present | $74.00 | $60.00 |
| 90847 | — | Family therapy with patient present | $83.00 | $67.00 |
| 90853 | — | Group psychotherapy | $27.00 | $22.00 |
| 90839 | — | Crisis psychotherapy, first 60 min | $175.00 | $140.00 |
| 90840 | — | Crisis psychotherapy, each additional 30 min | $89.00 | $72.00 |
| 99213 | — | Outpatient E/M (moderate complexity) | $80.00 | $72.00 |
| 99214 | — | Outpatient E/M (detailed) | $109.00 | $98.00 |
| 99215 | — | Outpatient E/M (high complexity) | $148.00 | $133.00 |
| H0004 | — | Behavioural health counselling, per 15 min | $15.00 | — |
| H0031 | — | Mental health assessment by non-physician | $95.00 | — |
| H2011 | — | Crisis intervention service | $115.00 | — |
| H2019 | — | Therapeutic behavioural services, per 15 min | $12.00 | — |
| H2017 | — | Psychosocial rehabilitation services, per 15 min | $10.00 | — |
| 90863 | — | Pharmacologic management (add-on) | $39.00 | $31.00 |
| 99484 | — | General behavioural health integration, 20 min | $49.00 | — |
1. Psychiatric Evaluation Services
Psychiatric evaluations are the entry point for new patients entering the behavioural health system. These visits require the most comprehensive documentation and establish the clinical foundation for all ongoing treatment.
| CPT Code | Description | Modifier | Reimbursement |
| 90791 | Psychiatric diagnostic evaluation | — | $131.00 |
| 90792 | Psychiatric evaluation with medical services | — | $158.00 |
2. Individual Psychotherapy Services
Individual psychotherapy codes follow a time-based structure. The correct code depends entirely on the documented session duration — not the provider’s preference or the fee amount.
| CPT Code | Description | Reimbursement |
| 90832 | Psychotherapy, 30 minutes (16–37 min) | $46.00 |
| 90834 | Psychotherapy, 45 minutes (38–52 min) | $65.00 |
| 90837 | Psychotherapy, 60 minutes (53+ min) | $94.00 |
3. Family and Group Therapy Services
Family and group therapy codes capture services that are often underbilled by providers who default to individual therapy codes even when the clinical modality is different.
| CPT Code | Description | Reimbursement |
| 90846 | Family therapy, patient not present | $74.00 |
| 90847 | Family therapy, patient present | $83.00 |
| 90853 | Group therapy | $27.00 |
4. Crisis Intervention Services
Crisis services carry the highest per-visit reimbursement in the entire behavioural health fee schedule, reflecting the urgency and clinical intensity of these encounters.
| CPT Code | Description | Reimbursement |
| 90839 | Crisis psychotherapy, first 60 min | $175.00 |
| 90840 | Crisis psychotherapy, each additional 30 min | $89.00 |
| H2011 | Crisis intervention service (HCPCS) | $115.00 |
5. Evaluation & Management (E/M) and Medication Management
| CPT Code | Description | Reimbursement |
| 99213 | Outpatient E/M, moderate complexity | $80.00 |
| 99214 | Outpatient E/M, detailed | $109.00 |
| 99215 | Outpatient E/M, high complexity | $148.00 |
| 90863 | Pharmacologic management (add-on) | $39.00 |
6. Community-Based and Rehabilitative Mental Health (HCPCS H-Codes)
Texas Medicaid uses HCPCS H-codes for community-based mental health services that fall outside standard CPT psychotherapy codes. These codes are critical for community mental health centres (CMHCs), certified community behavioural health clinics (CCBHCs), and outpatient programs serving high-need populations.
| HCPCS Code | Description | Reimbursement |
| H0004 | Behavioural health counselling, per 15 min | $15.00 |
| H0031 | Mental health assessment (non-physician) | $95.00 |
| H2019 | Therapeutic behavioural services, per 15 min | $12.00 |
| H2017 | Psychosocial rehabilitation services, per 15 min | $10.00 |
| 99484 | General behavioural health integration, 20 min | $49.00 |
Compliance Guidelines for Behavioural Health Providers
To avoid denied claims, behavioural health providers need to understand how Texas Medicaid billing works. That means knowing how to document sessions, select the right codes, and use modifiers so TMHP approves the claim and pays under the current fee schedule.
Document your records as though they will be audited today.
Every chart entry must immediately demonstrate why a specific service was provided, what the clinical need was, and how the service delivered met that need. Even if the codes selected are accurate, the claim will likely be rejected if the auditor cannot determine whether the service was medically necessary.
Use time-based codes only when time thresholds are met.
Do not bill 90837 unless the session lasted at least 53 minutes — and document the exact start and stop time. Upcoding a standard 45-minute session to 90837 to collect the higher rate is the most common audit trigger for outpatient behavioural health in Texas Medicaid.
Apply modifiers correctly.
Modifiers such as GT (telehealth) and HO (master’s-level) describe how or by whom a service was delivered — they are not tools to increase reimbursement. Any misuse of a modifier may result in rejection of your claim or a compliance audit.
Be careful with LCSW reimbursement rules.
Texas Medicaid reimburses Licensed Clinical Social Workers at 70% of the psychologist rate. Claims submitted without reflecting this reduction, or without proper provider type enrollment, will be denied or recouped. Confirm your provider type designation with TMHP before submitting.
Verify Managed Care Organization (MCO) rules separately.
Texas Medicaid is largely delivered through managed care plans such as Superior HealthPlan, Amerigroup, Molina, and others. Each MCO may have:
- Different prior authorization requirements
- Shorter timely filing windows (typically 95–120 days)
- Additional documentation standards
- Separate telehealth credentialing requirements
Always verify your contracted MCO’s guidelines before submitting — the TMHP fee schedule is the baseline, but MCO contracts govern the actual payment.
Do not over-document to justify a higher code.
Write what is clinically accurate and necessary to support the code billed. Excessive, repetitive, or inflated documentation does not increase your payment — it increases your audit risk. Auditors view over-documentation as a red flag for upcoding.
Frequently Asked Questions (FAQs)
What is the Texas Medicaid Behavioural Health Fee Schedule for 2026?
The Texas Medicaid Behavioural Health Fee Schedule for 2026 is the official reimbursement structure managed by HHSC and administered through TMHP, effective as of January 1, 2026. It outlines how licensed behavioural health providers are reimbursed for services including psychiatric evaluations, individual and group therapy, crisis intervention, and community-based mental health services under Texas Medicaid.
How much does Texas Medicaid pay for therapy sessions in 2026?
Texas Medicaid pays approximately:
- 90832 (30 min): $46.00
- 90834 (45 min): $65.00
- 90837 (60 min): $94.00
Reimbursement varies based on provider type, place of service, and managed care plan. LCSWs receive 70% of psychologist rates.
What is the difference between CPT 90791 and 90792?
- 90791 = Psychiatric diagnostic evaluation without medical services ($131.00)
- 90792 = Psychiatric diagnostic evaluation with medical services ($158.00)
The 90792 code is reserved for psychiatrists and PMHNPs only, as it includes medication prescribing, physical examination, or lab order components. It reimburses approximately $27 more than 90791.
What does the GT modifier mean in Texas Medicaid behavioural health billing?
The GT modifier is applied when a behavioural health service is delivered via telehealth (live, interactive audio-video). Texas Medicaid and most MCOs recognize GT for psychotherapy and E/M codes. Always verify that the specific MCO you are billing has authorized the telehealth code combination before submitting.
What are the most common behavioural health billing errors in Texas Medicaid?
Most denied behavioural health claims trace back to a handful of recurring errors:
- Billing 90837 for sessions shorter than 53 minutes (upcoding)
- Missing or incorrect use of the GT modifier for telehealth claims
- Billing CPT codes when HCPCS H-codes are required by the MCO
- Incorrect provider type resulting in wrong reimbursement rate
- Failure to obtain prior authorization from the patient’s MCO
What is the 90839 reimbursement for behavioural health providers?
Texas Medicaid pays approximately:
- $175.00 for the first 60 minutes of crisis psychotherapy (90839)
- $89.00 for each additional 30 minutes (90840)
These are the highest per-visit rates in the outpatient behavioural health fee schedule and require detailed documentation of the crisis presentation.
Why does Texas Medicaid deny behavioural health claims?
Texas Medicaid denies behavioural health claims most often because of:
- Insufficient documentation of medical necessity
- Missing or incorrect modifiers
- Time-based codes billed beyond the documented session length
- Services not covered under the patient’s MCO plan
- Provider not enrolled or credentialed correctly with TMHP or the MCO
