Is this table the member's benefits?

No. It is what each payer publishes. The member's plan decides coverage, visit limits, authorization and cost sharing, so verify benefits before the first visit.

Each fact shows the day we opened its source. The latest check was October 30, 2026.

Free tools

Psychotherapy coverage by payer and state, with sources

Q: Where do the facts come from?

From each payer's own policy, provider manual or fee schedule, from CMS for Medicare, a state Medicaid agency or the statute itself. Each fact links to its source.

The short answerWhat payers publish about psychotherapy for therapists: which of 90791, 90832, 90834 and 90837 and the other codes each policy names, telehealth rules, visit limits and prior authorization, for 17 payers, state Medicaid programs and state laws. Every fact links to its source and the day we checked it.

By Javier Alvarez · Updated October 30, 2026 · 1 min read

Rows	17 payers, Medicaid programs and state laws, each with its own page
Codes	90791, 90832, 90834, 90837, 90846, 90847, 90853 and 90785
Sources	29 official documents

18 rows: All payers and states. Public policy, not the member's benefits.

Medicare

Original Medicare (Part B) · All states

90785	Listed [1]
90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed (covered when medically reasonable and necessary with patient treatment as the primary purpose; PFS status indicator R (restricted coverage)) [1][2]
90847	Listed [1]
90853	Listed [1]
Other codes	Crisis psychotherapy 90839 and 90840 are on the CMS list of commonly used mental health codes and are marked as codes CPs, CSWs, MFTs and MHCs can bill. CPs, CSWs, MFTs and MHCs can bill the general behavioral health integration code G0323 when they personally perform the services. [1]
Telehealth POS	Use POS 02 when the patient is not at home and POS 10 when the patient is at home. Telehealth to the patient's home is paid at the non-facility rate. [3]
Telehealth rules	Behavioral health telehealth has no geographic or place-of-service restriction and the patient may be at home. Through December 31, 2027 audio-only is allowed at home; from January 1, 2028 audio-only behavioral health at home is allowed when the practitioner can use video but the patient cannot or does not consent to video. After December 31, 2027 an in-person visit is required within 6 months before the first home mental health telehealth service and then within 12 months of each one, with limited exceptions; patients who began mental health telehealth by December 31, 2027 count as established and need only the 12-month visit. [3][1]
Visit limits	Services billed by MFTs and MHCs are not paid under their benefit category when a hospital outpatient department or CMHC provides them in a partial hospitalization or intensive outpatient program. Services to SNF residents are excluded from consolidated billing, so include the SNF's Medicare provider number. [1]
Who can bill	Clinical psychologists, clinical social workers, MFTs and mental health counselors (including certified alcohol and drug counselors) are eligible professionals. MFTs and MHCs need a master's or doctoral degree that qualifies for state licensure or certification, a state license or certification, and at least 2 years or 3,000 hours of post-master's supervised clinical experience. Since January 1, 2024 they may enroll and bill Medicare independently. [1]
Payment	CSWs, MFTs and MHCs must accept assignment and are paid 75% of the PFS amount for clinical psychologists. Computed from the RVU26D October 2026 file (non-facility total RVUs x 33.4009 conversion factor, national, before geographic adjustment): about $167.00 for 90837, $113.90 for 90834, $85.84 for 90832, $173.35 for 90791, $109.55 for 90847 and $30.39 for 90853, before the 75% rate. [1][2]
Medicare rules	MFTs and MHCs enroll with PECOS or the paper CMS-855I, are limited screening risk, and pay no application fee. A separate CMS-855I is needed in each state where services are rendered. Medicaid enrollment does not enroll you in Medicare. [4]

CMS: MLN Medicare & Mental Health Coverage, MLN1986542 (March 2026), checked October 30, 2026
CMS: PFS Relative Value Files, RVU26D (zip updated 08-26-2026, file PPRRVU2026_Oct_nonQPP), checked October 30, 2026
CMS: Telehealth FAQ (updated 10/8/26), checked October 30, 2026
CMS: Provider Enrollment FAQs for Marriage and Family Therapists and Mental Health Counselors (May 2024), checked October 30, 2026

Cigna and Evernorth Behavioral Health

Cigna Commercial Virtual Care policy R31 (behavioral health section) and Evernorth Behavioral Health prior authorization guide · All states

90785	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90791	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90832	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90834	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90837	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90846	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90847	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
90853	Listed (eligible for virtual care reimbursement under a Behavioral Health plan) [1]
Where it applies	Applies to CMS-1500 claims for Cigna Commercial plans and to CMS-1500 and UB-04 claims for Behavioral Health administered plans. Virtual care must be provided by a professional who is licensed or acting within licensure. [1]
Telehealth POS	Report place of service 02 for behavioral health virtual care. [1]
Telehealth modifier	Append modifier 93, 95, FQ, GQ or GT. The permanent record must show whether the visit was audio/video or telephone only. [1]
Telehealth rules	Behavioral health virtual care must be interactive audio and/or video (synchronous) and is reimbursed as if provided face-to-face. Exclusively virtual services should be limited to low to moderate complexity and not be the primary intervention for an emergent condition. Not reimbursed on the same day as a face-to-face visit by the same provider for the same condition. The policy does not apply to care through an intermediary vendor or when a superseding state mandate applies. [1]
Prior authorization	The Evernorth guide (03/26) shows prior authorization 'No' for 90785, 90791, 90792, 90832, 90834, 90837, 90839, 90846, 90847 and 90853, billed on a CMS 1500 (UB only if outpatient). It says the list is not complete and subject to change, the codes are only suggestions, and to verify eligibility and benefits. [2]

Cigna: Reimbursement Policy R31 Virtual Care, Commercial (last updated 02/17/2026), checked October 30, 2026
Evernorth Behavioral Health: Resource Guide, Prior Authorizations and Billing (PCOMM-2026-168, 03/26), checked October 30, 2026

Texas Medicaid

Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook (October 2026) · Texas

90785	Not named [1]
90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Limited (90846 (family therapy without the patient) only for Medicaid clients age 20 and younger; 90847 any age) [1]
90847	Listed [1]
90853	Listed [1]
Diagnoses	90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847 and 90853 are limited to a published list of covered diagnosis codes (the F-code list in the handbook). [1]
Other codes	The add-on codes 90833, 90836 and 90838 may only be billed by physician, APRN or PA providers. [1]
Telehealth modifier	Synchronous audiovisual services are billed with modifier 95. Audio-only services are billed with modifier FQ. LMFTs must bill with modifier U8 to differentiate from LPCs. [1]
Telehealth rules	90791, 90792 and psychotherapy 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847 and 90853 can be delivered by synchronous audiovisual technology or, for people with an existing clinical relationship, audio-only. That means at least one in-person or audiovisual outpatient mental health service from the same billing provider in the 6 months before the first audio-only service (cannot be waived), then one every rolling 12 months unless the person and provider agree it is clinically contraindicated or its risks or burdens outweigh the benefits. The record must say why audio-only was used. [1]
Visit limits	30 individual, group or family psychotherapy visits per person per calendar year, and psychotherapy is limited to 4 hours per person per day. Bill the preponderance of each half hour and show units on the claim. Documentation must include start and end time of the session and the modalities used. [1]
Prior authorization	Visits beyond 30 per calendar year must be prior authorized; requests for up to 10 additional visits at a time may be considered, on the Outpatient Mental Health Services Request Form. Providers with an established relationship must request it when the person is approaching 30 visits; a new provider who cannot get the full treatment history is encouraged to request it before rendering services. [1]
Who can bill	Mental health providers include LCSWs, LMFTs, LPCs, psychologists, physicians, PAs and APRNs. LCSWs, LMFTs and LPCs must be licensed, and must also be enrolled in Medicare or get a pediatric practice exemption from TMHP. Temporary licenses are not eligible and a license due to expire within 30 days blocks enrollment. [1]

Texas Medicaid (TMHP): Provider Procedures Manual, Behavioral Health and Case Management Services Handbook (October 2026), checked October 30, 2026

California Medi-Cal (non-specialty mental health)

Medi-Cal Provider Manual, Non-Specialty Mental Health Services: Psychiatric and Psychological Services · California

90785	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed [1]
90847	Listed [1]
90853	Listed [1]
Other codes	Interactive complexity 90785 may be billed with 90791, 90792, 90832, 90834, 90837, 90853 and E/M-paired psychotherapy codes when listed complicating factors are present. For pregnant and postpartum individuals with risk factors for perinatal depression, preventive counseling 90832, 90834 and 90837 and group 90853 are payable in the prenatal period and the 12 months after childbirth, with modifier 33. [1]
Telehealth rules	NSMHS may be delivered via telehealth when Medi-Cal requirements are met; the manual refers to its Telehealth Modalities section. [1]
Visit limits	Individual therapy is limited to a maximum of 1.5 hours per day by the same provider. Group therapy sessions under 1.5 hours are not reimbursable. For recipients 21 and older with persistent symptoms but no mental health disorder, Medi-Cal pays up to six psychotherapy sessions per provider per year. Family therapy is capped at 50 minutes without the patient (90846) and 110 minutes with the patient (90847). [1]
Prior authorization	A Treatment Authorization Request is not required for NSMHS unless specified age restrictions or frequency limits are exceeded. Recipients may self-refer for psychotherapy (CPT 90832 thru 90853). [1]
Who can bill	NSMHS may be provided by primary care providers, LCSWs, LPCCs, LMFTs, licensed psychologists, psychiatric PAs and NPs and psychiatrists within their training and licensure. Associate MFTs, associate PCCs, associate clinical social workers and registered psychological associates may render services under the scope of their supervising clinician. [1]

Medi-Cal Provider Manual: Non-Specialty Mental Health Services, Psychiatric and Psychological Services (pages updated December 2021 to October 2026), checked October 30, 2026

Ohio Medicaid

Ohio Administrative Code rule 5160-8-05, Behavioral health services, other licensed professionals · Ohio

Where it applies	Covered: psychiatric diagnostic evaluation, psychological and neuropsychological testing, alcohol or substance use structured assessment and intervention, individual psychotherapy of 30, 45 and 60 minutes, crisis psychotherapy, interactive complexity, family psychotherapy with or without the patient when the primary purpose is treating the patient, group and multiple-family group psychotherapy, and prolonged service. [1]
Visit limits	Diagnostic evaluation is one encounter per code per billing provider per recipient per calendar year and not on the same date as a therapeutic visit. Psychological testing is 12 hours and neuropsychological testing 8 hours per calendar year. Limits can be exceeded only with prior authorization. [1]
Who can bill	Independent practitioners are the licensed professional clinical counselor, licensed independent social worker, licensed independent marriage and family therapist, licensed independent chemical dependency counselor and licensed school psychologist. Supervised practitioners are the LPC, LSW, LMFT and LCDC II and III. Licensed psychologists and independent practitioners must be enrolled in Medicaid; those in independent practice who can participate in Medicare must do so, or if the practice is limited to pediatric treatment, meet all Medicare participation requirements other than serving Medicare beneficiaries. [1]
Also	Services by supervised practitioners or supervised trainees under general supervision (supervisor available by phone) are paid to the supervising physician group practice, clinic, community behavioral health center, physician, APRN, PA, or licensed psychologist or independent practitioner in independent practice. Progress notes must record the date, time of day, duration and the time the provider spent with the patient. A treatment plan is due within five sessions or one month, whichever is longer. No payment for family therapy to train family members or caregivers, or for services unrelated to a specific behavioral health diagnosis. [1]

Ohio Administrative Code rule 5160-8-05, Behavioral health services, other licensed professionals (effective January 1, 2021), checked October 30, 2026

Washington Apple Health

Apple Health (Medicaid) Mental Health Services Billing Guide, October 1, 2026 · Washington

90785	Listed [1]
90791	Limited (one per client per provider per calendar year) [1]
90837	Listed [1]
Telehealth rules	Telemedicine is covered under the Mental Health Services program. The guide points to HCA's Telehealth page for the telemedicine policy and the audio-only procedure code lists. [1]
Visit limits	HCA pays only one psychiatric diagnostic interview exam (90791 or 90792) per client, per provider, per calendar year; more sessions need a limitation extension request. 90791 or 90792 and psychological testing cannot be billed on the same day without prior authorization. [1]
Who can bill	Licensed mental health professionals include LICSWs, LASWs, LMFTs and LMHCs, and their associates (LSWAIC, LASWA, LMFTA, LMHCA) share the matching taxonomy. For dates of service from January 1, 2026, associates use their associate taxonomy or 101Y00000X for Medicaid-only clients, and their associate taxonomy with the claim note 'LMHP associate' for dual-eligible clients. The guide also notes licensed associates cannot bill Medicare. [1]

Washington Apple Health (HCA): Mental Health Services Billing Guide (Oct 1, 2026), checked October 30, 2026

North Carolina Medicaid

NC Medicaid Clinical Coverage Policy 8C, Outpatient Behavioral Health Services (amended January 1, 2025) · North Carolina

90785	Listed [1]
90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed (may not be used with 90785) [1]
90847	Listed (may not be used with 90785) [1]
90853	Listed [1]
Telehealth rules	Selected services (marked in Attachment A) can be delivered by telehealth following Policy 1-H, and some by telephonic audio-only when physical or behavioral health status, transportation or technology prevent in-person or telehealth. The same service by the same or a different attending provider on the same day is not allowed. [1]
Prior authorization	Medicaid shall not require prior approval for outpatient behavioral health services; the policy lists no utilization management. [1]
Referral	A written service order from a physician, doctoral licensed psychologist, NP or PA is required for associate-level professionals on or before the first date of treatment (excluding the initial assessment). Fully licensed professionals do not need a separate order. [1]
Who can bill	In addition to physicians, licensed psychologists, licensed psychological associates, LCMHCs, LCMHCAs, LCSWs, LCSWAs, LMFTs, LMFTAs, LCASs, LCASAs, PAs and NPs (including PMHNPs) can bill these services. [1]
Payment	Providers bill their usual and customary charges; rates are on the NC Medicaid website. NC Medicaid will not reimburse conversion therapy. A copayment may not be charged separately for 90785 or psychotherapy add-on codes; one copayment is allowed per office visit. [1]

NC Medicaid: Clinical Coverage Policy 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers (amended January 1, 2025), checked October 30, 2026

Illinois Medicaid (HFS), LPHA fee schedule

HFS Fee Schedule for Licensed Practitioners of the Healing Arts, effective 08/01/2026 · Illinois

90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Not named [1]
90847	Listed [1]
90853	Not listed (group psychotherapy is not on this schedule; billable by an FQHC or RHC for LPHAs in those settings) [1]
Where it applies	Group psychotherapy is not on this fee schedule; FQHCs or RHCs can bill it when an LPHA renders it in those settings. NCCI edits and medically unlikely edits apply, and a code on the schedule does not guarantee payment. [1]
Who can bill	The schedule applies to services rendered by an LCSW, Licensed Clinical Psychologist, LMFT or LCPC practicing independently. Testing codes 96130 to 96137 are billable only by licensed clinical psychologists. [1]
Payment	LPHA fee schedule effective 08/01/2026, unit price and max quantity: 90791 $91.58 (max 1), 90832 $35.24 (max 1), 90834 $46.52 (max 2), 90837 $68.69 (max 2), each with a rate effective date of 01/01/25. A psychiatric add-on is multiplied by the units billed and added to the unit price (dates of service from 7/1/2019): 90791 $127.88, 90832 $66.50, 90834 $87.78, 90837 $129.63. 90847 is $52.35 (max 1, effective 04/01/24, no add-on). [1]

Illinois HFS: Fee Schedule for Licensed Practitioners of the Healing Arts, effective 08/01/2026 (updated 07/28/2026), checked October 30, 2026

New York Medicaid (fee-for-service)

NYS Medicaid FFS LCSW, LMHC and LMFT Policy Guidelines (July 2025) · New York

90785	Listed [1]
90791	Limited (billable by LCSWs; not in the LMHC and LMFT code table in this manual) [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed [1]
90847	Listed [1]
90853	Listed [1]
Where it applies	Session length guides: 90832 typically 16 to 37 minutes, 90834 38 to 52 minutes, 90837 a minimum of 53 minutes. The LCSW table says not to report 90846 or 90847 for family sessions under 26 minutes; the LMHC/LMFT table says this for 90847. 90839 typically lasts 30 to 74 minutes (LCSW table). [1]
Other codes	For LMHCs and LMFTs, use 90785 with psychotherapy 90832, 90833, 90834, 90837 and group 90853, and not with 90839 or 90840; for LCSWs, 90785 is listed with 90791 and group 90853. 90840 is not reported with 90832 to 90837 (both tables), and the LMHC/LMFT table also bars 90839 with 90832 to 90837. [1]
Who can bill	LCSWs, LMHCs and LMFTs in a private or group practice enrolled in NYS Medicaid FFS can bill directly for their services and for services of supervised limited permit holders. Use your own NPI as attending provider. A LCSW may supervise up to six LMSWs. [1]
Also	Services in Article 28 clinics are paid to the clinic, and a professional claim cannot be billed. Fees are in the separate eMedNY procedure code and fee schedule documents. [1]

NY Medicaid FFS: LCSW, LMHC and LMFT Policy Guidelines (July 2025), checked October 30, 2026

Florida Medicaid (community behavioral health)

Florida Medicaid Community Behavioral Health Fee Schedule 2026 · Florida

90834	Not named [1]
90837	Not named [1]
Other codes	Individual and family therapy: H2019 HR, $21.87 per quarter hour, telemedicine allowed. Group therapy: H2019 HQ, $6.73 per quarter hour. Brief individual medical psychotherapy: H2010 HE, $15.13 per quarter hour. The CPT psychotherapy codes are not named on this fee schedule. [1]
Telehealth rules	A 'Y' in the telemedicine column marks services that can be delivered by telemedicine under rule 59G-1.057. Individual and family therapy (H2019 HR) is marked Y. [1]
Visit limits	Individual and family therapy: a maximum of 104 quarter-hour units (26 hours) per recipient per state fiscal year and 4 quarter-hour units (1 hour) per day. Group therapy: 156 quarter-hour units (39 hours) per recipient per state fiscal year. Brief individual medical psychotherapy: 16 quarter-hour units (4 hours) per state fiscal year, 2 units daily. [1]

Florida Medicaid: Community Behavioral Health Fee Schedule 2026, checked October 30, 2026

TRICARE

TRICARE mental health pages (tricare.mil) · All states

Where it applies	TRICARE covers office-based outpatient psychotherapy when medically or psychologically necessary to treat a mental health disorder. Individual, family or conjoint, and group sessions are covered. TRICARE covers marriage counseling only when needed to treat a diagnosed mental disorder. [1]
Visit limits	Individual sessions are covered up to 60 minutes (individual crisis sessions up to 120 minutes). Regular family or conjoint sessions are covered up to 90 minutes (crisis sessions up to 180 minutes). Group sessions are covered up to 90 minutes. [1]
Referral	Prime enrollees need no referral or pre-authorization for outpatient visits with a network psychiatrist or psychologist, except for psychoanalysis and outpatient therapy for substance use disorder. Active duty members must get a referral and pre-authorization to see a civilian provider. [2]
Who can bill	TRICARE's provider-type list includes clinical psychologists, certified clinical social workers (master's in social work with psychotherapy training) and certified marriage and family therapists (must agree to participate in TRICARE). TRICARE certified mental health counselors need no referral or physician oversight. Supervised mental health counselors and pastoral counselors need a referral from a medical doctor and physician oversight. [3]
Medicare rules	For TRICARE For Life, Medicare's rules for mental health care apply until those benefits are exhausted. [2]
Also	These pages do not name CPT codes, so no code-level status is shown here. For TRICARE Prime, inpatient mental health stays need a referral and pre-authorization from the regional contractor. [2]

TRICARE: Mental Health Therapeutic Services (last updated 11/26/2025), checked October 30, 2026
TRICARE: Mental Health Appointments (last updated 8/18/2025), checked October 30, 2026
TRICARE: Types of Mental Health Providers (last updated 5/22/2025), checked October 30, 2026

UnitedHealthcare and Optum Behavioral Health

Optum telemental health reimbursement policy (commercial) and telehealth billing quick reference · All states

90785	Listed [1]
90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed [1]
90847	Listed [1]
90853	Listed [1]
Telehealth POS	Every behavioral health telehealth claim needs POS 02 or POS 10, effective Nov. 1, 2023, across commercial, Medicare Advantage and Medicaid/Community Plan lines. Use POS 10 when the member is at home and POS 02 when not. POS is the member's location, not the provider's. POS 11 is not an appropriate telehealth place of service. [2]
Telehealth modifier	Modifiers 93, 95 and GT are not required to identify telehealth but are accepted as informational with eligible services and POS 02 or 10. A claim with only a telehealth modifier and no POS 02 or 10 is not reimbursed. Audio-only is paid only with modifier 93 and POS 02 or 10, when mandated by state regulation or covered by the member's plan; the policy says to use modifier FQ only for FQHC or rural health clinic services. [1][2]
Telehealth rules	The commercial policy covers live, interactive audio and video (synchronous only). The clinician must hold a valid license in the state where the member is receiving services and work within the scope of that license. The policy applies to participating and non-participating providers when the plan has out-of-network coverage. The visit should be documented as audio-video. [1]
Visit limits	The eligible telehealth code list is described as not exhaustive. Payment may also be subject to benefit plan provisions and prior authorization requirements. [1][2]

Optum Behavioral Health: Telemental Health Services Reimbursement Policy, Commercial, 2020RP503A (history shows June 2026 update), checked October 30, 2026
Optum Behavioral Health: Telehealth Billing Quick Reference Guide (updated September 2025), checked October 30, 2026

Arizona Medicaid (AHCCCS)

AHCCCS Fee-For-Service Provider Billing Manual Chapter 19 and Covered Behavioral Health Services Guide · Arizona

90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed [1]
90847	Listed [1]
90853	Listed [1]
Where it applies	CPT codes may be used only by independently licensed qualified clinicians. Other behavioral health counseling and therapy is billed with HCPCS codes such as H0004. [1][2]
Telehealth modifier	For telemedicine (interactive audio and video) use the GT modifier. The POS for telehealth claims is the originating site. See the AHCCCS Telehealth Code Set for what can be billed. [2]
Who can bill	Provider types that can bill category of service 47 (mental health) include LISW (type 85), LMFT (type 86) and LPC (type 87), as well as psychologists. Independently licensed behavioral health professionals register with AHCCCS as independent billers and use their own NPI as rendering provider for services they personally provide. [2]
Payment	All outpatient and professional services are billed on a CMS 1500 claim form with ICD diagnosis and CPT procedure codes. Claims with DSM-IV codes are denied. [2]
Also	These rules come from AHCCCS's fee-for-service billing manual, Chapter 19. The manual says not all providers can bill all services and points to the B2 Matrix for procedure codes by provider type. [2]

AHCCCS: Covered Behavioral Health Services Guide (updated 10/01/2026), checked October 30, 2026
AHCCCS: Fee-For-Service Provider Billing Manual, Chapter 19 Behavioral Health Services (revision 09/15/2026), checked October 30, 2026

New Jersey Medicaid (NJ FamilyCare)

NJ FamilyCare Behavioral Health Integration provider guidance (April 2025) and enrollment FAQs (October 2024) · New Jersey

90791	Listed [1]
90832	Listed [1]
90834	Listed [1]
90837	Listed [1]
90846	Listed [1]
90847	Listed [1]
90853	Listed [1]
Prior authorization	The packet's Phase 1 table shows prior authorization required: No, for MH evaluation 90791-90792, individual psychotherapy 90832-90839, family therapy 90846-90847 and group therapy 90853. Check the plan for current rules. [1]
Who can bill	To bill independently, providers must enroll as an individual and be fully clinically licensed. For behavioral health this includes LCSWs, LPCs and LMFTs. Junior licensed providers (such as LSW or licensed associate MFT) and unlicensed providers cannot bill independently. [1]
Managed care plans	Since January 1, 2025, Phase 1 behavioral health services are billed to the managed care plans for all populations and are no longer reimbursed through fee-for-service. The packet lists MH outpatient counseling and psychotherapy for independent and agency clinicians among the services for integration. Providers must enroll with the state before credentialing with the plans. [1][2]

NJ Department of Human Services (DMAHS and DMHAS): Behavioral Health Managed Care Provider Guidance Packet (last updated April 25, 2025), checked October 30, 2026
NJ DMAHS: BH Integration Provider Enrollment and Credentialing Training FAQs (last updated October 28, 2024), checked October 30, 2026

Michigan Medicaid

MDHHS Non-Physician Behavioral Health training slides, November 2021 · Michigan

Where it applies	As of November 2021, these services are covered in a non-facility setting or outpatient hospital clinic, within each profession's scope of practice under State law. The slides do not list CPT codes or rates. [1]
Who can bill	As of November 2021, covered provider types include licensed master's-level social workers, licensed marriage and family therapists and licensed professional counselors, plus licensed psychologists. They must be licensed by LARA, enrolled as Medicaid providers and identified on all claims. [1]
Managed care plans	As of November 2021, services covered by the PIHPs/CMHSPs are reimbursed through the PIHP/CMHSP. Beneficiaries not in Medicaid Health Plans, for services outside those capitation payments, are covered through Medicaid fee-for-service. [1]

Michigan MDHHS: Non-Physician Behavioral Health training slides (November 16, 2021), checked October 30, 2026

Georgia Medicaid

Georgia DCH Medicaid-funded Behavioral Health Services chart for ages 0 to 6 (April 2022) · Georgia

Where it applies	The chart lists psychological and therapy services as diagnostic assessment, psychological testing, individual psychotherapy and group psychotherapy. It is a coverage chart for ages 0 to 6, not a full manual. [1]
Who can bill	As of April 2022, the chart says Psychological Services were expanded as of 1/1/2022 to include those provided by licensed LPC, LCSW and LMFT providers, in both managed care (CMO) and fee-for-service Medicaid. [1]

Georgia DCH: Medicaid-funded Behavioral Health Services, Ages 0-6 chart (April 2022), checked October 30, 2026

Ohio insurance mandates

Ohio Revised Code 3902.30 (telehealth) and 3923.281 (biologically based mental illness) · Ohio

Where it applies	Sickness and accident policies must cover diagnosis and treatment of biologically based mental illness on the same terms as other physical diseases. The defined illnesses are schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder and panic disorder. Medicaid policies are excluded from this section. [1]
State law	A health benefit plan must cover telehealth services on the same basis and to the same extent as in-person services and may not exclude a service solely because it is delivered by telehealth (effective March 23, 2022). [2]
Who can bill	For the mandate to apply, the illness must be clinically diagnosed by a physician, a licensed psychologist, a licensed professional clinical counselor, licensed professional counselor, independent social worker or independent marriage and family therapist licensed under Chapter 4757, or a clinical nurse specialist or certified nurse practitioner whose nursing specialty is mental health. [1]
Payment	The telehealth law does not require a specific reimbursement amount and does not require telehealth to be paid at the same rate as in-person services. [2]

Ohio Revised Code section 3923.281, biologically based mental illness coverage (effective March 23, 2015), checked October 30, 2026
Ohio Revised Code section 3902.30, telehealth coverage (effective March 23, 2022), checked October 30, 2026

Anthem Blue Cross and Blue Shield, Virginia commercial

Anthem Virginia Commercial Reimbursement Policy C-08002, Virtual Visits (effective 03/01/2025) · Virginia

Telehealth POS	Audio and visual professional claims need POS 02 or 10 to indicate telehealth, the appropriate CPT/HCPCS code and the applicable telehealth modifier. [1]
Telehealth modifier	The policy lists modifier 95 (synchronous telemedicine, real-time interactive audio and video), GT and GQ, each required when no telehealth-specific code has been reported. [1]
Telehealth rules	Services rendered by audio-only communication are listed as nonreimbursable, as are virtual visits by facility providers. State mandates and contracts may override the policy. [1]

Anthem Blue Cross and Blue Shield (Virginia): Commercial Reimbursement Policy C-08002, Virtual Visits (effective 03/01/2025), checked October 30, 2026

How to use the table

Pick a payer, a state or a code, and the table keeps only the rows that match. Open a row for every field and its numbered sources.

Every payer and state on the table

National payers: Medicare, Cigna and Evernorth Behavioral Health, TRICARE, UnitedHealthcare and Optum Behavioral Health.
Regional plans and contractors: Anthem Blue Cross and Blue Shield, Virginia commercial.
Medicaid: all states side by side, and Texas Medicaid, California Medi-Cal (non-specialty mental health), Ohio Medicaid, Washington Apple Health, North Carolina Medicaid, Illinois Medicaid (HFS), LPHA fee schedule, New York Medicaid (fee-for-service), Florida Medicaid (community behavioral health), Arizona Medicaid (AHCCCS), New Jersey Medicaid (NJ FamilyCare), Michigan Medicaid.
State laws: Ohio insurance mandates.

Codes by payer

What a payer's own text says about one code: units, time rules, authorization and who can bill it.

90837: Medicare, Illinois Medicaid (HFS), LPHA fee schedule, New York Medicaid (fee-for-service).

Where the facts come from

From the payer's own policy, provider manual or fee schedule, from CMS for Medicare, a state Medicaid agency or the statute itself: 29 official documents. Each fact links to its source and shows the day we opened it (October 30, 2026 for the latest). No source, no fact.

The same table exists for dietitians and MNT, and for pediatric speech and OT, physical therapy and psychological testing.