Medicaid psychotherapy coverage by state: codes, authorization and limits
The short answerIt depends on the state. We found public psychotherapy rules for 11 Medicaid programs: Arizona, California, Florida, Illinois, Michigan, New Jersey, New York, North Carolina, Ohio, Texas and Washington. Each sets its own codes, prior authorization and limits, and managed care plans can add their own. Each state's page has its sources.
By Javier Alvarez · Updated · 3 min read
12 rows: Medicaid (by state). Public policy, not the member's benefits.
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] |
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] |
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] |
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] |
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] |
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
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] |
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
11 state Medicaid programs side by side
Each state runs Medicaid under its own manual and fee schedule, and managed care plans add their own rules on top. Each program below has its own page with every fact and its source.
| State | Codes | Prior authorization | Limits |
|---|---|---|---|
| Arizona Medicaid (AHCCCS) | 7 of 8 listed | Not published: call the payer. | Not published: call the payer. |
| California Medi-Cal (non-specialty mental health) | 7 of 8 listed | 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). | 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). |
| Florida Medicaid (community behavioral health) | 0 of 8 listed | Not published: call the payer. | 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. |
| Illinois Medicaid (HFS), LPHA fee schedule | 5 of 8 listed | Not published: call the payer. | Not published: call the payer. |
| Michigan Medicaid | Not published: call the payer. | Not published: call the payer. | Not published: call the payer. |
| New Jersey Medicaid (NJ FamilyCare) | 7 of 8 listed | 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. | Not published: call the payer. |
| New York Medicaid (fee-for-service) | 7 of 8 listed | Not published: call the payer. | Not published: call the payer. |
| North Carolina Medicaid | 8 of 8 listed | Medicaid shall not require prior approval for outpatient behavioral health services; the policy lists no utilization management. | Not published: call the payer. |
| Ohio Medicaid | Not published: call the payer. | Not published: call the payer. | 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. |
| Texas Medicaid | 6 of 8 listed | 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. | 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. |
| Washington Apple Health | 2 of 8 listed | Not published: call the payer. | 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. |
Your state isn't here?
We only add a state when we could open a document that states the rule. Call the state's provider line or the member's managed care plan, and ask which codes therapists can bill, whether prior authorization is needed and how many visits a year. The psychotherapy table has every payer we checked.