California Medi-Cal (non-specialty mental health) psychotherapy coverage: codes, telehealth, limits and prior authorization
The short answerMedi-Cal lets LCSWs, LPCCs and LMFTs provide non-specialty mental health services, and associates can work under a supervising clinician. No treatment authorization is needed unless age or frequency limits are exceeded. Individual therapy is capped at 1.5 hours per day by the same provider.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · California. Public policy, not the member's benefits.
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] |
What California Medi-Cal (non-specialty mental health)'s documents say
The table above has every field we found for California Medi-Cal (non-specialty mental health), with numbered sources. In short:
- 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).
- 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).
- 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.
- Codes. 90785, 90832, 90834, 90837, 90846, 90847 and 90853 are listed.
Check California Medi-Cal (non-specialty mental health)'s claim against the row
Before the claim goes out, compare it with the row above: the code matches the session length you documented, the place of service and modifier fit a video or audio-only visit, and the rendering clinician's license is one the payer enrolls. The psychotherapy table compares Medicaid with every other payer we checked.