Texas Medicaid psychotherapy coverage: codes, telehealth, limits and prior authorization
The short answerTexas Medicaid pays LCSWs, LMFTs and LPCs for 90791, 90832, 90834, 90837, 90846 (age 20 and younger), 90847 and 90853, with 30 psychotherapy visits per calendar year before prior authorization. LMFTs bill modifier U8. Video uses modifier 95 and audio-only uses FQ.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Texas. 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] |
What Texas Medicaid's documents say
The table above has every field we found for Texas Medicaid, with numbered sources. In short:
- 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.
- 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.
- 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.
- Codes. 90785 is not named in this policy. 90791, 90832, 90834, 90837, 90847 and 90853 are listed. 90846 is limited.
Check Texas Medicaid'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.