Billing for Group Therapy, Substance Use Treatment, and Crisis Intervention: A Texas Guide
Mental health providers in Texas are facing a growing demand for services like group therapy, substance use treatment, and crisis intervention, especially in underserved areas. But meeting clinical needs is only half the battle. Getting reimbursed properly for these behavioral health services is a challenge that requires navigating complex state-specific regulations, payer policies, and CPT code nuances.
Group Therapy Billing in Texas: Know the Code, Know the Rules
Group therapy is widely used across community clinics, outpatient facilities, and private practices. But many providers are underbilling or being denied altogether because of the confusion between CPT code 90853 (Group Psychotherapy) and inappropriate use of modifiers
In Texas, Medicaid and many commercial payers will reimburse for 90853, but only under strict conditions:
- The group must be therapeutic, not recreational or educational.
- The licensed provider must be physically or virtually present and actively performing the session.
- The documentation should clearly outline individual goals and participation within the group dynamic.
Additionally, certain MCOs like Superior HealthPlan and Amerigroup require prior authorization, particularly for recurring sessions. Instapay Healthcare Services’ billing team ensures that claims for group therapy include all supporting documentation and meet Texas payer requirements, so you don’t leave money on the table.
Substance Use Treatment: A Coding Minefield
Billing for SUD (Substance Use Disorder) services in Texas is more complex because of the varying coverage across Medicaid, Medicare, and private insurers. Add in multiple service formats; detox, IOP, MAT (Medication-Assisted Treatment), and providers have to deal with dozens of possible CPT/HCPCS combinations.
Here are a few examples we frequently see mishandled:
- H0005 (Group counseling, per session): Used for outpatient substance use programs, but must be supported by diagnosis codes specific to SUD.
- H0015 (Intensive outpatient services): Often denied if not pre-authorized or when submitted without time-based documentation.
- G2086-G2088 (Office-based MAT): Medicare recognizes these codes, but some Texas Medicaid plans do not.
What makes Texas more complicated is that not all Medicaid MCOs cover all levels of care. Instapay Healthcare Services works directly with Texas MCO representatives and keeps track of each plan’s billing rules to reduce denials for SUD services.
Crisis Intervention: Urgent Care, Urgent Billing Precision
Crisis intervention services are critical for patients in acute distress, but they’re also among the most frequently denied claims due to vague documentation and misuse of time-based codes.
Texas Medicaid allows reimbursement for:
- H2011 (Crisis intervention service, per 15 minutes)
- H0036 (Community psychiatric support and treatment)
But here’s the catch: most payers require a minimum of 15 minutes, detailed clinical notes, and proof that the service was provided in response to an immediate behavioral health need. Location also matters, mobile crisis units and community settings have unique modifiers that must be used correctly to get paid.
Instapay Healthcare Services helps behavioral health providers in Texas document and bill these services accurately so they can focus on patient safety, not administrative rework.
Final Thoughts: You Don’t Have to Navigate Texas Billing Alone
Billing for group therapy, substance use treatment, and crisis intervention in Texas isn’t easy but with the right partner, it doesn’t have to be stressful. At Instapay Healthcare Services, we specialize in behavioral health billing for Texas providers, helping you stay compliant, avoid denials, and improve cash flow.
Need help with mental health billing in Texas? Let’s talk. Instapay Healthcare Services is here to handle the billing complexities so you can focus on healing your community.
