Texas is one of the largest mental health markets in the US, with a growing demand for out-of-network therapy. This guide covers Texas license types, parity law, OON fee ranges, and how to work with the state's major payers.
Texas License Types for Therapy Billing
Texas recognizes three primary license types that can provide and bill independently for mental health services:
- LPC — Licensed Professional Counselor. Issued by the Texas State Board of Examiners of Professional Counselors.
- LCSW — Licensed Clinical Social Worker. Issued by the Texas State Board of Social Worker Examiners.
- LMFT — Licensed Marriage and Family Therapist. Issued by the Texas State Board of Examiners of Marriage and Family Therapists.
All three license types can issue superbills for OON reimbursement. Licensed Psychologists (doctoral level) are separately licensed by the Texas State Board of Examiners of Psychologists and bill under 103T00000X taxonomy.
Texas Mental Health Parity
Texas follows the federal Mental Health Parity and Addiction Equity Act (MHPAEA) but does not have a state parity law that is substantially stronger than federal requirements. Key points:
- Fully-insured employer plans and individual/family plans must comply with MHPAEA
- Self-funded employer plans (ERISA plans) are governed by federal law only
- Texas Medicaid (STAR, CHIP) has limited OON mental health benefits
Texas OON Fee Ranges
- Austin: $150–$220 per 50-minute session
- Dallas / Fort Worth: $140–$210 per 50-minute session
- Houston: $130–$200 per 50-minute session
- San Antonio: $120–$180 per 50-minute session
- Smaller markets (Lubbock, El Paso, Amarillo): $100–$160 per session
Major Texas Payers
- Blue Cross Blue Shield of Texas — Largest insurer in the state; PPO plans have solid OON benefits; HMO plans (Blue Advantage) have very limited OON coverage
- UnitedHealthcare — Major employer-plan presence; standard OON superbill submission via myuhc.com
- Aetna — PPO plans accept superbills; 4–6 week processing
- Humana — Significant presence in TX Medicare Advantage; limited OON mental health for MA plans
- Cigna — Available on ACA marketplace and employer plans
Texas CHIP and Children's Mental Health
Texas Children's Health Insurance Program (CHIP) covers mental health services for eligible children through age 18. CHIP is a managed care program — therapists must be enrolled as CHIP providers to receive reimbursement. OON superbill submissions are generally not accepted for CHIP. For children whose families have commercial insurance, standard OON billing applies.
Telehealth in Texas
Texas enacted strong telehealth legislation in 2017 (HB 1697), requiring commercial insurers to cover telehealth services covered in-person. Texas was an early adopter of telehealth parity. Use POS 10 for client-in-home sessions. Audio-only therapy is covered by most major TX payers with the 93 modifier — confirm with each plan.
Filing Insurance Complaints in Texas
Clients can file complaints with the Texas Department of Insurance (TDI)at tdi.texas.gov or call 1-800-252-3439. TDI handles complaints about fully-insured plans. For self-funded ERISA plans, complaints go to the US Department of Labor.
Getting Started with OON Billing in Texas
The steps are straightforward: obtain your NPI, set your fee, create a superbill workflow using Superbilled, and clearly disclose your OON status at intake. Texas clients with PPO plans can typically recover 50–70% of your fee through OON reimbursement.