Virginia Therapist Billing: OON Superbills and Insurance
VA-specific guide for LPCs, LCSWs, and LMFTs — CareFirst BCBS, Anthem HealthKeepers, Northern Virginia high-rate markets, and telehealth parity rules.
2026-03-28 · 6 min read · By The Superbilled Team
Virginia's mental health market is bifurcated: Northern Virginia (the DC suburbs) operates at some of the highest OON therapy rates in the entire South, while Richmond, Virginia Beach, and Roanoke run at moderate Southeastern norms. Understanding which carrier dominates each region — CareFirst BCBS in NoVA vs. Anthem HealthKeepers elsewhere — is essential for Virginia therapists setting fees and advising clients.
Virginia License Types and Billing
The Virginia Board of Counseling, the Virginia Board of Social Work, and the Virginia Board of Psychology oversee the following credential types that can independently bill insurance:
- LPC— Licensed Professional Counselor (Virginia's independent counselor credential)
- LCSW — Licensed Clinical Social Worker
- LMFT — Licensed Marriage and Family Therapist
- Licensed Psychologist — Doctoral level
Virginia uses "LPC" for its independent counselor credential. The Resident in Counseling is a supervised pre-licensure credential and cannot independently bill commercial insurance. Your Virginia license number, NPI, and taxonomy code must appear on every superbill.
Out-of-Network Therapy in Virginia: The Landscape
Northern Virginia (Fairfax, Arlington, Alexandria, Loudoun, and Prince William counties) is the highest-rate OON market in the South, driven by federal government contractors, defense industry professionals, and technology firms. Washington DC proximity means many NoVA residents carry DC-domiciled or Maryland-domiciled employer plans through CareFirst BCBS. Richmond is Virginia's second market, driven by financial services and state government employees. Virginia Beach and the Hampton Roads metro have a large military and government contractor presence.
Dominant Insurance Carriers in Virginia
- CareFirst BlueCross BlueShield — Dominant in Northern Virginia and the DC metro region. CareFirst covers federal employees via the BCBS Federal Employee Program (FEP) and also offers commercial plans. PPO plans include OON mental health benefits. Clients submit via carefirst.com or by mail. Processing typically 3–6 weeks. Note: CareFirst FEP and CareFirst commercial plans have different OON benefit structures.
- Anthem HealthKeepers / Anthem BCBS Virginia — Dominant in Richmond, Virginia Beach, and the rest of non-NoVA Virginia. PPO plans include OON mental health benefits. Clients submit via anthem.com. Processing typically 30–45 days.
- Optima Health (Sentara) — Virginia-based insurer with strong presence in Hampton Roads, Richmond, and Northern Virginia. PPO plans include OON benefits. HMO plans generally do not.
- Aetna — Common in Northern Virginia and Richmond corporate employer plans. OON PPO benefits; clients submit via the Aetna member portal.
- Cigna / Evernorth — Present in defense contractor and tech employer plans across Virginia. PPO plans include OON mental health benefits.
- Virginia Medicaid (Medallion 4.0) — No OON psychotherapy benefit. Medicaid managed care organizations contract with in-network providers only.
Typical OON Reimbursement Rates in Virginia
| CPT Code | Northern VA / DC Suburbs | Richmond | Virginia Beach / Hampton Roads | Roanoke / Other |
|---|---|---|---|---|
| 90837 (60 min) | $165–$190 | $145–$170 | $140–$165 | $125–$150 |
| 90834 (45 min) | $135–$160 | $115–$140 | $110–$135 | $100–$120 |
| 90832 (30 min) | $95–$120 | $80–$105 | $80–$100 | $70–$90 |
| 90791 (intake) | $200–$250 | $175–$225 | $170–$215 | $155–$195 |
State-Specific Billing Regulations
- Mental health parity.Virginia enforces the federal MHPAEA. The Virginia State Corporation Commission's Bureau of Insurance handles parity complaints.
- Telehealth parity. Virginia enacted comprehensive telehealth parity legislation. Commercial insurers must cover telehealth mental health services at parity with in-person services. Use Place of Service 10 on superbills for patient-home sessions. Virginia requires coverage of audio-only telehealth for behavioral health.
- Federal Employee Program (FEP) distinction.Many NoVA therapists' clients are federal employees or contractors carrying BCBS FEP. FEP is governed by federal contract, not Virginia insurance law, and has distinct OON benefit structures. FEP members submit claims directly to the FEP program, not CareFirst commercial.
- Good Faith Estimates. Virginia therapists must provide GFEs to self-pay clients per the No Surprises Act. See our GFE guide.
Tips for Virginia Therapists
- Northern Virginia supports the highest OON fees in the South. Fairfax County, Loudoun County, and Arlington are among the wealthiest counties in the US by median household income. OON fees of $180–$250+ are sustainable for experienced therapists in these markets.
- Identify CareFirst plan type precisely. CareFirst offers FEP, BlueChoice HMO, and BluePChoice PPO products. HMO members have no OON benefit. FEP members submit claims via a different process than CareFirst commercial PPO. Always ask clients to identify their specific plan.
- Military and VA coverage in Hampton Roads. Virginia Beach has a large active-duty and veteran population. TRICARE (military insurance) and VA healthcare are separate from commercial insurance and have distinct billing requirements. TRICARE does have OON benefits for mental health under its Standard/Select plans.
- Richmond is a corporate market.Richmond's financial services and consulting sector drives meaningful employer-sponsored PPO coverage. Aetna and UHC are common among corporate clients.
- Use the most specific ICD-10 codes. Anthem HealthKeepers Virginia and CareFirst both flag superbills with non-specific diagnosis codes. Reference our ICD-10 coding guides for specificity best practices.
Generate Your Virginia Superbill
Superbilled generates HIPAA-compliant superbill PDFs for Virginia-licensed LPCs, LCSWs, LMFTs, and psychologists. Visit our Virginia superbill generator to build your practice profile and generate superbills in under 60 seconds.