LCSW credentialing in Texas: Medicare, Medicaid and the commercial plans

• LPC
• LCSW
• LMFT
• Psychologist
• LCDC
• Psychiatric NP

LCSW credentialing at a glance

What plans verify about an LCSW

• The license level. Plans look you up on BHEC's license verification search and read the level, not just "social worker." An application that lists an LMSW number for therapy services gets stopped. If you upgraded recently, make sure the LCSW number, not the old LMSW number, is on your CAQH profile, NPI record and every application.
• Your MSW (or doctoral) degree, a CV with month and year for every job, and an explanation of any gap of more than a few months.
• Malpractice declarations with your name, limits and dates, and your claims history.
• Specialty settings. If you work in hospice, home health, a hospital or a school as well as private practice, list each one. Plans credential the individual, but each billing location and tax ID has to be linked separately.
• Exclusion lists. Plans check the OIG exclusion list and state lists; so should you, before you apply.

The page-by-page packet is on our credentialing documents checklist, and the profile itself in the CAQH ProView guide.

Taxonomy and claim modifiers

Pick 1041C0700X (Social Worker, Clinical) as your primary taxonomy in NPPES. The general social worker code doesn't describe an independent clinical license, and a plan that credentialed you as an LCSW may reject claims that carry it. If you bill through a PLLC, the practice gets its own Type 2 NPI (NPI Type 1 vs Type 2 explains which goes where).

Some payers also want a modifier that tells them the clinician type. The HCPCS modifier for a clinical social worker is AJ; others you'll see are AH (clinical psychologist) and HO (master's degree level). Whether a payer wants one, and on which codes, is in its billing guide or your contract. In Cima EHR, AJ, AH and HO are in the modifier list on every charge line, and the claim check stops a telehealth line that's missing its 95 or 93 before it goes out.

Medicare for clinical social workers

Social workers are the longest-standing master's-level therapy provider in Medicare; counselors and MFTs only joined in 2024 (CMS). What matters for an LCSW:

• Enroll in PECOS on the CMS-855I. No application fee for individual clinicians. If a group or PLLC bills for you, reassign your benefits to it on the same application; the group enrolls on the CMS-855B.
• The rate: 80% of the lesser of your actual charge or 75% of what Medicare pays a clinical psychologist for the same service (42 CFR 414.53). You accept assignment and can't bill the client above the allowed amount; the Part B deductible and coinsurance still apply.
• What you bill: diagnostic evaluations (90791) and psychotherapy (individual, family, group, crisis). Codes that include medical services, like 90792 and the E/M visits, belong to prescribers.
• The timing rule: Medicare lets you bill back no more than 30 days before your filing date in limited circumstances (42 CFR 424.521), so file before your first Medicare client.
• Medicare Advantage plans credential you separately, usually through their commercial networks, after you're in Medicare.

The PECOS screens and reassignment steps are the same for every non-physician practitioner; our Medicare enrollment guide walks through them (it's written for LPCs and LMFTs, but the PECOS steps don't change for an LCSW). Medicare generally doesn't pay a freestanding IOP or PHP for the program day, which matters if you work in one; that guide explains why.

Texas Medicaid for LCSWs

• Medicare enrollment comes first for providers who serve people with both Medicare and Medicaid (1 TAC §352.13). The 2024 notices that made this explicit were aimed at LPCs and LMFTs, who were new to Medicare. LCSWs have long been Medicare-eligible, so plan on enrolling in Medicare before TMHP. If you see only children, ask TMHP in writing whether Medicare enrollment is required for you.
• TMHP, then each managed care plan. Enroll in PEMS on TMHP, then apply to each STAR, STAR+PLUS, STAR Kids and CHIP plan in your service area. The plans share one credentialing verification organization, so your documents are checked once.
• The rate. In 2023 HHSC's chief medical director told lawmakers that Texas Medicaid pays LCSWs, LPCs and LMFTs 70% of the psychologist rate for psychotherapy (Texas Tribune). Check the current TMHP fee schedule for your codes.
• Joining a group? Texas Medicaid managed care plans must offer an expedited process to LCSWs who join an established contracted group, if they're already Medicaid-enrolled (1 TAC §353.423).

Every step of PEMS and the managed care plans is in our Texas Medicaid credentialing guide.

Commercial plans and EAPs

Blue Cross and Blue Shield of Texas, Aetna, Cigna and UnitedHealthcare all credential independently licensed social workers for outpatient therapy, through CAQH, where their panels are open. Three things trip LCSWs up:

• The behavioral network may be a different company. Many plans send behavioral health to a separate network. Apply where the members' behavioral benefits are administered (how carve-outs work). Plan specifics: BCBSTX, Aetna.
• Panels close by county and specialty. Ask whether the plan is taking LCSWs in your county and whether a specialty (children, Spanish-language, trauma, perinatal) gets you in when the general panel is closed. If it's closed, our guide to closed insurance networks covers what to try.
• Employee assistance programs run their own networks and set their own license requirements and session limits. Ask each one directly.

LMSWs and the road to LCSW

An LMSW gathering clinical hours under an LCSW-S needs at least 3,000 hours of supervised clinical experience over at least 24 months, with at least 100 hours of supervision, before applying for the LCSW (BHEC's LMSW-to-LCSW requirements). For credentialing:

• Medicare enrolls clinical social workers, which an LMSW isn't yet.
• Texas Medicaid doesn't pay associate-level clinicians directly. A 2025 bill to change that for LMSWs, LPC Associates and LMFT Associates (HB 1716) passed the House but didn't get a Senate hearing (PHNTX 2025 recap).
• Commercial plans mostly credential only the LCSW. Where a plan allows supervised clinicians, get its rule in writing; never bill an LMSW's session under the supervisor's name without that written policy.

Have the CAQH profile built and the packet ready while the LCSW application is with the board, then file with each plan the day the new license posts. Supervision logs and plan-by-plan billing are covered in supervising associates and interns in Texas.

The step list

1. Confirm the LCSW is on BHEC's search and your legal name matches your IRS letter and bank account. Day 1
2. Update NPPES: 1041C0700X as primary, current practice address; a Type 2 NPI if you bill through a PLLC. Days 1–5
3. Gather the packet and build and attest CAQH, authorizing every plan you'll apply to. Weeks 1–2
4. Enroll in Medicare in PECOS, with reassignment if someone else bills for you. Week 2; we budget about 60 days
5. Apply to the commercial plans and any EAPs at the same time. Week 2; 60–120 days each
6. Enroll with TMHP, then apply to the Medicaid managed care plans in your area. After the Medicare number; 60–120 days per plan
7. Read each contract before signing: rates for your codes, any modifier rule, timely filing, termination. As each arrives
8. Get each effective date and provider ID in writing, load them in your EHR, then see that plan's members in network. Before the first claim
9. Keep it current: CAQH every 120 days, recredentialing about every three years, Medicare and Medicaid revalidation about every five. Ongoing

What it costs

There's no government fee for an individual clinician's NPI, CAQH profile or Medicare enrollment. If you'd rather hand it off, our credentialing service prices each item: CAQH $250 per clinician, each plan $175 per plan, Medicare $350 per clinician, Texas Medicaid $350 per clinician. An LCSW starting with CAQH, Medicare, Texas Medicaid and four commercial plans would pay $1,650. Try your own mix in the credentialing cost calculator.

Opening a practice of your own? The Solo Practice Launch: Complete ($3,450) includes six plans with Medicare, plus billing set-up; Essentials ($1,950) includes three. Building a group with LMSWs who'll upgrade later? The Group Practice Launch includes the supervision plan and decides, plan by plan, where each clinician can work.

Questions

More credentialing guides by license: LPC · LMFT · Psychologist · LCDC · Psychiatric NP. The general process for any license: how to get credentialed with insurance.

Sources

Checked October 24, 2026.

1. Texas Behavioral Health Executive Council. bhec.texas.gov
2. BHEC, requirements for holders of an LMSW seeking an LCSW. bhec.texas.gov
3. National Uniform Claim Committee, taxonomy code set. nucc.org
4. 42 CFR 414.53, fee schedule for clinical social worker, MFT and MHC services. law.cornell.edu
5. 42 CFR 424.521, retrospective billing. law.cornell.edu
6. CMS, Marriage and family therapists and mental health counselors. cms.gov
7. 1 TAC §352.13, Medicare enrollment before Medicaid enrollment. law.cornell.edu
8. 1 TAC §353.423, expedited credentialing. law.cornell.edu
9. Texas Tribune, "When it comes to upping mental health services, Texas has a Medicaid problem," April 28, 2023. texastribune.org
10. Texas Legislature, HB 1716 (89th Legislature). capitol.texas.gov; PHNTX 2025 legislative recap. phntx.org
11. TMHP, Texas Medicaid provider enrollment. tmhp.com
12. HHS OIG, exclusions database. oig.hhs.gov

General information, not legal or billing advice. Cima Consulting isn't a law firm or an accounting firm. Payers make their own credentialing decisions; we don't guarantee approvals, rates or dates.