LMFT credentialing in Texas: getting a marriage and family therapist in network

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

LMFT credentialing at a glance

What plans verify about an LMFT

• The LMFT license, not the associate license, on BHEC's license verification search, with status, expiration and any board orders. If you were an LMFT Associate until recently, update the license number on your NPI record and CAQH profile before you apply anywhere.
• Your degree: the master's or doctorate that qualified you for MFT licensure. Medicare's definition depends on it, so keep the diploma and, if a plan asks, a transcript ready.
• Post-degree supervised experience. Medicare requires at least two years or 3,000 hours after the degree; your license required the same kind of hours, so the dates on your associate license and your LMFT license usually prove it.
• Work history, malpractice and exclusions: a CV with month and year for every job, the declarations page and claims history, and a clean check on the OIG exclusion list.

Put it in one packet using our credentialing documents checklist, and load it into CAQH with the CAQH ProView guide. Your taxonomy, 106H00000X, goes on your Type 1 NPI in NPPES; a PLLC adds a Type 2 (which NPI goes where).

Medicare for LMFTs

The Consolidated Appropriations Act, 2023 added marriage and family therapists to Medicare Part B, effective January 1, 2024 (CMS). The coverage rule for MFTs is 42 CFR 410.53: a master's or doctoral degree that qualifies for MFT licensure, at least two years or 3,000 hours of post-degree supervised clinical experience, and a current state license.

• The rate: 80% of the lesser of your charge or 75% of the clinical psychologist amount for the same service (42 CFR 414.53). You accept assignment.
• Telehealth: MFTs were added as distant-site telehealth practitioners in the 2024 fee schedule (National Council summary).
• Dates before 2024 were never payable for MFTs, and Medicare limits billing back to 30 days before your filing date (42 CFR 424.521). File in PECOS before the first Medicare client.
• Family sessions for Medicare clients: Medicare pays for the diagnosis and treatment of the beneficiary's mental illness. Family psychotherapy is billable when it's part of treating the Medicare client; check the coverage rules for the specific family code before you bill it.

The PECOS screens, reassignment to a group and the common rejections are in our Medicare guide for LPCs and LMFTs.

Texas Medicaid and the pediatric exemption

• Medicare first, since March 1, 2024. Texas Medicaid health plans told LMFTs and LPCs they must enroll in Medicare, or get the pediatric practice exemption by answering the question in their TMHP (PEMS) record; those without either submit a Medicare Waiver Request (BCBSTX Medicaid; Community Health Choice).
• Why the exemption matters for family therapists: many LMFTs who take Medicaid see children and their families under STAR, STAR Kids and CHIP. If your practice is pediatric, claim the exemption in PEMS instead of enrolling in a program you won't bill. If you also see adults who might be dually eligible, enroll in Medicare.
• Joining a pediatric group doesn't cover you. An LMFT who sees mainly children and joins Medicaid through a Medicare-enrolled group still needs their own Medicare enrollment or the exemption.
• The rate. HHSC said in 2023 that Texas Medicaid pays LMFTs, LPCs and LCSWs 70% of the psychologist rate for psychotherapy (Texas Tribune). Check the current TMHP fee schedule.
• Group joiners get a faster lane: Texas Medicaid managed care plans must expedite Medicaid-enrolled LMFTs who join an established contracted group (1 TAC §353.423).

The PEMS steps, the managed care plans by service area and revalidation are in our Texas Medicaid credentialing guide.

Commercial plans

Blue Cross and Blue Shield of Texas, Aetna, Cigna and UnitedHealthcare credential LMFTs for outpatient therapy through CAQH, where their panels are open. Several send behavioral health to a separate network, so apply where the member's behavioral benefits are actually managed (behavioral health carve-outs). Plan-specific steps: BCBSTX, Aetna. Before each application, ask whether the panel is open for LMFTs in your county; a specialty such as children and adolescents, Spanish-language sessions or perinatal work can open a door the general panel has closed.

Family and couples work: ask before you apply

Insurance pays for treating a diagnosed condition in an identified client. That fits family therapy well and couples work less well, so the questions an LMFT should put to every plan, in writing, before choosing it are:

Write the answers into your fee schedule notes. Where a plan won't pay couples work without a diagnosed condition, offer it self-pay with a good faith estimate, and don't put a diagnosis on a claim to make it fit. Cima EHR has 90846 and 90847 in its code list and prints a superbill for families who use out-of-network benefits.

LMFT Associates

An LMFT Associate needs at least two years and 3,000 hours of supervised clinical practice, including 1,500 hours of direct services and 500 with couples or families, and at least 200 hours of supervision by an LMFT-S (22 TAC §801.142). For credentialing:

• Medicare and Texas Medicaid don't enroll associates in their own name. A 2025 bill that would have let associate-level clinicians bill Texas Medicaid (HB 1716) passed the House but not the Senate (PHNTX recap).
• Most commercial plans credential only fully licensed clinicians. Where one allows supervised clinicians, it sets the terms; get them in writing.
• Plan the upgrade week. Build the CAQH profile and packet while the LMFT application is with the board, and file with each plan the day the license posts.

Supervision logs and the billing question are covered in supervising associates and interns in Texas.

The step list

1. Check the LMFT license on BHEC and make your legal name match the IRS letter and bank account. Day 1
2. NPPES: 106H00000X as primary, current address; a Type 2 NPI if a PLLC bills. Days 1–5
3. Decide on Medicare: enroll if you'll see any adults who may have Medicare; if your Medicaid caseload is all children, plan the pediatric exemption instead. Day 5
4. Packet and CAQH, attested, with every plan authorized. Weeks 1–2
5. PECOS (if enrolling), with reassignment to your group or PLLC. Week 2; we budget about 60 days
6. Commercial applications, after asking each plan the family-therapy questions above. Week 2; 60–120 days each
7. TMHP enrollment with your Medicare number or the exemption, then each Medicaid managed care plan. 60–120 days per plan
8. Contracts and effective dates: rates for 90791, 90834, 90837, 90846 and 90847; timely filing; termination. Load each effective date and ID before the first in-network session. As each arrives

New to all of this? How to get credentialed with insurance covers the general process for any license.

What it costs

No government fee applies to an individual LMFT's NPI, CAQH profile or Medicare enrollment. Handing it to our credentialing service: CAQH $250 per clinician, each commercial plan $175 per plan, Medicare $350 per clinician, Texas Medicaid $350 per clinician. A pediatric-focused LMFT taking CAQH, Texas Medicaid and three commercial plans (no Medicare) would pay $1,125; add Medicare and it's $1,475. Price your own set in the credentialing cost calculator.

Opening your own practice? Solo Practice Launch: Essentials ($1,950) includes NPIs, CAQH and three plans; Complete ($3,450) includes six plans with Medicare and billing set-up. See how to start a private practice in Texas for the steps around credentialing.

Questions

More credentialing guides by license: LPC · LCSW · Psychologist · LCDC · Psychiatric NP.

Sources

Checked October 24, 2026.

1. Texas Behavioral Health Executive Council. bhec.texas.gov
2. National Uniform Claim Committee, taxonomy code set. nucc.org
3. CMS, Marriage and family therapists and mental health counselors. cms.gov
4. 42 CFR 410.53, marriage and family therapist services. law.cornell.edu
5. 42 CFR 414.53, fee schedule for clinical social worker, MFT and MHC services. law.cornell.edu
6. 42 CFR 424.521, retrospective billing. law.cornell.edu
7. National Council for Mental Wellbeing, CY 2024 PFS and OPPS summary. thenationalcouncil.org
8. Blue Cross and Blue Shield of Texas (Medicaid), Medicare requires LPC, LMFT enroll, May 14, 2024. bcbstx.com
9. Community Health Choice, LPC and LMFT providers must enroll in Medicare effective 03/01/2024. communityhealthchoice.org
10. Texas Tribune, Texas Medicaid behavioral health rates, April 28, 2023. texastribune.org
11. 1 TAC §353.423, expedited credentialing. law.cornell.edu
12. 22 TAC §801.142, LMFT Associate supervised experience. law.cornell.edu
13. Texas Legislature, HB 1716 (89th Legislature). capitol.texas.gov; PHNTX 2025 recap. phntx.org
14. 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 and coverage decisions; we don't guarantee approvals, rates or dates.

Opening your own practice? Read how to start an LMFT private practice in Texas for the business, payer and opening steps that go with credentialing.