PMHNP credentialing in Texas: getting a psychiatric nurse practitioner in network

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

PMHNP credentialing at a glance

The prescriber packet

Everything a therapist sends (license, NPI, CV, malpractice, W-9, IRS letter, bank letter), plus these. They come from the checklist we use with our own prescriber clients:

• APRN license and prescriptive authority from the Board of Nursing, with numbers and expiration dates. Plans verify them with the Board.
• National board certification as a PMHNP (or FNP). Medicare requires NP certification from a recognized national certifying body, and CMS's list of recognized bodies includes the American Nurses Credentialing Center and the American Academy of Nurse Practitioners (CMS program integrity transmittal on NP qualifications).
• The signed prescriptive authority agreement, the delegating physician's name, Texas license number and NPI, and confirmation that the physician registered the delegation with the Texas Medical Board. Have all four before the first application; plans ask, and a missing registration stalls the file.
• DEA registration at your Texas practice address, if you'll prescribe controlled substances. Texas has no separate state controlled-substance registration. If you'll practice at more than one address, ask each plan which DEA address it needs.
• Texas PMP account confirmation. It's on our prescriber checklist because groups and some plans ask for it.
• Hospital affiliation or admitting arrangement, if any. Outpatient psychiatric NPs often have none; say so plainly and describe how you refer patients who need admission.
• A CLIA certificate of waiver, only if you'll run waived tests such as urine drug screens in the office.

The order those registrations happen in (the office, then the DEA, then the PMP and e-prescribing) is in our guide to opening a psychiatric NP practice in Texas. The general packet is on the credentialing documents checklist, and the profile in the CAQH ProView guide.

Medicare for NPs

• Who qualifies: a registered nurse authorized by the state to practice as a nurse practitioner, certified by a recognized national certifying body, and, for NPs first enrolling after January 1, 2003, holding a master's degree in nursing or a Doctor of Nursing Practice (42 CFR 410.75; First Coast Service Options, NP enrollment).
• The rate: 80% of the lesser of the actual charge or 85% of what a physician would be paid under the physician fee schedule (CMS: advanced practice registered nurses).
• Enroll in PECOS on the CMS-855I, with no application fee for individual clinicians, and reassign your billing to your practice or group on the same application. File before your first Medicare patient; Medicare limits billing back to 30 days before the filing date (42 CFR 424.521).
• Medicare Advantage plans credential you separately, usually after you're in Medicare.

Texas Medicaid for NPs

• The rate: Texas pays nurse practitioners and clinical nurse specialists the lower of billed charges or 92% of what a physician would be paid for the same service (1 TAC §355.8281).
• Medicare first: Texas expects providers who serve people with both Medicare and Medicaid to enroll in Medicare before Medicaid (1 TAC §352.13). For a psychiatric NP who will see adults, enroll in Medicare first.
• TMHP, then each plan. Enroll in PEMS on TMHP, then credential with each STAR, STAR+PLUS, STAR Kids and CHIP plan in your service area. One credentialing verification organization checks your documents for all the Medicaid plans.
• Behavioral health inside Medicaid plans: some Texas Medicaid managed care plans manage behavioral health themselves and some use a separate company. Ask each one where psychiatric prescribers credential.

The PEMS steps and revalidation are in our Texas Medicaid credentialing guide.

Commercial plans: medical or behavioral network?

A psychiatric NP sits between a plan's medical network and its behavioral health network, and the plan decides which one credentials you. Several plans send behavioral health, including psychiatric medication management, to a separate company. Before you apply, ask each plan:

The carve-out question is the one that wastes the most time when it's missed; behavioral health carve-outs explains how to tell from a member's card. Plan-specific steps: BCBSTX, Aetna.

FNPs with a psychiatric caseload

An FNP can be credentialed with the same payers, under 363LF0000X and their FNP certification. The questions come from scope: the Board of Nursing expects every APRN to practice within their education, certification and role. If you're an FNP planning a mostly psychiatric caseload:

• Read the Board's current scope-of-practice guidance first, and keep records of your psychiatric training and continuing education.
• Expect plans' behavioral health networks to ask how your training fits the psychiatric services you'll bill, and ask each one up front whether it credentials FNPs for psychiatric medication management.
• Don't list the psychiatric NP taxonomy unless you hold that certification; the taxonomy should match the certification plans verify.

Codes your contracts must cover

Before you sign, check the fee schedule covers what a psychiatric NP bills most: 90792 (psychiatric evaluation with medical services), 99202–99205 and 99212–99215 (new and established visits), the psychotherapy add-ons 90833, 90836 and 90838 with an E/M visit, and, if you'll do therapy alone, 90832, 90834 and 90837. Some plans prefer a new-patient E/M code to 90792; your contract or the plan's billing guide says which. Cima EHR for nurse practitioners picks the E/M level from time on the date of the visit and checks add-on pairs before a claim goes out.

The step list

1. Confirm APRN license and prescriptive authority on the Board of Nursing; match your legal name everywhere. Day 1
2. Sign the prescriptive authority agreement and get confirmation the physician registered it with the TMB. Before applications
3. NPPES: 363LP0808X as primary, practice address current; a Type 2 NPI for your practice (Type 1 vs Type 2). Days 1–5
4. DEA registration at the practice address, then the Texas PMP. After the office lease
5. Packet and CAQH, with certification, the agreement and DEA uploaded; attest and authorize your plans. Weeks 1–2 after DEA
6. Medicare in PECOS, with reassignment to your practice. We budget about 60 days
7. Commercial applications, after the network question above. 60–120 days each
8. TMHP, then each Medicaid managed care plan. After the Medicare number; 60–120 days per plan
9. Contracts and effective dates: NP rates for your E/M and add-on codes, timely filing, termination; load each effective date and ID before the first in-network visit. As each arrives
10. Keep it current: CAQH every 120 days; DEA, APRN and certification renewals; a new agreement and plan updates whenever your delegating physician changes. Ongoing

What it costs

There's no government fee for your NPI, CAQH profile or Medicare enrollment as an individual clinician; the DEA registration has its own federal fee. Through our credentialing service: CAQH $250 per clinician, each commercial plan $175 per plan, Medicare $350 per clinician, Texas Medicaid $350 per clinician. A PMHNP starting with CAQH, Medicare, Texas Medicaid and five commercial plans would pay $1,825. Price your own set in the credentialing cost calculator.

Opening your own practice? The Prescriber Practice Launch ($4,950) includes the DEA and PMP, the prescriptive authority checklist, e-prescribing set-up and eight insurance plans, Medicare and Medicaid among them.

Questions

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

Sources

Checked October 24, 2026.

1. Texas Board of Nursing. bon.texas.gov; Texas Medical Board. tmb.state.tx.us
2. 42 CFR 410.75, nurse practitioners' services. law.cornell.edu
3. First Coast Service Options, nurse practitioner (NP) enrollment. medicare.fcso.com
4. CMS, Program Integrity Manual transmittal on NP and CNS qualifications and recognized certifying bodies. cms.gov
5. CMS, Advanced practice registered nurses (payment at 85% of the physician fee schedule). cms.gov
6. 42 CFR 424.521, retrospective billing. law.cornell.edu
7. 1 TAC §355.8281, reimbursement methodology for nurse practitioners and clinical nurse specialists. law.cornell.edu
8. 1 TAC §352.13, Medicare enrollment before Medicaid enrollment. law.cornell.edu
9. TMHP, Texas Medicaid provider enrollment. tmhp.com
10. NUCC taxonomy code set. nucc.org

General information, not legal or clinical advice. Cima Consulting isn't a law firm or an accounting firm; have a health-care attorney review your delegation agreement. Payers make their own credentialing decisions; we don't guarantee approvals, rates or dates.