How to start an LCSW private practice in Texas

1. LBSW, LMSW, LCSW: who can practice on their own

The Texas State Board of Social Worker Examiners, part of the Behavioral Health Executive Council (BHEC), licenses social workers under Texas Occupations Code chapter 505 and the rules in 22 TAC chapter 781.

License	Clinical private practice?	What it means for a practice
LCSW	Yes	Diagnose and treat on your own, own the practice, and credential with Medicare, Texas Medicaid and commercial plans.
LCSW-S	Yes, and you may supervise	Supervise LMSWs working toward the LCSW, which is how a solo practice grows into a group.
LMSW	No: clinical work only under supervision	Clinical hours count only under a board-approved supervision plan with an LCSW-S. If you're considering non-clinical independent work (consulting, training, case management), read the current chapter 781 rules on independent practice before you advertise it.
LBSW	No	A baccalaureate license for generalist practice; not a route to a therapy practice of your own.

2. The LMSW-to-LCSW path

From BHEC's requirements for LMSWs seeking the LCSW, as of October 2026 (BHEC):

• 3,000 hours of supervised professional clinical experience over at least 24 months.
• At least 100 hours of supervision from a Texas LCSW-S over those 3,000 hours, roughly in proportion to the hours you work. BHEC's example is about one hour a week for about 30 hours of work a week.
• Paperwork: the clinical supervision plan goes in with your application, and each LCSW-S completes a separate verification form.

Use the last six months to do the practice paperwork that doesn't need the new license: entity, EIN, NPI, office, budget and the credentialing packet. Plans credential the LCSW, not the LMSW, so the applications go in the week the LCSW is issued. Supervisors and employers: our guide to supervising associates has the logs and agreements.

3. Payers for LCSWs

Payer	What to know for an LCSW
Medicare	Clinical social workers were Medicare providers long before counselors and MFTs were added in 2024 (CMS). Enroll in PECOS; there's no application fee for individual clinicians. Look up what Medicare pays for your codes in your Texas locality in the physician fee schedule search.
Texas Medicaid	Enroll through TMHP, then credential with each managed care plan in your area. Texas requires providers who serve people with both Medicare and Medicaid to enroll in Medicare first (1 TAC 352.13). Plans must expedite an LCSW joining an established contracted group if the LCSW is Medicaid-enrolled (1 TAC 353.423). Full process: Texas Medicaid credentialing.
Commercial plans	BCBSTX, Aetna, Cigna's Evernorth and UnitedHealthcare's Optum all credential LCSWs where panels are open. Start with the plans your clients carry: BCBSTX, Aetna.
EAPs	Many social workers come from EAP or hospital work. EAP networks set their own license lists and session limits; ask each.
Self-pay	Give a good faith estimate before services (CMS). See the cash-pay practice guide.

Some plans and Medicaid programs ask for a credential modifier on each line, such as AJ for a clinical social worker. Don't add one by habit: follow each plan's billing manual, because a modifier a plan doesn't expect can deny the line.

4. Services and codes

An LCSW practice bills the same psychotherapy codes as other therapists: 90791 for the diagnostic evaluation; 90832, 90834 and 90837 for psychotherapy of 16–37, 38–52 and 53 or more minutes; 90846 and 90847 for family sessions; 90853 for group; 90839 and 90840 for crisis. What's different is what social workers tend to add:

• Care coordination and resource work (benefits, housing, school meetings). Most plans don't pay for it as a separate service in a therapy practice, so decide up front whether it's part of the session, a self-pay service with its own fee, or something you refer out.
• Assessments for courts, schools or employers. These are often paid by the person or agency asking, not by insurance. Put the fee, what's included and who gets the report in writing, with the client's signed release.
• Medical social work experience (oncology, dialysis, hospice, perinatal) is a niche worth naming on your website and directory listings, because referral sources search for it.

5. Leaving a hospital or agency job

• Read your employment agreement with your attorney before you tell anyone you're leaving: non-solicitation and non-compete terms, who owns client records, and notice periods.
• Clients belong to their care, not to you or the agency. Follow your employer's transfer process; don't take records or contact lists.
• Your malpractice coverage changes. An employer's policy usually stops covering you when you leave. Buy your own, in the practice's name as well as yours, and ask about tail coverage for past work.
• Your NPI is yours for life. Update its practice address and taxonomy in NPPES; don't get a second individual NPI.
• Medicare reassignment: if a hospital or group billed Medicare for you, end that reassignment in PECOS when you leave so your new practice gets paid for your work.

6. Telehealth and the compact

• Chapter 781 recognizes "electronic practice," social work delivered through technology (22 TAC 781.102). The same rules, confidentiality and records apply.
• Texas hasn't joined the Social Work Licensure Compact. HB 3503 and SB 1726 would have joined it in 2025; both died in committee, and the board says joining takes a law passed by the Legislature (BHEC, interstate licensing compact). Until then, a client located in another state needs that state's license or permission.
• Rules for video, location checks, BAAs and modifiers are in our telehealth practice guide.

7. Social work rules that shape the practice

• Confidentiality: communications and records are confidential however they're created or stored (22 TAC 781.311), which is why every vendor that touches client information needs a business associate agreement.
• Records: BHEC's guidance is at least 7 years after services end, or until a minor client turns 23, whichever is later; see how long to keep records in Texas.
• Taxonomy: list 1041C0700X (Social Worker, Clinical) on your NPI.
• Substance use work: if you hold yourself out as treating substance use disorders and are federally assisted (Medicare or Medicaid count), 42 CFR Part 2 protects those records; see the Part 2 guide.

8. Opening, in order

The order for every license is in how to start a private practice in Texas. For an LCSW on our solo roadmap, the typical milestones look like this:

Step	Typical timing
Kickoff and your dated roadmap	Week 1
Individual NPI for each clinician	Weeks 1–2
Business formed with the Texas Secretary of State (you or your attorney file)	Week 4
HIPAA policies and client forms adopted	Weeks 4–6
CAQH profile built and attested	Weeks 6–7
Cima EHR set up with your forms and fees	Weeks 7–8
Insurance applications filed, then followed up every 2 weeks	Months 2–5
You open: self-pay clients can start	Week 11
Each plan's effective date confirmed	Month 6
Billing each plan from its effective date	Month 6

From the kickoff, on the earliest path through our 62-step Texas roadmap. Agencies and insurance plans set their own pace, so treat these as typical, not promised.

Insurance is the long pole: most commercial plans take 60 to 120 days from a complete application, so see self-pay clients while you wait and move each plan's members to insurance on its effective date. How long credentialing takes breaks it down by plan type.

Already open? Credentialing is $175 per plan, and Medicare enrollment is $350 per clinician. Or book a free 30-minute call.

Questions

Can an LMSW have a private practice in Texas?

Not a clinical one. An LMSW provides clinical services only under a supervision plan with an LCSW-S while earning hours toward the LCSW. Read the current 22 TAC chapter 781 rules before offering any non-clinical services independently.

How long does it take to go from LMSW to LCSW in Texas?

At least 24 months: BHEC requires 3,000 hours of supervised clinical experience over at least 24 months, with at least 100 hours of supervision from an LCSW-S.

Can an LCSW bill Medicare?

Yes. Clinical social workers enroll in Medicare through PECOS with no application fee. Look up the rates for your codes and Texas locality in the Medicare physician fee schedule search.

Is Texas in the Social Work Licensure Compact?

No, as of October 2026. Bills to join (HB 3503 and SB 1726) died in committee in 2025. A Texas LCSW needs another state's license or permission to see a client located there.

What NPI taxonomy should an LCSW use?

1041C0700X, Social Worker, Clinical. Use the same name and practice address in NPPES, CAQH and every plan application.

Sources

• Texas Legislature, Occupations Code chapter 505 (social workers)
• BHEC, requirements for LMSWs seeking an LCSW; interstate licensing compact FAQ
• 22 TAC §781.102 and §781.311 (Cornell LII)
• CMS, marriage and family therapists and mental health counselors; physician fee schedule search; PECOS
• 1 TAC §352.13 and 1 TAC §353.423; TMHP
• CMS, No Surprises Act