How to start an LMFT private practice in Texas

1. The LMFT license and the associate rules

The Texas State Board of Examiners of Marriage and Family Therapists, under the Behavioral Health Executive Council (BHEC), licenses LMFTs under Texas Occupations Code chapter 502 and 22 TAC chapter 801.

License	Own private practice?	What to know
LMFT	Yes	Credential with commercial plans, Medicare and Texas Medicaid in your own name.
LMFT-S	Yes, and you may supervise	Requires a Texas LMFT in good standing, at least 3,000 hours of independent practice over at least three years, and a supervision course (22 TAC 801.143).
LMFT Associate	Only under an LMFT-S	At least two years and 3,000 hours of supervised clinical practice: 1,500 direct (no more than 750 by technology-assisted services), at least 500 with couples or families, and 200 hours of supervision, 100 of them individual, about weekly (22 TAC 801.142).

Two planning notes for associates. First, the 750-hour cap on technology-assisted hours means a video-only associate practice can't finish on video alone. Second, Medicare and many commercial plans won't credential an associate, so most associates build their caseload on self-pay and the plans that allow supervised clinicians, then credential the week the LMFT is issued. Supervision logs and agreements are in our guide to supervising associates.

2. Billing couples and family therapy

Health plans pay for medically necessary treatment of a covered member's condition. A session with a spouse or parent in the room is billable when it treats that member's diagnosis; a relationship that's struggling isn't, by itself, a diagnosis most plans pay to treat. Work through these before the first couple books:

Situation	How it's usually handled
One partner has a diagnosed condition (depression, PTSD, a substance use disorder) and the sessions treat it with the partner present	Family psychotherapy with the client present, 90847, billed to the identified client's plan, with the treatment plan showing how the joint work treats that diagnosis.
You meet with the family or partner without the identified client	90846, billed to the identified client's plan, documented as treatment for the client's condition. Check whether the plan covers it at all.
The couple wants help with the relationship and neither partner meets criteria for a diagnosis	Ask each plan whether it pays family psychotherapy when the only diagnosis is a relationship code such as Z63.0 (problems in relationship with spouse or partner). Where it doesn't, the work is self-pay, with a good faith estimate before services.
A child is the identified client	Bill the child's plan, get consent from the parent or guardian who can legally give it, and keep the custody paperwork in the chart.

Never assign a diagnosis that the assessment doesn't support so a session will pay. That's a false claim, and it follows the client in their medical record. If the honest answer is "this isn't covered," say so on the first call and offer a self-pay rate. Our cash-pay practice guide covers rates, estimates and superbills.

Family codes aren't timed like 90832–90837, but plans still expect the session length and who attended in the note. In Cima EHR, 90846 and 90847 sit with the individual codes, and the note records who was present.

3. Records and consent with more than one client

• Decide whose chart it is. Some practices keep one chart for the identified client with others noted as participants; others open a chart for each adult in couples work. Write the rule in your policy and explain it in your consent, because it decides who can request the record later.
• Spell out the secrets policy in the consent to treatment: what you'll do if one partner tells you something in an individual call that the other doesn't know.
• Releases are individual. Each adult signs their own release before you share their information, including with the other partner's individual therapist.
• Minors: before providing technology-assisted services to a minor, get the required consent from a parent or guardian (22 TAC 801.58, summarized in BHEC's MFT guidelines for technology-assisted services).
• Retention: keep records at least 7 years after services end, or 5 years after the client reaches the age of majority, whichever is longer (22 TAC 801.48).

4. Payers for LMFTs

Payer	What to know for an LMFT
Medicare	Since January 1, 2024. Enroll in PECOS on the CMS-855I with no application fee; Medicare pays the lesser of 80% of your charge or 75% of the clinical psychologist rate, and you accept assignment (CMS). Step by step: Medicare enrollment for LPCs and LMFTs.
Texas Medicaid	Through TMHP, then each managed care plan. Since March 1, 2024, LMFTs must enroll in Medicare first unless they get the pediatric practice exemption (BCBSTX Medicaid notice), which matters to family therapists who mostly see children. See Texas Medicaid credentialing.
Commercial plans	Credential LMFTs where panels are open. Ask each how it handles 90846, 90847 and relationship-only diagnoses before you sign. Start with BCBSTX and Aetna.
EAPs	EAP benefits are usually a set number of short-term sessions under the employer's program rather than a diagnosis-driven benefit. Ask each EAP network whether it covers relationship concerns, how many sessions it authorizes and what it pays.

5. Telehealth with couples and families

• Every participant's location counts. BHEC's MFT guidance treats you as practicing in Texas when the client is in Texas, and tells you to check with the licensing authority of any other state where a client is located (BHEC MFT guidelines). A couple living apart, or a college student joining from another state, can put part of the session outside your license.
• Give your license number and how to reach the council to clients you serve by technology (22 TAC 801.44(o), per the same guidance), plus local crisis resources for each person's location before a crisis happens.
• Texas isn't part of an MFT licensure compact as of October 2026; check BHEC before seeing anyone located in another state.
• Modifiers, places of service, BAAs and the rest are in the telehealth practice guide.

6. LMFT rules that shape the practice

• Taxonomy: list 106H00000X (Marriage & Family Therapist) on your NPI.
• Referrals: divorce attorneys, family courts, pediatricians and schools send families to MFTs. Build those relationships on good communication, and never give or take anything of value for a referral (Texas Occupations Code chapter 102).
• Court-related work (custody evaluations, testimony, reunification) has its own rules, fees and risks. Put your court policy and fees in your financial policy, and talk to your malpractice carrier before you take it on.

7. Opening, in order

The business and credentialing steps are the same for every license; follow them in how to start a private practice in Texas. What an LMFT practice adds to that list: a consent to treatment that covers joint sessions and the secrets policy, a financial policy that says which couples work is self-pay, an intake that records who the identified client is, and a fee for family sessions on your fee schedule. Our policies and forms kit ($750) includes the consent, privacy notice, telehealth consent, financial policy and good faith estimate under your practice's name.

Or book a free 30-minute call, or see credentialing by the plan.

Questions

Can an LMFT open a private practice in Texas?

Yes. A fully licensed LMFT can own a private practice and credential with commercial plans, Medicare (since January 1, 2024) and Texas Medicaid. An LMFT Associate practices under an LMFT-S until licensed.

Does insurance cover couples therapy?

Plans pay for family psychotherapy (90847 or 90846) when it treats a covered member's diagnosed condition. Many don't pay when the only issue is the relationship itself. Ask each plan before billing, and offer a self-pay rate with a good faith estimate when it isn't covered.

What's the difference between 90846 and 90847?

90847 is family psychotherapy with the identified client present; 90846 is family psychotherapy without the client present. Both are billed to the identified client's plan, documented as treatment of that client's condition.

Can LMFTs bill Medicare?

Yes, since January 1, 2024. Enroll in PECOS with no application fee. Medicare pays the lesser of 80% of the charge or 75% of the clinical psychologist rate, and you must accept assignment.

How many hours does an LMFT Associate need in Texas?

At least 3,000 hours of supervised clinical practice over at least two years, including 1,500 direct hours (no more than 750 by technology), at least 500 with couples or families, and 200 hours of supervision, at least 100 of them individual.

Sources

• Texas Legislature, Occupations Code chapter 502 (marriage and family therapists)
• 22 TAC §801.142, §801.143, §801.48 (Cornell LII)
• BHEC, MFT guidelines for technology-assisted services (July 2025)
• CMS, marriage and family therapists and mental health counselors
• Blue Cross and Blue Shield of Texas Medicaid, Medicare enrollment required for LPCs and LMFTs
• Texas Legislature, Occupations Code chapter 102; CMS, No Surprises Act