Everything a Therapy Practice Needs

Each state licenses counselors, marriage and family therapists and social workers through its own board, often under different titles: LPC, LMHC, LCPC, LPCC, LMFT, LCSW and others. Requirements for supervised hours, exams and jurisprudence differ from state to state, and so do the rules for associates and pre-licensed clinicians. A new license usually means transcripts, verification of supervised hours, exam scores, verification of every license you have held and a background check.

The Counseling Compact gives a licensed professional counselor a privilege to practice in other member states, which the compact treats as equivalent to a license there. You must hold a license in a member state and live there, and your license must let you independently assess, diagnose and treat. Graduates still completing supervised hours are not eligible, even where their title includes LPC. The compact requires the licensee to complete and submit the entire application, and says employers, third-party affiliates and other representatives may not legally complete or submit it. We confirm your eligibility, identify each state's jurisprudence requirement and prepare everything, and then you submit it.

The Social Work Licensure Compact works differently. It creates a multistate license, in clinical, master's and bachelor's categories, that authorizes practice in all member states, governed by each remote state's scope of practice and laws. The clinical category requires an accredited MSW or higher, the qualifying national exam, and 3,000 hours or two years of post-graduate supervised clinical practice. The current status of both compacts is shown with the compact details on this page. Until a compact covers you, you need a full license in each state where your clients are.

Since January 1, 2024, Medicare Part B has covered services by marriage and family therapists and mental health counselors for the diagnosis and treatment of mental illnesses. Clinical social workers were already covered. Each type must enroll in Medicare to bill, and assignment is required, so you accept Medicare's allowed amount as payment in full.

To enroll as a marriage and family therapist or a mental health counselor, you need a master's or doctoral degree that qualifies you for licensure in your state, at least two years or 3,000 hours of post-master's supervised clinical experience, and a state license. Medicare's mental health counselor category includes licensed professional counselors and clinical professional counselors. Addiction and alcohol and drug counselors can enroll as mental health counselors if they meet the same education, supervised experience and licensure requirements.

Clinical social workers need a master's or doctoral degree in social work, at least two years of supervised clinical social work, and a state license or certification as a clinical social worker. For all three types, services to hospital inpatients are not covered under this benefit.

Commercial plans, Medicaid and Medicaid managed care plans each credential separately, and most rely on a complete, attested CAQH ProView profile. Some plans hand behavioral health to a separate company, so we confirm who actually credentials therapists for each plan before we apply. Some panels close to new therapists in some areas, and when that happens we ask for an exception where your specialty, languages or availability fill a gap.

If you run a group, each clinician is credentialed individually and linked to the group with each payer. Plans differ on whether they will credential pre-licensed associates at all, so we check each plan's rules before you hire.

Most of what a therapy practice bills is a diagnostic evaluation and timed psychotherapy. Medicare contractor guidance tells you to choose the psychotherapy code closest to the actual time, not to report psychotherapy shorter than 16 minutes, and to document start and stop times or total time. Crisis psychotherapy is based on total face-to-face time and is not reported with a diagnostic evaluation. When you add the interactive complexity code, the note must show the time spent on it.

We code from your notes, submit claims, post payments, appeal denials and follow up on every open claim. Because each plan sets its own rules on session limits, telehealth and authorizations, we load those rules for your payers so claims go out right the first time.

Many therapists see some or all clients outside of insurance. A superbill gives the client what they need to ask their own plan for out-of-network reimbursement: your NPI and tax ID, diagnosis codes, service codes and fees. Our patient portal produces superbills from the visit, and payment processing takes cards, HSA and FSA cards and ACH.

The No Surprises Act requires a good faith estimate for uninsured clients and for clients who choose not to use their insurance. When a service is scheduled at least three business days ahead, you provide the estimate within one business day of scheduling. When it is scheduled at least ten business days ahead, you have three business days. A client can also ask for one, and you have three business days to provide it. The estimate must be in writing, on paper or electronically.

For ongoing therapy, one estimate can cover recurring sessions if it describes the expected scope, such as frequency and number of sessions, for no more than 12 months. It must include the client's name and date of birth, the expected services with diagnosis codes, service codes and expected charges, your NPI and tax ID, and the required disclaimers. If the final bill is at least $400 more than the estimate, the client may be able to dispute it.

HIPAA treats psychotherapy notes, the notes you keep separately to document or analyze the contents of a session, differently from the rest of the record. Using or disclosing them generally needs the client's authorization, and they are excluded from the client's right of access. Session times, the type and frequency of treatment, diagnoses, treatment plans and progress summaries are not psychotherapy notes, and clients can request those. You must act on a request for access within 30 days, with one 30-day extension if you explain the delay in writing.

Our HIPAA program covers your security risk assessment, written policies, staff training, a business associate agreement with every vendor, and a breach response plan. We also review your website's analytics and ad pixels so client information never reaches an ad platform.

For telehealth, the license that counts is the one for the state where the client is during the session. We map where your clients are against your licenses and compact privileges and tell you when a client's move creates a gap.

Our telehealth platform runs HIPAA video sessions that clients join from a browser with no app to install, covered by a signed business associate agreement. Medicare's telehealth rules for behavioral health are shown in the callout here, with their current dates.