Behavioral Health Reimbursement Library: Primary Sources | CIN
Center for
Integrative Neuroscience
The Reimbursement Library. Primary sources, dated.

Read the original rule.

No summaries of summaries. Each entry links the government or payer document itself, carries its document number, and is stamped with the date we last read it. If a link is dead or a rule has moved, tell us and we fix it the same week.

Medicare

The federal rules: collaborative care, incident-to, and the 2024 door that opened for counselors and MFTs.

Behavioral Health Integration Services bookletVerified Aug 2026

CMS Medicare Learning Network · MLN909432 · January 2026 edition

The authoritative definition of Collaborative Care: codes 99492, 99493, 99494, add-on G2214, and general BHI 99484, with the care-team roles.

Behavioral Health Integration FAQsVerified Aug 2026

CMS · December 5, 2023

Question 5 settles the most misreported fact in collaborative care: the Behavioral Health Care Manager needs formal education or specialized training, no minimum degree, and does not need to be independently Medicare-eligible.

Marriage and Family Therapists & Mental Health CounselorsVerified Aug 2026

CMS Physician Fee Schedule topic page

Counselors and MFTs bill Medicare independently since January 1, 2024, paid at 75 percent of the psychologist rate. This is the enrollment page.

MFT and MHC enrollment FAQsVerified Aug 2026

CMS · May 2024 · authority: sec. 4121, Div. FF, CAA 2023

The practical enrollment answers, and the statute they rest on.

Become a Medicare providerVerified Aug 2026

CMS enrollment hub

Where PECOS and the CMS-855I actually start.

Consolidated Appropriations Act, 2023Verified Aug 2026

Public Law 117-328 · sec. 4121, 4123, 4113

The law itself, for when a payer or a biller wants chapter and verse.

Medicare Benefit Policy Manual, chapter 15Verified Aug 2026

CMS Pub. 100-02 · sections 60, 60.1, 60.2

The controlling incident-to text: what direct supervision means and who counts as auxiliary personnel.

CY2024 Physician Fee Schedule final ruleVerified Aug 2026

CMS-1784-F · rule text at 88 FR 78818

Implements counselor and MFT coverage, extends the health behavior codes, pays crisis psychotherapy at 150 percent.

CY2025 Physician Fee Schedule final ruleVerified Aug 2026

CMS-1807-F · rule text at 89 FR 97710

Safety planning interventions, digital mental health treatment devices, audio-only flexibility for opioid treatment.

CY2026 Physician Fee Schedule final ruleVerified Aug 2026

CMS-1832-F · rule text at 90 FR 49266

New behavioral health add-on G-codes under APCM, digital mental health extended to ADHD, and virtual direct supervision made permanent. Audio-visual, not audio-only.

Telehealth FAQVerified Aug 2026

CMS · updated February 26, 2026

Behavioral telehealth keeps no geographic restriction, audio-only stays permitted, and the in-person requirement does not begin until January 1, 2028, grandfathering anyone in care by the end of 2027.

List of telehealth services, CY2026Verified Aug 2026

CMS annual list

The code-level authority. Check psychotherapy codes here, not in a summary article.

Medicare & Mental Health Coverage bookletVerified Aug 2026

CMS MLN · MLN1986542 · March 2026

All ten Medicare-eligible mental health provider types, the psychotherapy code family, and confirmation that psychologists, social workers, MFTs and counselors may bill the health behavior codes.

CMS Behavioral Health StrategyVerified Aug 2026

CMS

The policy frame CMS itself uses. Useful in grant applications and advocacy letters.

Medicaid

The federal hub, then the twelve states the Observatory currently covers. Where a state does not publish openly, we say so rather than linking around it.

Medicaid behavioral health servicesVerified Aug 2026

Medicaid.gov

The federal entry point for benefit design, parity, SUD and youth services.

Peer support services FAQVerified Aug 2026

CMCS · June 5, 2024

Loosens who may supervise peer support: experienced peers, unlicensed practitioners, SUD counselors.

State Plan Amendment databaseVerified Aug 2026

Medicaid.gov · 16,000+ SPAs

How a clinician traces exactly what their own state got approved to cover.

CCBHC demonstrationVerified Aug 2026

Medicaid.gov

The clinic model rewriting community behavioral health payment. Maine, Rhode Island and Illinois are round one; Alaska, Colorado and Washington round two.

Michigan: Medicaid Provider ManualVerified Aug 2026

State Medicaid agency

The behavioral health chapter lives inside the manual; delivery runs through PIHPs and CMHSPs.

Florida: Adopted rules index (59G series)Verified Aug 2026

State Medicaid agency

Chapter 491 licensees render through community behavioral health agencies. AHCA reorganised its site, so link this index; old deep links 404.

Illinois: Community-based behavioral health servicesVerified Aug 2026

State Medicaid agency

Distinguishes independent practitioners from community mental health centers, which decides what an associate-level clinician may bill.

Washington: Apple Health billing guidesVerified Aug 2026

State Medicaid agency

The mental health guide addresses associates explicitly: taxonomy codes and a claim note for LMHCA, LSWAIC, LMFTA from January 2026, and a 120-day pending-license grace period.

Tennessee: TennCare providersVerified Aug 2026

State Medicaid agency

TennCare publishes no open behavioral health manual or fee schedule. Rates and rules come from your contracted MCO. That is worth knowing before you ask.

Colorado: HCPF rates and fee schedulesVerified Aug 2026

State Medicaid agency

Colorado publishes specific supervision limits, including the number of supervisees, weekly time and oversight rules for pre-licensed clinicians.

Connecticut: CT Behavioral Health PartnershipVerified Aug 2026

State Medicaid agency

Behavioral health is carved out to an administrative services organization; this is the provider-facing home.

Delaware: DSAMH provider policiesVerified Aug 2026

State Medicaid agency

Delaware files its manuals in a search-driven repository, so deep links rot. Start here.

Maine: MaineCare Benefits Manual, chapter 101Verified Aug 2026

State Medicaid agency

Section 65 is the behavioral health rule text: provider qualifications and rates.

Rhode Island: Medicaid provider manualVerified Aug 2026

State Medicaid agency

Rehabilitative services chapter carries the behavioral health definitions; fee schedules sit behind a click-through agreement.

Alaska: Behavioral health provider supportVerified Aug 2026

State Medicaid agency

Supervision standards live in the 1115 waiver provider standards manual.

Missouri: MO HealthNet behavioral healthVerified Aug 2026

State Medicaid agency

Unusually complete: an open provider manual and a searchable rate lookup.

Commercial payers

What the national payers publish openly, which is less than you would hope. Where a payer does not publish its associate-level policy, we say that too. The four stories below are the ones practices are living through right now.

Arizona: the change arrived in a newsletter, not a policy library.

AZ Blue's January 2026 provider newsletter requires the supervising provider to be "readily available (physically or via real-time audio/visual) to step in" whenever an associate carries out the treatment plan, and states plainly that audio-only supervision is not acceptable. The December 2025 issue also cut H0004 from 50 units to 32 per day. None of this appears in the public policy library. And on its Medicaid line, the same payer says incident-to is not allowed at all. One payer, opposite rules.

Oregon: associates lose private-practice Medicaid billing July 1, 2027.

The Oregon Health Authority policy page and the June 2026 rulemaking memo (OAR 410-172-0660) are definitive. News reports still carry the old 2026 date; the provision was delayed a year.

Michigan: the payer that publishes its rules properly.

Blue Cross Blue Shield of Michigan is the national outlier: its LLP and LMFT FAQ and BCN requirements document state openly which licensure levels bill directly, which bill under supervision, and which modifier to use. Collaborative care in Michigan runs through PGIP and MICMT.

A common question about care managers.

CMS's own BHI FAQ, question 5: the Behavioral Health Care Manager in collaborative care needs formal education or specialized training in behavioral health, with no minimum degree specified, and need not be independently eligible to bill Medicare. This is what makes the model a real answer for limited-license clinicians.

UnitedHealthcare commercial reimbursement policiesVerified Aug 2026

UnitedHealthcare

The best-indexed public commercial policy library. Its incident-to policy (2026R5025A) is open, but defines renderers as PAs, NPs and auxiliary personnel; it creates no associate behavioral health pathway.

Optum behavioral health network manualVerified Aug 2026

Optum · effective September 2026

The behavioral network rulebook for UHC's behavioral arm.

Anthem provider policiesVerified Aug 2026

Elevance Health

No single national list; Anthem forces a state selection first.

Aetna clinical policy bulletinsVerified Aug 2026

Aetna

The public policy library. The behavioral health provider manual requires a current, unrestricted license and is silent on associates.

Evernorth behavioral health administrative guidelinesVerified Aug 2026

Cigna/Evernorth · PCOMM-2026-191 · March 2026

The network rulebook. Describes its network as psychiatrists, psychologists and master's-level therapists; silent on associates.

Humana claims payment policiesVerified Aug 2026

Humana

The library renders in the browser only, so it can look empty to search engines. It is not.

Parity and complaints

Read the first two together. Publishing either alone misleads.

The 2024 parity final ruleVerified Aug 2026

DOL, HHS, Treasury · 89 FR 77586

The strongest parity requirements ever written: comparative analyses, meaningful benefits, data evaluation.

The May 2025 non-enforcement statementVerified Aug 2026

DOL, HHS, Treasury

The catch: the new 2024 requirements will not be enforced pending litigation plus 18 months. The underlying statutory parity obligations still apply.

Where to complain: your state insurance departmentVerified Aug 2026

NAIC

The route for fully insured and individual-market plans.

Where to complain: Ask EBSAVerified Aug 2026

US Department of Labor

The route for self-funded employer plans, which state regulators cannot touch. Also 1-866-444-3272.

Parity RegistryVerified Aug 2026

The Kennedy Forum

Guided appeal letters and a public registry of denials.

ParityTrackVerified Aug 2026

The Kennedy Forum

The credible tracker of state parity law.

Center for Connected Health PolicyVerified Aug 2026

CCHP

The reference database for state telehealth policy.

Payer changes can hide in newsletters. We keep a public log.

Parity trackers cover the law. Telehealth trackers cover telehealth. The Arizona change shipped in an emailed newsletter and appeared in no policy library. Payer Watch is where we log every one we find, with the primary source.

Open Payer Watch →