Child and Adolescent Mental Health Billing for Private Practices

Medtransic bills insurance for child and adolescent mental health practices: therapists, psychologists and psychiatric prescribers who treat children and teens. We bill Medicaid, CHIP and commercial plans, including parent sessions, family therapy and level-of-care requests, inside SimplePractice, TherapyNotes, Qualifacts or the system you already use. Billing is 4-8% of what we collect for you. Credentialing is $150 per application, per provider. There is no long-term contract.

Last reviewed 2026-10-04.

Where children's mental health claims go wrong

A child's care involves more people and more rules than an adult's. Each of these gaps costs money on a different kind of session.

  1. Medicaid says the service is not covered

    For Medicaid enrollees under 21, federal law requires states to cover medically necessary treatment for mental illness found through screening, whether or not the state plan covers that service. A "not covered" denial for a child is not always the last word. We answer it with a note that shows why the treatment is needed to correct or ameliorate the child's condition, the standard the law uses.

  2. Parent sessions that read like the parent's therapy

    When you meet with a parent alone, the note has to tie the session to the child's treatment. Medicare's rule, the clearest federal one, allows family psychotherapy with or without the patient present when treating the patient is the primary purpose. Medicaid and commercial plans set their own family therapy rules, so we check each plan first.

  3. Hard sessions billed as routine ones

    Some sessions take more work because of who is in the room. There is an add-on for sessions where a parent's conflict, a mandated abuse report, or play or interpreter needs make the session harder to deliver. If the note does not name the reason, the add-on is either missed or denied.

  4. Level-of-care requests judged on child criteria

    Several commercial plans review children's requests with tools built for children, not the adult tool. A request written to adult language can be judged against criteria it never addressed. We match the request to the tool the plan uses.

  5. School work left unbilled

    Practices that place clinicians in schools sometimes assume Medicaid will not pay for a service the school offers every student for free. That is not CMS's current policy. Covered services to enrolled students can be billable, subject to state rules.

What we handle for a child-focused practice

What we run

What stays with you

Your EHR shows what you billed. Your portal shows what we are doing about it.

Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.

Did that claim get paid?

Every claim with its stage and amount, the denials we're working, and your receivables by age.

Where is my application with Aetna?

Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.

What do you still need from me?

One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

Rules that apply only because the patient is a child

These federal rules and guidance sit on top of each plan's normal mental health policy. They are current as of October 2026.

The September 2024 letter to states. On September 26, 2024, CMS sent states a State Health Official letter on best practices for meeting EPSDT requirements. For children with behavioral health conditions, it says states need enough options and provider capacity for screening and assessment, care when early signs of concern appear, community services at varying intensity, and crisis or urgent care. It is guidance to states on what EPSDT requires.

CHIP has to follow mental health parity. Separate CHIP programs must follow federal mental health and substance use parity rules. Limits on mental health benefits can be no more restrictive than those on medical and surgical benefits. A CHIP plan that includes EPSDT coverage is deemed to meet parity.

School-based Medicaid services. On May 18, 2023, CMS published a guide to Medicaid services and administrative claiming in school settings. It came from the Bipartisan Safer Communities Act, which charged CMS with expanding Medicaid services in schools, behavioral health included. The guide clarified school billing, which matters if you contract with schools or place clinicians there.

Free to other students, still billable. CMS withdrew its old "free care" guidance. CMS now says Medicaid reimbursement is available for covered services even when the provider does not charge for the service. Your state's rules decide how that works in practice.

Consent and parent access depend on state law. Whether a teen can consent to their own outpatient mental health care depends on state law. Where state law allows it and the teen consents, HIPAA generally does not treat the parent as the teen's personal representative for that care. We follow your written policy on who receives bills and statements.

Credentialing clinicians who see children

A child may be covered by Medicaid, CHIP or a parent's commercial plan. A clinician who treats children usually needs enrollment with several of them.

  1. Find the plans your families carry

    We look at the plans on your current caseload and waitlist. That tells us which Medicaid, CHIP and commercial plans to file with first.

  2. Build the file once

    We collect your licenses, NPI and the documents each payer asks for. The same file then feeds every application.

  3. File and follow each application

    We submit each application and follow up until the payer sets an effective date. Your client portal shows each application and its stage, the documents we need from you, and your claims.

  4. Keep re-credentialing on schedule

    We track each payer's re-credentialing dates. That way a lapsed enrollment does not stop payment for your patients.

Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer. The client portal is included with every client account.

Payer notes for children's mental health

Medicaid

EPSDT applies to every enrollee under 21. Since January 1, 2026, Medicaid fee-for-service programs and managed care plans must decide standard prior authorization requests within 7 calendar days and expedited ones within 72 hours. We follow up when a decision runs past the deadline.

CHIP

The same 7-day and 72-hour decision deadlines apply to CHIP fee-for-service programs and managed care plans. Separate CHIP programs must also meet federal parity rules.

Commercial plans

Aetna and Evernorth use CALOCUS-CASII for children and adolescents ages 6 to 18. Aetna and Optum use the Early Childhood Service Intensity Instrument (ECSII) for children from birth through age 5. We write level-of-care requests to the tool each plan names.

The add-on for harder sessions

A Medicare contractor's checklist lists four factors that complicate a session and support the add-on: communication among participants that gets in the way of care; caregiver emotions or behavior that interfere with the treatment plan; a sentinel event that requires a mandated report, such as abuse or neglect reported to a state agency; and play equipment, devices or an interpreter used to overcome barriers. The note has to name the factor that applied.

When another arrangement makes more sense

If your practice is entirely self-pay and you do not plan to join insurance panels, you do not need a billing company.

If your clinicians are employed by a school district and the district bills Medicaid itself, that billing runs through the district, not your practice.

If you need advice on minor consent or parent access to records, that belongs with a health care attorney in your state. We follow your policy; we do not set it.

Questions child and adolescent practices ask us

Does Medicaid have to cover mental health treatment for children?

For enrollees under 21, yes. EPSDT requires states to cover medically necessary treatment for mental illness found through screening, whether or not the state plan otherwise covers that service.

Can we bill a session with parents when the child is not in the room?

Medicare allows family psychotherapy without the patient present when treating the patient is the primary purpose. Medicaid and commercial plans set their own rules, so we check each plan first.

Does CHIP have to follow mental health parity?

Yes. Separate CHIP programs must follow federal parity rules, and a CHIP plan that includes EPSDT coverage is deemed to meet them.

Can Medicaid pay for counseling a school gives every student for free?

It can. CMS withdrew its old "free care" guidance, and Medicaid can now pay for covered services to enrolled students even when the service is free to others. State rules still apply.

Can a teenager consent to their own therapy?

It depends on state law. Where the law allows it and the teen consents, HIPAA generally does not treat the parent as the teen's personal representative for that care.

What does Medtransic charge a child and adolescent practice?

Billing is 4-8% of collections. Credentialing is $150 per application, per provider. There is no long-term contract, and the revenue audit before you sign is free.

Sources

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