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Therapists, psychologists and prescribers who treat children and teens

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.

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One hard session, two notes

Illustrative

A session with a parent in conflict, a mandated report or an interpreter

Note names the factor

  • The add-on is billed with the session
  • The note supports the claim

Note is silent

  • The add-on is missed
  • Or the add-on is denied
The add-on for a harder session depends on the note naming the factor that applied.
Billing
4-8%
of what we collect for you
Credentialing
$150
per application, per provider
Software
SimplePractice
or the system you already use
Contract
None
no long-term contract

Where children's mental health claims go wrong

A child's care involves more people and more rules than an adult's.

Medicaid says the service is not covered

For enrollees under 21, states must cover medically necessary treatment found through screening, whether or not the state plan covers it. We answer with a note showing why it is needed to correct or ameliorate the condition.

Parent sessions that read like the parent's therapy

A parent-only session note has to tie the session to the child's treatment. Medicaid and commercial plans set their own family therapy rules, so we check each plan first.

Hard sessions billed as routine ones

An add-on covers sessions made harder by parent conflict, a mandated abuse report, or play or interpreter needs. If the note does not name the reason, the add-on is missed or denied.

Level-of-care requests judged on child criteria

Several commercial plans review children's requests with tools built for children, not the adult tool. We match each request to the tool the plan uses.

School work left unbilled

Some practices assume Medicaid will not pay for a service a school offers every student free. Under CMS's current policy, covered services to enrolled students can be billable, subject to state rules.

What we handle for a child-focused practice

Medtransic runs

  • Coverage checks on every plan the child is on, including Medicaid and CHIP
  • Prior authorizations, tracked against Medicaid and CHIP decision deadlines
  • Claims for child, parent and family sessions, with the add-on when supported
  • Level-of-care requests written to the child criteria each plan uses
  • Denials and appeals, including EPSDT appeals for Medicaid patients under 21
  • Credentialing with the Medicaid, CHIP and commercial plans your families carry

Your practice keeps

  • Clinical care, assessments and treatment plans
  • Your consent policy and who signs it, under your state's law
  • Decisions about what parents can see in the record
  • Contracts with schools and districts

Rules that apply only because the patient is a child

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

  1. 01

    EPSDT letter, September 2024

    Applies to
    State Medicaid programs
    What it says
    States need capacity for screening, early care, community services at varying intensity, and crisis care.
  2. 02

    CHIP parity

    Applies to
    Separate CHIP programs
    What it says
    Mental health limits can be no stricter than medical ones. EPSDT coverage is deemed to meet parity.
  3. 03

    School-based Medicaid

    Applies to
    Practices with clinicians in schools
    What it says
    CMS's May 18, 2023 guide clarified school billing. Covered services can be paid even when free to others.
  4. 04

    Teen consent

    Applies to
    Teens and their parents
    What it says
    Depends on state law. We follow your written policy on who receives bills and statements.

Credentialing clinicians who see children

A clinician who treats children usually needs Medicaid, CHIP and commercial enrollment.

  1. 1

    Find the plans your families carry

    We check the plans on your caseload and waitlist to decide which Medicaid, CHIP and commercial plans to file with first.

  2. 2

    Build the file once

    We collect your licenses, NPI and payer documents once, and that file feeds every application.

  3. 3

    File and follow each application

    We follow up until each payer sets an effective date, and your client portal shows each application's stage.

  4. 4

    Keep re-credentialing on schedule

    We track each payer's re-credentialing dates so a lapsed enrollment does not stop payment.

Payer notes for children's mental health

What each payer applies to children's mental health claims, and how we handle it.

Payer notes for children's mental health
PayerWhat appliesWhat we do
MedicaidEPSDT for every enrollee under 21. Since January 1, 2026, standard prior authorizations must be decided within 7 calendar days, expedited within 72 hours.Follow up when a decision runs past the deadline.
CHIPThe same 7-day and 72-hour deadlines. Separate CHIP programs must also meet federal parity rules.Track authorizations against those deadlines.
Commercial plansAetna and Evernorth use CALOCUS-CASII for ages 6 to 18. Aetna and Optum use ECSII from birth through age 5.Write level-of-care requests to the tool each plan names.
Medicare contractor checklistFour factors support the add-on: communication that gets in the way of care, caregiver interference, a mandated report, or play equipment or an interpreter.Make sure the note names the factor that applied.

Your client portal, included

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.
See the client portal →
The billing screen in the Medtransic client portal: totals billed, paid, adjusted and outstanding, a twelve-month chart and A/R by age.
The billing screen. Shown with sample data. It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon.

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 a school district employs your clinicians and bills Medicaid itself, that billing runs through the district.
  • Advice on minor consent or parent access to records 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 consultation before you sign is free.

Keep reading

+ Sources: 15 checked 2026-10-04

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HIPAA Compliant & SecureDedicated Account ManagerNo Long-Term Contract