For recovery coaches

Can recovery coaches bill Medicaid in Texas?

Yes, but not on their own. Texas Medicaid has paid for peer specialist services since 2019, billed by a Medicaid-enrolled provider that employs or contracts with the peer specialist. Here's how it works, what it pays, and what you need to have in place.

By Ryan Coane, LCDC-I. Updated October 27, 2026. General information, not legal or billing advice: rules and rates change, so check the current Texas Medicaid manual and your health plan.

The short answer

Texas Medicaid covers peer specialist services for adults, starting January 1, 2019, after the Legislature passed HB 1486 in 2017. The service is delivered by a certified peer specialist, either a Recovery Support Peer Specialist (for substance use) or a Mental Health Peer Specialist, and it's billed with procedure code H0038.

The catch: a peer specialist can't enroll in Texas Medicaid and bill by themselves. They work for, or under contract with, a provider that is enrolled, and that provider bills.

Who can bill

The Texas Medicaid Provider Procedures Manual lists the enrolled providers that can employ or contract with peer specialists, including:

Clinics and group practices
Physicians (MD or DO), nurse practitioners, clinical nurse specialists and physician assistants
Psychologists, LCSWs, LMFTs and LPCs
Mental health rehabilitation and case management agencies
Local mental health and behavioral health authorities (LMHAs and LBHAs)
Licensed chemical dependency treatment facilities
Opioid treatment programs
Federally qualified health centers and rural health clinics

Not every one of these is paid separately for the service: the manual says FQHCs and rural health clinics report H0038 for information only, and it names clinics and groups and behavioral health physicians, NPs, CNSs and PAs as the providers reimbursed for it. A peer support agency that isn't enrolled can subcontract with an enrolled provider. If you're setting this up, read section 6 of the Behavioral Health handbook for your provider type, and ask the health plans you work with how they want it billed.

Who can get peer services

Adults 21 and older with a mental health condition or a substance use condition, when peer services are part of their person-centered recovery plan. Children's plans (STAR Kids) don't cover this benefit because their members are under 21.

Texas Medicaid managed care covers it for adults; we confirmed this for STAR from a health plan's published procedure, but didn't find a primary source for STAR+PLUS or STAR Health, so check with those plans.

Codes, limits and the rate

What	How it's billed
Peer services, substance use	H0038 with modifier HF
Peer services, mental health	H0038 with modifier HE
In a group (12 people at most)	Add HQ
By video	Add 95
By phone (audio only)	Add FQ

Units and limits. H0038 is billed in units (the national code description is per 15 minutes). Texas allows 104 units in a rolling 6 months without prior authorization; more needs prior authorization through TMHP, at most 30 units per request. Peer services can't be billed for the same time as another behavioral health service.

The rate. Texas Medicaid's fee-for-service rate, effective March 1, 2026, is $8.55 a unit for individual services and $1.22 a unit for group services, per TMHP's fee schedules. Health plans set their own contracted rates, so ask each plan.

Supervision

A peer specialist is supervised by a qualified credentialed counselor (QCC), a licensed practitioner of the healing arts (LPHA), or a QMHP-CS or qualified peer supervisor who is themselves overseen by a QCC or LPHA. Supervisors must be certified. Supervision is weekly during the first, six-month certification, and monthly after that, and it's documented.

Telehealth

The manual allows peer services by video when it's clinically appropriate and in the recovery plan (modifier 95), and by audio only when there's an existing relationship: an in-person or video service in the prior 6 months, at least one every 12 months, and a documented reason (modifier FQ).

Heads up: another part of the same manual says peer services "must be delivered in person." The two passages conflict, so before you bill telehealth peer services, confirm with HHSC or the health plan which rule they apply.

Documentation

Each service note includes the date, time and place; the purpose and content of the service; and the strategies used, tied to the goals in the person's recovery plan. Peer services have to be written into that recovery plan. Supervision notes go in the peer specialist's personnel file.

How peer specialists actually get paid

Employed by an enrolled provider: a treatment program, a recovery community organization working with one, an LMHA, a clinic or group. The provider bills Medicaid and pays you.
Contracted: your own peer support business subcontracts with an enrolled provider, which bills.
Private pay or grants: recovery coaching outside Medicaid, paid by the person or their family, or by a grant program.

Whichever way you work, people need to find you. Claim your free Find Care listing: it comes with a free one-page website at gocimahealth.com/yourname and free online booking. See how to start a recovery coaching practice in Texas.

Questions

Can I get my own Medicaid number as a peer specialist?

No. Texas Medicaid doesn't enroll peer specialists as billing providers. An enrolled provider that employs or contracts with you bills for your services.

Do I need to be certified to bill?

Yes. Medicaid peer services are delivered by a certified peer specialist (Mental Health or Recovery Support), including during the first six-month certification, when you're building your 250 supervised hours.

Does Medicaid cover recovery coaching for teenagers?

Not through this benefit: Texas Medicaid peer specialist services are for adults 21 and older.

Is PRSS still a Texas certification?

The old Peer Recovery Support Specialist (PRSS) credential was folded into the state's peer specialist certification in 2019; PRSS holders could move over to the Recovery Support Peer Specialist (RSPS) endorsement in 2021.

Sources

Texas Medicaid Provider Procedures Manual, October 2026, Vol. 2, Behavioral Health and Case Management Services Handbook, section 6 (peer specialist services): tmhp.com
1 Texas Administrative Code Chapter 354, Subchapter N, Peer Specialist Services (§354.3001 and following; supervision §354.3103 and §354.3105; scope §354.3055)
CMS approval of Texas State Plan Amendment TX-18-0011, effective January 1, 2019: medicaid.gov
HB 1486, 85th Legislature (2017): capitol.texas.gov
HHSC, Certification for peer support, a Medicaid benefit: hhs.texas.gov
TMHP static fee schedules (rates effective March 1, 2026): public.tmhp.com