Delaware Medicaid Mental Health Billing: What Therapists Need to Know

Delaware Medicaid — formally DMAP, the Delaware Medical Assistance Program — is a critical payer for mental health practices serving low-income adults, families, foster children, and individuals with serious mental illness in Delaware. But DMAP billing is not the same as commercial insurance billing. The enrollment process, claim routing, authorization rules, and reimbursement rates are all different. Getting them right requires understanding how Delaware has structured its Medicaid program — specifically the split between managed care and fee-for-service that routinely trips up practices new to the state.

How Delaware Medicaid Is Structured for Mental Health

Delaware Medicaid operates through two tracks, and determining which applies to each patient is the most critical step in DMAP billing. The majority of Delaware Medicaid enrollees receive benefits through Highmark Health Options, the state-contracted Managed Care Organization (MCO). A smaller population — including certain aged, blind, and disabled individuals and some foster care children — receives benefits through DMAP fee-for-service (FFS), administered through DXC Technology. Submitting a claim to the wrong payer is the most common DMAP billing error. The solution is always to verify a patient's specific plan at the time of their appointment — not just confirm they have a Delaware Medicaid card.

Enrolling as a Delaware Medicaid Mental Health Provider

To bill Delaware Medicaid, you must complete two separate enrollment processes. First: enrollment with DMAP fee-for-service through the Delaware MMIS provider portal, administered by DXC Technology. Second: separate credentialing with Highmark Health Options if you plan to see managed care Medicaid patients. These are independent processes — being enrolled in DMAP FFS does not make you a participating provider with Highmark Health Options, and vice versa. LCSWs and LPCs are eligible to enroll as independent billing providers under Delaware Medicaid. No physician supervision is required.

DMAP Enrollment Timeline

DMAP fee-for-service enrollment takes approximately 30–60 days from complete application submission. Highmark Health Options credentialing runs 60–90 days. Both require your Type 1 NPI, Delaware license number, malpractice insurance certificate, and a W-9. Unlike commercial credentialing, DMAP FFS does not use CAQH — you submit documents directly through the DXC Technology provider enrollment portal. Highmark Health Options does use CAQH, so your CAQH profile must be fully attested before applying. Submit both applications simultaneously to minimize your start date.

CPT Codes Covered Under Delaware Medicaid

Delaware Medicaid covers the standard outpatient mental health CPT code set for independently practicing LCSWs and LPCs.

• ▸90791 — Psychiatric Diagnostic Evaluation (initial assessment; generally once per year per provider relationship)
• ▸90832 — Psychotherapy, 30 minutes (16–37 minutes of face-to-face time)
• ▸90834 — Psychotherapy, 45 minutes (38–52 minutes of face-to-face time)
• ▸90837 — Psychotherapy, 60 minutes (53+ minutes of face-to-face time)
• ▸90853 — Group Psychotherapy (billed separately for each group participant)
• ▸90847 — Family Psychotherapy with patient present
• ▸90846 — Family Psychotherapy without patient present
• ▸90839 — Crisis Psychotherapy, first 60 minutes (requires crisis-level clinical documentation)
• ▸90840 — Crisis Psychotherapy add-on per additional 30 minutes

Prior Authorization Under Delaware Medicaid

Delaware Medicaid requires prior authorization for mental health services beyond a specific session threshold. Under Highmark Health Options, prior authorization is generally required after 20 outpatient mental health sessions per calendar year. Under DMAP FFS, authorization thresholds are similar but administered separately. IOPs and PHPs require prior authorization from the first session. Track authorized session counts carefully — claims submitted beyond authorized limits result in automatic CO-22 denials with no appeal pathway unless authorization was in place.

Delaware Medicaid Reimbursement Rates

DMAP reimbursement rates are set by the state and run below commercial payer rates. These are approximate 2024 fee schedule rates for the most common codes billed by LCSWs and LPCs.

• ▸90791 (Psychiatric Diagnostic Evaluation): approximately $135–148
• ▸90837 (60-minute individual therapy): approximately $89–98
• ▸90834 (45-minute individual therapy): approximately $68–74
• ▸90832 (30-minute individual therapy): approximately $50–58
• ▸90853 (Group therapy per patient): approximately $32–41

Billing Highmark Health Options vs. DMAP Fee-for-Service

Highmark Health Options claims are submitted to Highmark's clearinghouse — Payer ID 23284 for most professional claims. DMAP FFS claims are submitted to DXC Technology — Payer ID 77003. Submitting a Highmark Health Options patient's claim to the DMAP FFS payer ID, or vice versa, produces a CO-4 or CO-97 denial requiring a corrected claim resubmission while the timely filing clock continues. Before billing any Medicaid patient's session, verify which track they are on by calling the provider services number on the back of their Medicaid card.

Telehealth Under Delaware Medicaid

Delaware has maintained Medicaid coverage for behavioral health telehealth following the COVID-19 public health emergency. As of 2024, synchronous audio-video telehealth for outpatient mental health is covered. Audio-only (phone-only) telehealth has more limited coverage. When billing telehealth, use Place of Service code 02 (telehealth at a location other than the patient's home) or POS 10 (telehealth at the patient's home), and append modifier 95 to indicate the service was rendered via telehealth. Missing modifier 95 is a frequent cause of Delaware Medicaid telehealth claim denials.

The Most Common DMAP Billing Mistakes

• ▸Routing claims to the wrong payer — submitting to DMAP FFS for a Highmark Health Options patient or vice versa
• ▸Billing beyond authorized session limits without renewing prior authorization
• ▸Missing modifier 95 or using the wrong place-of-service code for telehealth sessions
• ▸Failing to complete Highmark Health Options enrollment separately from DMAP FFS enrollment
• ▸Billing 90791 more than once per year without documented clinical justification

Delaware Medicaid billing requires precise payer routing, authorization tracking, and fluency with the DMAP structure that catches many providers off guard. Logicware handles Medicaid billing for mental health practices in Delaware — including DMAP enrollment, Highmark Health Options credentialing, and ongoing claim management. Contact us to discuss what billing Delaware Medicaid patients would look like for your practice.