Marriage and Family Therapists and Licensed Professional Counselors Billing for Medicare Services

As of January 1, 2024, Medicare will pay marriage and family therapists and licensed professional counselors for services related to the diagnosis and treatment of mental illness at 75% of what a clinical psychologist is paid (as listed in the Medicare Physician Fee Schedule).

What are the criteria for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) to bill for Medicare services?

Marriage and Family Therapists (MFTs) can bill Medicare for services if they:

• Have a master's or doctorate degree which qualifies for licensure or certification as a marriage and family therapist in the state where they deliver services
• Performed at least two years or 3,000 hours of post master's degree clinical supervised experience in marriage and family therapy
• Are licensed or certified as a marriage and family therapist by the state where they deliver services

Mental Health Counselors (MHCs), including addiction counselors and alcohol and drug counselors, can bill Medicare for services if they:

• Have a master's or doctorate degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, professional counselor in the state where they deliver services
• Performed at least two years or 3,000 hours of post master's degree clinical supervised experience in mental health counseling
• Are licensed or certified as a mental health counselor, clinical professional counselor or professional counselor by the state where they deliver services

How do MFTs and MHCs bill for Medicare?

MFTs and MHCs must enroll in Medicare before billing for services. To enroll in Medicare, MFTs and MHCs must:

1. Register for an account in the Identity & Access Management (I&A) System
2. Get a National Provider Identifier (NPI) in the National Plan & Provider Enumeration System (NPPES)
3. Enroll in Medicare through the electronic Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or a paper CMS-855 application
4. Contact their Medicare Administrative Contractor (MAC)

Can MFT and MHC services be provided by telehealth?

Yes, MFTs and MHCs are eligible to provide services by telehealth.

Are there any special considerations for billing at a Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC)?

MFT and MHC services are covered when provided in a RHC or FQHC.

Resources

• Marriage and Family Therapists & Mental Health Counselors, Centers for Medicare & Medicaid Services
• Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) Provider Enrollment Frequently Asked Questions (FAQs), Centers for Medicare & Medicaid Services
• Medicare & Mental Health Coverage, Centers for Medicare & Medicaid Services
• Psychotherapy for Crisis, Centers for Medicare & Medicaid Services
• Behavioral Health Integration Services, Centers for Medicare & Medicaid Services
• Provider Enrollment Changes to the Medicare Program Integrity Manual, Centers for Medicare & Medicaid Services
• New Details on Medicare Coverage of Marriage and Family Therapists and Mental Health Counselors in RHCs, National Association of Rural Health Clinics

Last Updated: 11/26/2024
Last Reviewed: 11/26/2024