Effective January 1, 2024, MFTs and MHCs can bill Medicare independently for their services furnished for the diagnosis and treatment of mental illnesses. Medicare Part B pays MFTs and MHCs for these services at 75% of what a clinical psychologist is paid under the Medicare Physician Fee Schedule.
- What Criteria Must MFTs Meet to Enroll in Medicare?
- Possess a master's or doctor's degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law of the State in which the individual furnishes the services defined as marriage and family therapist services
- Performed at least 2 years or 3,000 hours of post master’s degree clinical supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice, or clinic
- Are licensed or certified as a marriage and family therapist by the State in which you perform services
- What Criteria Must MHCs Meet to Enroll in Medicare?
- Possess a master's or doctor's degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, professional counselor under the State law of the State in which the individual furnishes the services defined as mental health counselor services
- Performed at least 2 years or 3,000 hours of post master’s degree clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic
- Are licensed or certified as a mental health counselor, clinical professional counselor or professional counselor by the State in which you perform services
Additionally, addiction counselors and alcohol and drug counselors who meet all the applicable requirements of an MHC may enroll in Medicare as MHCs and bill Medicare for MHC services.
- I Meet These Criteria, How Do I Enroll in Medicare?
To submit claims so we can pay you for covered items or services you provide to Medicare patients, enroll in Medicare.
Be sure to:
- Register for an account in the Identity & Access Management (I&A) System
- Get an NPI in the National Plan & Provider Enumeration System (NPPES)
- Enroll in Medicare through PECOS or a paper CMS-855 application
- Work with your MAC: Contact Your MAC (PDF)
Your effective enrollment date will be January 1 or later.
For more information, visit:
- Where Can I Find Information About Medicare-Covered Services?
- Medicare & Mental Health Coverage (PDF) for commonly used CPT codes for the diagnosis and treatment of mental illness
- Psychotherapy for Crisis (PDF) for information on CPT codes 90839 and 90840 – services appropriate for patients in high distress with life-threatening, complex problems that require immediate attention
- Behavioral Health Integration Services (PDF): for information on this type of care management service
- How Do I Bill for These Services?
Use the 837P (Professional) to send health care claims electronically. The ANSI ASC X12N 837P (Professional) Version 5010A1 is the current electronic claim version. Find more information on the ASC X12 website.
Physicians, practitioners, and suppliers can submit a 1500 Health Insurance Claim Form under certain situations.
MFT and MHC services furnished to skilled nursing facility (SNF) residents on or after January 1, 2024 are excluded from consolidated billing. Include the SNF's Medicare provider number when you bill for these Part B services.
See the Medicare Claims Processing Manual for instructions on how to submit claims:
- Chapter 1 (PDF) has health care providers and suppliers general billing requirements
- Chapter 12 (PDF) has claims processing instructions for physicians and non-physician practitioners
- Chapter 24 (PDF) explains electronic filing requirements and the Electronic Data Interchange (EDI) form required before submitting electronic claims
- Chapter 26 (PDF) explains what you must include in each 837P or CMS-1500 claim
The Medicare Benefit Policy Manual and Medicare National Coverage Determinations Manual include information about submitting claims and what Medicare covers.
The Medicare Billing: 837P & Form CMS-1500 (PDF) fact sheet is another helpful resource.
Find your MAC’s website for billing information.
- Where Can I Get More Information?
- View MLN Matters Article MM13331 (PDF)
- Get information for all Medicare providers on enrollment, coding, and more
- Read Guidance to State Medicaid Agencies on Dually Eligible Beneficiaries