Marriage & Family Therapists and Counselors Can Now Enroll in Medicare
As of January 1, 2024, an estimated 400,000 Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) are now eligible to enroll as Medicare providers under new legislation.
This inclusion expands the pool of available practitioners and offers a more diverse range of therapeutic approaches and specialties to Medicare recipients.
Covered Services
MFT and MHC services covered under Medicare Part B are defined as “services for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital) which the marriage and family therapist is legally authorized to perform under state law (or the state regulatory mechanism provided by state law) of the state in which the services are furnished, as would otherwise be covered by a physician or as incident to a physician’s professional service.”
Like clinical social workers, MFTs and counselors will be paid 75% of the rates paid to psychologists.
Provider Eligibility
Under Medicare, MFTs eligible to enroll as a Medicare provider are those who:
- Possess a master’s or doctorate which qualifies for licensure or certification as an MFT under State law of the State in which such individual furnishes marriage and family therapist services; and
- Is licensed or certified as an MFT by the State in which they furnish services; and
- Has performed at least 2 years of clinical supervised experience in marriage and family therapy or mental health counseling after obtaining the degree referenced above; and
- Meet other requirements as the Secretary of Health and Human Services (HHS) determines appropriate.
Under Medicare, MHCs eligible to enroll as a Medicare provider are those who:
- Possess a master’s or doctorate which qualifies for licensure or certification as an MHC, clinical professional counselor, or professional counselor under State law of the State in which such individual furnishes marriage and family therapist services; and
- Is licensed or certified as an MHC, clinical professional counselor, or professional counselor by the State in which they furnish services; and
- Has performed at least 2 years of clinical supervised experience in marriage and family therapy or mental health counseling after obtaining the degree referenced above; and
- Meet other requirements as the Secretary of Health and Human Services (HHS) determines appropriate.
How to Enroll
Although MFTs and MHCs became eligible for payment beginning January 1, 2024, enrollment in Medicare may take several weeks or even months.
To enroll in Medicare, you must:
- Obtain a National Provider Identifier (NPI) through the National Plan & Provider Enumeration System (NPPES).
- Either enroll in Medicare electronically using the Provider Enrollment, Chain, and Ownership System (PECOS) or by completing the paper CMS-855I enrollment application. Applying through the PECOS system will have a faster processing time.
- Be enrolled with the MAC that governs the state that you are licensed and providing services. If you practice in multiple states that are governed by different MACs, you must submit an enrollment to the MAC of each state.
For more information on the enrollment process, refer to the CMS Provider Enrollment FAQs.
