Can Therapists Enroll in Medicare? What Counselors and MFTs Need to Know

Yes. Mental health counselors (MHCs) and marriage and family therapists (MFTs) can now enroll in Medicare and bill for their services. Enrollment opened on November 2, 2023, and billing started on January 1, 2024. Before that, those two professions could not be paid by Medicare at all.

Who qualifies

You need to meet all of these:

• A master's or doctoral degree that qualifies you for licensure as an MFT or mental health counselor.
• A state license or certification as an MFT or mental health counselor, in the state where you see clients.
• At least two years of clinical supervised experience in marriage and family therapy or mental health counseling after earning your degree.

Addiction and drug and alcohol counselors can enroll as mental health counselors if they meet these requirements.

What you can bill for

Under the rule, MFTs and MHCs can bill for diagnosis and treatment of mental illness, with the exception of services to hospital inpatients. They can also bill for health behavior assessment and intervention codes, serve on hospice care teams, and provide added behavioral health services in rural health clinics and federally qualified health centers.

Medicare pays these services at 80% of the lesser of the amount you charge or a set cap tied to the payment for a psychologist's services. Claims for dates of service before January 1, 2024 are not payable.

How to enroll

1. Make sure you have your NPI, state license, and supervised-experience records ready.
2. Complete the CMS-855I enrollment application, on paper or online through PECOS. On the paper form, you choose the "Undefined Non-Physician Practitioner Specialty" box and write in MFT or MHC.
3. Submit the application and answer any requests for more information quickly.
4. Do not bill Medicare for services until you have your effective date.

Does it make sense for your practice?

Enrolling opens your practice to older adults and people with disabilities who rely on Medicare. It also adds paperwork and a payer with its own rules, so it helps to decide it on purpose, not by default. Reports from the counseling field suggest many therapists have enrolled; one national counseling group reported more than 38,000 mental health counselors enrolled by mid-2024.

See how long a Medicare application may take with our timeline estimator, read credentialing vs. payer enrollment, or ask for a quote if you would like us to handle the application.

Quick answers

This article is general information, not legal or financial advice. Rules and timelines vary by insurer and state, so check directly with each insurer or with CMS. Sources: Foley & Lardner: CMS expands access to behavioral health services, NBCC: Remarkable start to counselor participation in Medicare.

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