Medicare Coverage for Marriage and Family Therapists and Mental Health Counselors

Through the Consolidated Appropriations Act, Congress directed Medicare to provide coverage and payment for services delivered by Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). These professionals must enroll in Medicare to offer services and submit claims.

Eligibility Criteria for Marriage and Family Therapists (MFTs)

To qualify for recognition under Medicare, Marriage and Family Therapists must meet specific educational, clinical, and licensure requirements as outlined below:

Educational Background

The individual must have earned a master's or doctoral degree that satisfies the state's criteria for licensure or certification as a Marriage and Family Therapist in the state where services are provided.

Postgraduate Clinical Experience

Following completion of the degree, the therapist must complete a minimum of two years or 3,000 hours of supervised clinical experience in marriage and family therapy. This experience should take place in an appropriate setting such as a hospital, skilled nursing facility (SNF), private practice, or clinic.

State Licensure or Certification

The therapist must hold a valid license or certification as a Marriage and Family Therapist issued by the state in which the services are delivered.

Eligibility Criteria for Mental Health Counselors (MHCs)

To be recognized for coverage under Medicare, Mental Health Counselors must fulfill key qualifications related to education, clinical experience, and state licensure:

Educational Background

The individual must have completed a master's or doctoral degree that meets the state's requirements for licensure or certification as a mental health counselor, clinical professional counselor, or professional counselor in the state where services are provided.

Postgraduate Clinical Experience

After earning the qualifying degree, the counsellor must complete at least two years or 3,000 hours of supervised clinical experience in mental health counselling. This experience should be acquired in suitable settings such as hospitals, skilled nursing facilities (SNFs), private practices, or clinics.

State Licensure or Certification

A valid license or certification as a mental health counsellor, clinical professional counsellor, or professional counsellor issued by the state in which the services are rendered must be held.

Additional Medicare Provisions for MFTs and MHCs

Beyond eligibility criteria, Medicare has outlined several key provisions related to coverage, billing, and service delivery for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs):

Covered Mental Health Services

Services provided must be aimed at the diagnosis and treatment of mental illness, as defined in the statutory benefits.

Reimbursement Rate

Medicare will reimburse MFTs and MHCs at 75% of the rate paid to clinical psychologists for services that are comparable in nature and scope.

Inclusion in RHCs and FQHCs

These services are now recognized as qualifying visits under Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

Telehealth Billing Eligibility

MFTs and MHCs are proposed to be added to the list of providers authorized to furnish and bill for telehealth services under Medicare.

Role of Addiction Counselors

Addiction counsellors who meet all applicable criteria and are certified as Mental Health Counselors will also be allowed to perform these services.

Use of Billing Code G0323

MFTs and MHCs may bill for general behavioural health integration services using code G0323, which will now include them in its official billing description.

Significant Billing Limitations and Conditions

Services provided by an MFT or MHC to a Medicare beneficiary who is an inpatient in a Medicare-participating hospital are not covered under Part B. In other words, if the patient is admitted under Part A, outpatient mental health services cannot be billed separately.

Additionally, to bill Medicare, the professional must be individually enrolled and must personally perform the service. There is no "incident to" billing allowed for MFTs or MHCs. It is not permissible to submit claims under the name or credentials of a licensed MFT or MHC for services rendered by another individual who is not licensed and enrolled.

BillingFreedom Simplifies Mental Health Billing for MFTs and MHCs

BillingFreedom helps Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) successfully manage Medicare's updated mental health billing guidelines. With recent policy changes, these professionals now qualify for Medicare reimbursement if they meet specific education, licensure, and clinical experience requirements. Enrolled professionals must personally provide services, as billing under "incident to" provisions is not allowed. Additionally, outpatient mental health services cannot be billed under Part B when the patient is admitted under Part A.

Our team at BillingFreedom specializes in mental health billing, ensuring that every claim is accurate, compliant, and submitted efficiently and accurately. We assist MFTs and MHCs with Medicare enrollment, the proper use of billing codes such as G0323, and staying informed about rules related to telehealth, Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs). With our support, providers can handle Medicare billing with ease, allowing them to focus on delivering quality care.

For more details about our exceptional mental health billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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