Marriage and Family Therapist (MFT) or Mental Health Counselors (MHC) - JE Part B
Marriage and Family Therapist (MFT) or Mental Health Counselors (MHC)
Enrollment
To see Medicare beneficiaries, you must apply and become approved as a Medicare provider. Further information is located on the Provider Enrollment page.
To Opt-In or Out
Before you can provide beneficiary services, you must be enrolled and have that application complete.
If you choose to not bill Medicare, but still provide services for Medicare patients, you have the option to opt-out. You can still see Medicare patients, but you will have a private contract with them. Neither you, nor the beneficiary, would be able to bill Medicare, secondaries for any services if you opt out. This is a 2-year contract that will roll over for another two years, if you don’t opt back in. Further information is located on the Opt-Out of Medicare page.
Education
Masters or Doctoral degree in counseling, marriage and family therapy, or a related field with equivalent coursework.
Pass exam prescribed by board.
License must be renewed annually.
Claim Submission
View Claim Submission related information.
Qualifications
MFTs and MHCs are mental health professionals trained in psychotherapy and family systems and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples, and family systems.
To enroll in Medicare as an MFT OR MHC:
- Have a master’s or doctor’s degree which qualifies for licensure or certification as a Marriage and Family Therapist or Mental Health Counselor pursuant to State law in the State that the individual wishes to provide services defined as Marriage and Family Therapist or Mental Health Counselor services.
- Performed at least 2 years or 3,000 hours of post master’s degree clinical supervised experience in an appropriate setting.
- Are licensed or certified as a Marriage and Family Therapist or Mental Health Counselor by the State in which you perform services.
Marriage and Family Therapist or Mental Health Counselor Services
Services furnished by an MFT or MHC for the diagnosis and treatment of mental illness (other than services furnished to an inpatient of a hospital), which is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are furnished, as would otherwise be covered if furnished by a physician or as an incident to a physician’s professional service.
Covered Services
Coverage is available for services furnished by a Marriage and Family Therapist or Mental Health Counselor that he or she is legally authorized to perform in accordance with State law. The services may be covered under Part B if they are:
The type of services for the diagnosis and treatment of mental illnesses that are otherwise covered if furnished by a physician or as incident to a physician’s service.
Performed by a person who meets the definition of an MFT OR MHC; and
Not otherwise excluded from coverage.
Noncovered Services
Services of an MFT OR MHC are not covered when furnished to inpatients of a hospital.
In addition, MFT OR MHC services are not covered if:
- They are otherwise excluded from Medicare coverage even though an MFT OR MHC is authorized by State law to perform them.
- MFT OR MHC services are excluded from consolidated billing requirements under the skilled nursing facility prospective payment system.
Consolidated Billing
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.
Place of Service
There is no restriction on places of service, other than inpatient hospitals.
MFT or MHC services are covered when furnished in a rural health clinic (RHC) and federally qualified health center (FQHC).
Hospice interdisciplinary team must include at least one social worker, MFT or MHC.
Payment
MFT OR MHC services will be paid at 75 percent of the amount determined for payment under the Medicare Physician Fee Schedule (MPFS).
Accepting assignments is required.
