This guide is the rule set for LPCs, LMHCs, and LMFTs. To have the application prepared and followed through approval, for these licenses or for psychologists, social workers, psychiatrists, and groups, see Medicare PECOS enrollment.
Since January 1, 2024, marriage and family therapists and mental health counselors can enroll in Medicare and bill Part B directly for diagnosing and treating mental illness. Licensed clinical social workers and psychologists already could. If your caseload includes older adults, this is a payer you can add on purpose instead of turning those clients away.
The rules below are summarized from CMS. Read the current page before you enroll: Marriage and Family Therapists & Mental Health Counselors.
Who can enroll
CMS requires a master's or doctoral degree that qualifies you for state licensure, a state license or certification in the state where you furnish the services, and at least two years or 3,000 hours of post-master's clinical supervised experience. The counselor category includes mental health counselors, clinical professional counselors, and professional counselors who meet those rules. Eligible addiction counselors who meet the mental health counselor requirements may enroll as mental health counselors.
An LPC, LMHC, or LMFT does not bill these services incident-to a psychiatrist. You enroll and bill under your own Medicare enrollment.
How payment works
Medicare pays MFT and mental health counselor services at 75% of the amount paid to clinical psychologists under the Physician Fee Schedule. That ratio is in 42 CFR 414.53. It is not a single national dollar amount. Look up the code and your locality on the current fee schedule before you quote a client a rate.
Enrollment steps
- Confirm your NPI in NPPES and that the taxonomy matches the license you will bill under.
- Create an Identity & Access Management (I&A) account if you do not have one.
- Enroll through PECOS (or the paper CMS-855) and answer any Medicare Administrative Contractor questions quickly. Complete applications often take 30–90 days.
- If you bill under a group, complete the reassignment so claims are not paid to the wrong entity.
- Note the effective date. Claims for earlier dates of service are not payable under this benefit.
Billing after you are approved
- Use the CPT codes the visit actually supports, including the time rules for psychotherapy. 90837 vs 90834 is the pair Medicare reviewers know well.
- Medicare's timely filing limit is 12 months from the date of service. Do not let a new enrollment sit until that window is the crisis.
- Commercial credentialing is a separate project. Medicare approval does not put you in-network with Blue Cross, Aetna, or Optum. Those timelines are in how long therapist credentialing takes.
We prepare the PECOS packet, track contractor requests, and line the enrollment up with billing so the first Medicare claims use the right identifiers. If you also want commercial panels, start them in parallel. They will not finish on Medicare's calendar.
This is general education based on CMS rules as published for the January 1, 2024 benefit. It is not legal advice for a specific enrollment. Confirm current requirements on CMS.gov.