Can LPCs and LMFTs Bill Medicare? How Counselors and MFTs Enroll

Yes. Since January 1, 2024, licensed professional counselors (LPCs, LMHCs and similar titles) and licensed marriage and family therapists (LMFTs) can enroll in Medicare and bill for their own services. Counselors enroll as “mental health counselors” and LMFTs as “marriage and family therapists”, using the CMS-855I application, usually online through PECOS. Medicare pays them 75% of the amount it pays clinical psychologists for the same service.

Before 2024, Medicare covered services from psychiatrists, psychologists, clinical social workers and some nurse practitioners, but not counselors or marriage and family therapists. The Consolidated Appropriations Act, 2023 changed that, and it opened a large group of Medicare patients to thousands of clinicians.

Who qualifies

To enroll as a mental health counselor (MHC) or marriage and family therapist (MFT), you generally need:

• A master’s or doctoral degree in counseling or marriage and family therapy (or a qualifying related field)
• A state license as a counselor or marriage and family therapist in the state where you practice
• At least 2 years or 3,000 hours of post-master’s supervised clinical experience in an appropriate setting

Addiction counselors who meet the same requirements can enroll as mental health counselors. Clinical social workers were already able to enroll and continue to enroll as clinical social workers.

How to enroll

1. Have your NPI and taxonomy in order. Your NPPES record should list the correct counselor or MFT taxonomy.
2. Create an Identity & Access account with CMS, then log in to PECOS.
3. Complete the CMS-855I for an individual practitioner, choosing the mental health counselor or marriage and family therapist specialty.
4. Reassign benefits (CMS-855R) if you will bill under a group practice’s NPI rather than your own.
5. Wait for your Medicare Administrative Contractor (MAC) to process it. Processing often takes several weeks to a few months, longer if the MAC asks for corrections.
6. Enroll for electronic claims and payments with your MAC, and add Medicare in your EHR and clearinghouse.

Medicare does not charge individual practitioners an application fee.

What you can bill

MHCs and MFTs can bill Medicare for the diagnosis and treatment of mental illness within their state scope of practice, using the same codes other therapists use:

Service	Common codes
Diagnostic evaluation	90791
Individual psychotherapy	90832, 90834, 90837
Family psychotherapy	90846, 90847
Group psychotherapy	90853
Crisis psychotherapy	90839, 90840

Telehealth for mental health is covered from the patient’s home. See our telehealth billing guide for place of service and modifiers.

How much Medicare pays

Medicare pays MFTs and mental health counselors 75% of the clinical psychologist amount for the same service under the Physician Fee Schedule. Actual amounts vary by locality and year. The patient normally pays the Part B deductible and 20% coinsurance, and supplemental coverage may pay some of that.

Medicare Advantage is a separate enrollment

About half of Medicare beneficiaries are in Medicare Advantage plans run by private companies. Enrolling in original Medicare does not put you in-network with those plans. Each Medicare Advantage plan (or its behavioral health network) has its own credentialing. See how to get paneled with insurance.

Common enrollment problems

• Wrong specialty or taxonomy on the application or NPPES record
• Practice location mismatch between PECOS, NPPES and your claims
• Missing reassignment when billing under a group
• Billing before the effective date, which leads to denials that are hard to recover

Our mental health credentialing team handles Medicare, Medicare Advantage, Medicaid and commercial enrollment for counselors and MFTs, with a status update every week until each application is approved.

Frequently asked questions