2024 Mental Health Enrollment Reminders

Effective 1/1/2024, Medicare covers services furnished by MFTs and MHCs.

Please note: The criteria listed below for mental health counselor includes clinical professional counselors and professional counselors. Providers who meet the criteria listed for MHC should list MHC on their application for enrollment.

Under 42 CFR Section 410.53(b)(1), MFT/MHC services means, services furnished by a MFT/MHC (as defined in Section 410.53[a]) for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the MFT/MHC 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. The services must be of a type that would be covered if they were furnished by a physician or as incident to a physician's professional service and must meet the requirements of Section 410.53.

An MFT is defined in CFR Section 410.53(a)(1)-(3) as an individual who:

1. Possesses a master's or doctor's degree which qualifies for licensure or certification as a MFT pursuant to state law of the state in which such individual furnishes the services defined as MFT services;
2. After obtaining such degree, has performed at least two years or 3,000 hours of post-master’s degree clinical supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice, or clinic; and
3. Is licensed or certified as an MFT by the state in which the services are performed. Under 42 CFR Section 410.53(b)(1), MFT services means services furnished by an MFT (as defined in Section 410.53(a)) for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the MFT 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. The services must be of a type that would be covered if they were furnished by a physician or as incident to a physician's professional service and must meet the requirements of Section 410.53(b)(1). Per 42 CFR Section 410.53(b)(2), MFT services furnished by an MFT to an inpatient of a Medicare-participating hospital are not MFT services for purposes of billing Medicare Part B under the MFT benefit category.

An MHC is defined in 42 CFR Section 410.54(a) as an individual who:

1. Possesses a master's or doctor's degree which qualifies for licensure or certification as an MHC, clinical professional counselor, or professional counselor under the state law of the state in which such individual furnishes the services defined as mental health counselor services;
2. After obtaining such a degree, has performed at least two years or 3,000 hours of postmaster’s degree clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice or clinic; and
3. Is licensed or certified as an MHC, clinical professional counselor, professional counselor, addiction counselor, or ADC by the state in which the services are performed.

Related Content

• CR 13331: Medicare Program Integrity Manual Chapter 10 - Medicare Enrollment, Transmittals for Chapter 10
• MLN Matters® MM13331: Provider Enrollment Changes to the Medicare Program Integrity Manual
• CMS MFTs and MHCs FAQ Effective 1/1/2024
• NGS News Article: Medicare Requirements for Marriage and Family Therapists and Mental Health Counselors

Posted 2/7/2024