In the Consolidated Appropriations Act, 2023 Congress mandated that Medicare provide coverage and payment for the services of health professionals who are Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). The effective date of coverage is January 1, 2024. And of course, these professionals must enroll in Medicare in order to provide the services and bill Medicare for them.
Requirements for MFT:
- Possesses a master’s or doctor’s degree which qualifies for licensure or certification as a marriage and family therapist pursuant to state law of the state in which such individual furnishes the services defined as marriage and family therapist services
- After obtaining the degree, performance of at least 2 years or 3,000 hours of post-master’s degree clinically supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice or clinic
- Is licensed or certified as a marriage and family therapist by the state in which services are performed
Similarly, the requirements for an MHC:
- Possesses a master’s or doctor’s degree which qualifies for licensure or certification as a mental health counselor, 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
- After obtaining the degree, performance of at least 2 years or 3,000 hours of post-master’s degree clinically supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice or clinic
- Is licensed or certified as a mental health counselor, clinical professional counselor, a professional counselor by the state in which services are performed
- The statutory benefits are defined as for the diagnosis and treatment have mental illness.
- The payment rate will be set at 75% of the amount determined for payment of a psychologist.
- In addition, services by these professionals will be added to the definition of visits for RHCs and FQHCs.
- Medicare is also proposing to add MFTs and MHCs to the list of providers for eligible to bill for telehealth services.
- They’re proposing to allow addiction counselors, who meet all of the applicable requirements (above) and are certified as an MHC to also perform these services.
- MFTs and MHCs may report code G0323, and general behavioral health integration services. The description for code G0323 will add them as billing clinicians.
Services furnished by an MFT or MHC to an inpatient of a Medicare participating hospital are not covered as a Part B benefit. That is, if a patient is an inpatient in Part A admission, outpatient mental health services cannot be billed.
Keep in mind that in order to bill Medicare for the services the professional must be enrolled and personally perform the service. There is no incident to benefit for either of these professional categories. It is not permissible to bill under a licensed and MFT or MHC for services what are performed by another professional who is not yet licensed and enrolled.
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