On January 1, 2024, one of the most significant expansions in the history of Medicare behavioral health coverage came into effect. For the first time, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) — including qualifying addiction counselors — gained the ability to enroll in Medicare Part B and bill directly for their services. This change, mandated by Section 4121 of the Consolidated Appropriations Act (CAA), 2023, has fundamentally reshaped how behavioral health practices approach billing, credentialing, and revenue cycle management.
What Changed: The CAA 2023 and Section 4121 Explained
Prior to 2024, MFTs and MHCs were absent from the list of Medicare-recognized provider types. Section 4121 of the CAA 2023 changed that, directing CMS to create coverage and payment pathways under the Physician Fee Schedule (PFS) for services delivered by these professionals. CMS implemented this through new regulatory sections § 410.53 (MFTs) and § 410.54 (MHCs), published in the CY 2024 Physician Fee Schedule Final Rule (issued November 2, 2023).
Key Date: MFTs and MHCs could begin enrolling in Medicare on November 2, 2023. Billing rights became effective January 1, 2024. Claims for services prior to January 1, 2024 are not payable under Medicare.
The same provision also extended eligibility to addiction counselors who meet the full MHC qualification requirements — a meaningful step toward integrating substance use disorder treatment into the Medicare mainstream.
Who Does This Apply To?
This policy applies to the following provider types, provided they meet CMS qualification standards:
- Marriage and Family Therapists (MFTs)
- Mental Health Counselors (MHCs)
- Clinical Professional Counselors / Licensed Professional Counselors (where state-licensed as MHCs)
- Addiction counselors who meet all MHC requirements
- Clinical Psychologists (for expanded HBAI code access)
- Clinical Social Workers (for expanded HBAI code access)
Medicare Enrollment Requirements for MFTs and MHCs
Eligibility Criteria for MFTs
To qualify and enroll as an MFT under Medicare, an individual must:
- Hold a master’s or doctoral degree that qualifies for licensure or certification as an MFT under state law
- Be licensed or certified as an MFT by the state in which services are furnished
- Have completed at least two years (or 3,000 hours) of post-degree, supervised clinical experience in marriage and family therapy
Eligibility Criteria for MHCs
To qualify as an MHC under Medicare, an individual must:
- Hold a master’s or doctoral degree qualifying for licensure as an MHC, clinical professional counselor, or professional counselor under state law
- Be licensed or certified as an MHC, clinical professional counselor, or professional counselor by the applicable state
- Have completed at least two years (or 3,000 hours) of post-degree, supervised clinical experience in mental health counseling or marriage and family therapy
How to Enroll in Medicare
MFTs and MHCs enroll through the standard Medicare provider enrollment process:
- PECOS (preferred): Use the online Provider Enrollment, Chain, and Ownership System at pecos.cms.hhs.gov. PECOS includes MFT (Specialty Code E1) and MHC (Specialty Code E2) as selectable specialties.
- Paper CMS-855I (if needed): The paper form does not list MFT/MHC specialties. Select “Undefined Non-Physician Practitioner Specialty” in Section 2H and specify MFT or MHC in the space provided.
Important: No application fee is required for MFTs or MHCs. Once approved, providers receive a Provider Transaction Access Number (PTAN) from their Medicare Administrative Contractor (MAC). MACs may issue a development letter requesting additional information — providers have 30 calendar days to respond or the application will be rejected.
SNF Consolidated Billing Exception
Effective January 1, 2024, MFT and MHC services are excluded from Skilled Nursing Facility (SNF) consolidated billing per Section 4121(a)(4) of the CAA 2023. This means MFTs and MHCs can bill Medicare separately for services provided to SNF residents rather than having them bundled into the Medicare Part A SNF payment — a significant revenue consideration for providers who serve SNF populations.
Covered CPT Codes and Payment Rates
Core Billable Services
Once enrolled, MFTs and MHCs can bill Medicare for services for the diagnosis and treatment of mental illness (excluding services to hospital inpatients). Key CPT codes include:
| CPT Code | Service Description | Eligible Providers |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | MFT, MHC, CSW, Psychologist |
| 90832 | Psychotherapy, 30 min | MFT, MHC, CSW, Psychologist |
| 90834 | Psychotherapy, 45 min | MFT, MHC, CSW, Psychologist |
| 90837 | Psychotherapy, 60 min | MFT, MHC, CSW, Psychologist |
| 90847 | Family psychotherapy with patient present | MFT, MHC, CSW, Psychologist |
| 90846 | Family psychotherapy without patient present | MFT, MHC, CSW, Psychologist |
| 90853 | Group psychotherapy | MFT, MHC, CSW, Psychologist |
| 96156 | Health behavior assessment/re-assessment | MFT, MHC, CSW, Psychologist |
| 96158 | Health behavior intervention, individual, 30 min | MFT, MHC, CSW, Psychologist |
| 96159 | Health behavior intervention add-on, each add’l 15 min | MFT, MHC, CSW, Psychologist |
| 96164 | Health behavior intervention, group, 30 min | MFT, MHC, CSW, Psychologist |
| 96167 | Health behavior intervention, family with patient, 30 min | MFT, MHC, CSW, Psychologist |
Note: Health Behavior Assessment and Intervention (HBAI) codes 96156–96168 were previously restricted to clinical psychologists. CMS expanded billing rights for these codes to include MFTs, MHCs, and clinical social workers, effective January 1, 2024.
Payment Rate Structure
MFT and MHC services are reimbursed at a rate set by statute — not at the full psychologist rate:
Payment Formula: 80% of the lesser of: (a) the actual charge for the service, OR (b) 75% of the Medicare Physician Fee Schedule amount determined for a psychologist for the same service.
Applicable Places of Service (POS)
MFTs and MHCs may bill Medicare across a range of care settings:
- POS 11 — Office
- POS 10 — Patient’s Home (including telehealth, effective January 1, 2024)
- POS 21 — Inpatient Hospital
- POS 51 — Inpatient Psychiatric Hospital
- POS 52 — Psychiatric Facility — Partial Hospitalization
- POS 53 — Community Mental Health Center (CMHC)
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Telehealth Billing for Behavioral Health: 2024–2026 Rules
Telehealth policy for behavioral health has undergone substantial and ongoing change. MFTs and MHCs must stay current with these rules to avoid claim denials and compliance risk.
What Was Made Permanent
The following telehealth provisions are now permanent for behavioral and mental health services under Medicare:
- Patients can receive behavioral/mental health telehealth services from their home — no geographic restrictions apply
- FQHCs and RHCs can permanently serve as Medicare distant site providers for behavioral/mental health telehealth
- Behavioral/mental health telehealth services can permanently be delivered using audio-only communication platforms
- There are no originating site geographic restrictions for behavioral health telehealth
In-Person Visit Requirements: Current Status Through 2027
A requirement had been anticipated that would mandate an in-person visit within six months before the first mental health telehealth service, and annually thereafter. Congress has repeatedly delayed this. Per the most recent congressional action and CMS guidance, this in-person requirement is not required through December 31, 2027.
Audio-Only Telehealth: How to Bill Correctly
For Medicare behavioral health services delivered via telephone (audio-only):
- Code set: Use standard psychotherapy or E/M CPT codes (e.g., 90832, 90834, 90837, 99202–99215)
- Modifier 93: Append Modifier 93 to indicate audio-only telehealth. Required by Medicare to distinguish telephone-only services from video-enabled visits.
- Modifier FQ: FQHCs and RHCs should use Modifier FQ (or both 93 and FQ) to indicate audio-only delivery.
- Documentation: Document that audio-video technology was available, but the patient was unable or chose not to use video.
Important 2025 Change: CPT codes 99441–99443 (telephone E/M codes) were retired on January 1, 2025. They are no longer accepted by Medicare. Use standard E/M codes with Modifier 93 instead.
Codes Retired vs. Active: Quick Reference
| Code/Modifier | Description | Status (2025–2026) |
|---|---|---|
| 99441–99443 | Telephone E/M codes | RETIRED as of Jan 1, 2025 |
| Modifier GT | Telehealth indicator (old) | No longer required by Medicare |
| Modifier 95 | Audio-video telehealth | Active for commercial payers; not required by Medicare |
| Modifier 93 | Audio-only telehealth | Required by Medicare for audio-only visits |
| Modifier FQ | Audio-only (RHC/FQHC) | Active; use with or instead of 93 |
| 98000–98015 | New 2025 AMA telehealth codes | NOT adopted by Medicare |
| G2012 / 98016 | Brief virtual check-in | G2012 replaced by CPT 98016 |
POS for Telehealth Claims
Since January 1, 2024, Medicare pays for telehealth services provided to patients in their homes at the non-facility payment rate. Use POS 10 (Patient’s Home) for home-based telehealth visits.
Behavioral Health Integration (BHI) Codes
CMS expanded access to Behavioral Health Integration (BHI) codes to allow MFTs and MHCs to provide integrated behavioral health care within primary care settings. Key codes:
| Code | Description | 2025 Note |
|---|---|---|
| 99484 | General BHI — care management, 20+ min/month | Reimbursement increased ~12% for 2025 |
| 99492 | Collaborative Care Model (CoCM) — initial month | MFTs/MHCs now eligible as behavioral health care managers |
| 99493 | CoCM — subsequent months | MFTs/MHCs now eligible as behavioral health care managers |
| 99494 | CoCM — additional 30 min add-on | Add-on to 99492 or 99493 |
A primary care practice using the Collaborative Care Model can now engage MFTs or MHCs as behavioral health care managers and still bill Medicare for CoCM services — creating new integration pathways and revenue opportunities for behavioral health providers.
Conclusion
Stay tuned for additional updates on these impending changes taking effect in January 2024. For assistance with preparing your practice for this change, do not hesitate to reach out to us directly. At Neolytix, we are always ready to assist your practice with medical billing, coding, and revenue cycle management.
Neolytix’s medical billing services are 100% HIPAA-compliant and provided by a certified team of professionals. Likewise, our medical credentialing services are fast, efficient, and organized according to rigorous workflow management procedures.
