In, Calendar Year 2024 CMS will be implementing Section 4121 of the Consolidated Appropriations Act (CAA), 2023, which provides for Medicare Part B coverage and payment under the PFS for the services of Marriage and Family Therapist Services (MFTS) and Mental Health Counselor Services (MHCs) when billed by these professionals. This finalization will allow addiction counselors that meet all the applicable requirements to be an MHC and enroll in Medicare as MHCs. MFTs and MHCs to enroll in Medicare and these providers would be able to bill Medicare for services, starting January 1, 2024, consistent with statute.
Everyone will want to verify CMS also amended § 410.32(a)(2) to add MFTs and MHCs to the list of practitioners who may order diagnostic tests to the extent that the MFT or MHC is legally authorized to perform the service under State law (or the State regulatory mechanism provided by State law) of the State in which such services are furnished.
Layman terms: Marriage and Family Therapists and Mental Health Counselors (including addiction counselors or alcohol and drug counselors who meet all the requirements to be a Mental Health Counselor) can enroll as Medicare providers. Which will allow them to bill the following CPT Codes the Health Behavior Assessment and Intervention (HBAI) services described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168, and any successor codes, to be billed by clinical social workers, MFTs, and MHCs, in addition to clinical psychologists.
Applies to Provider Types: Clinical social workers, MFTs, and MHCs, in addition to clinical psychologists.
Applicable year: 2024
Location: Place of service (POS) 11 Office, POS 21 Inpatient Hospital, POS 51 Inpatient Psychiatric Hospital, POS 52 Psychiatric Facility-Partial Hospitalization and POS 53 Community Mental Health Center.
Example: Mrs. Jones needs a heart transplant. She has been encouraged to stop smoking and to keep active while waiting on a donor. While waiting for a donor Mrs. Jones meets with the Mental Health Counselor to assess the patient’s ability to comply with the requirements and drug regiment if a donor match is found. This session lasted 1 hour from 10:00am- 11:00am. Visits would be billed using CPT code 96156 Health behavior assessments, or re-assessment.
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.
Our 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.