Tapping into Medicare: MFT’s Roadmap to Enrollment and Billing

Marriage and family therapists (MFTs) play a vital role in providing mental health services to individuals, couples, and families. Effective January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) has made a significant change that allows MFTs and mental health counselors (MHCs) to bill Medicare independently for their services related to the diagnosis and treatment of mental illnesses. This development opens up new opportunities for MFTs to expand their reach and provide much-needed support to Medicare beneficiaries.

Understanding Medicare Enrollment Criteria for MFTs

Before MFTs can begin billing Medicare, they must meet specific criteria set forth by CMS. These requirements ensure that MFTs have the necessary qualifications and experience to deliver high-quality mental health services to Medicare beneficiaries.

To enroll in Medicare, MFTs must possess a master’s or doctoral degree that qualifies them for licensure or certification as a marriage and family therapist pursuant to the state law where they practice.

Requirements for Enrollment

Additionally, they must have completed 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, skilled nursing facility (SNF), private practice, or clinic.

MFTs must also be licensed or certified as Marriage and family therapists by the state in which they perform services.

The Enrollment Process

Once Marriage and family therapists meet the necessary criteria, they can begin the enrollment process to participate in the Medicare program. Here are the key steps:

• Register for an account in the Identity & Access Management (I&A) System.
• Obtain a National Provider Identifier (NPI) in the National Plan & Provider Enumeration System (NPPES).
• Enroll in Medicare through the Provider Enrollment, Chain, and Ownership System (PECOS) or by submitting a paper CMS-855 application.
• Work closely with your Medicare Administrative Contractor (MAC) for guidance and support throughout the enrollment process.

It’s important to note that the effective enrollment date for MFTs will be January 1, 2024, or later, depending on when the application is submitted and processed.

Billing for Medicare-Covered Services

After successful enrollment, Marriage and family therapists can begin billing Medicare for covered services related to the diagnosis and treatment of mental illnesses. CMS has provided detailed guidance on the appropriate CPT codes to use and the types of services that are covered.

For individual psychotherapy services, MFTs should use CPT codes such as 90832 (Psychotherapy, 30 minutes), 90834 (Psychotherapy, 45 minutes), and 90837 (Psychotherapy, 60 minutes). These codes are used for diagnostic evaluation and treatment of mental health disorders.

For family and couple therapy services, MFTs can bill using codes like 90846 (Family psychotherapy without patient present), 90847 (Family psychotherapy with patient present), and 90849 (Multiple-family group psychotherapy).

In addition to psychotherapy services, CMS also covers psychotherapy for crisis situations and behavioral health integration services. For psychotherapy for crisis (CPT codes 90839 and 90840), MFTs can bill for services provided to patients in high distress with life-threatening, complex problems that require immediate attention. Behavioral health integration services (CPT codes 99492, 99493, 99494) involve care management for patients with mental health conditions.

MFTs should also be aware that Medicare Part B pays them 75% of what a clinical psychologist is paid under the Medicare Physician Fee Schedule for the diagnosis and treatment of mental illnesses. This reimbursement rate reflects the recognition of MFTs as qualified mental health professionals.

Some of the other components that should be considered for billing are:

Electronic Billing

MFTs are encouraged to use the ANSI ASC X12N 837P (Professional) Version 5010A1, the current electronic claim version, to submit health care claims electronically. This streamlined process ensures efficient and accurate billing.

Paper Claim Submissions

In certain situations, MFTs may submit paper claims using the 1500 Health Insurance Claim Form. This option is available when electronic billing is not feasible or practical.

Skilled Nursing Facility Billing

For MFT services provided to skilled nursing facility (SNF) residents on or after January 1, 2024, these services are excluded from consolidated billing. MFTs must include the SNF’s Medicare provider number when billing for these Part B services.

Billing Resources

CMS has provided numerous resources to assist MFTs with billing and claims processing, including:

• Medicare Claims Processing Manual
• Medicare Benefit Policy Manual
• Medicare National Coverage Determinations Manual
• Medicare Billing: 837P & Form CMS-1500 fact sheet
• MAC websites for billing information specific to your region

Streamline Your Billing with TherapyPM

As an MFT navigating the complexities of Medicare enrollment and billing, having a comprehensive practice management solution can streamline your operations and ensure compliance with Medicare requirements. 

TherapyPM offers a user-friendly platform that simplifies billing, scheduling, and other administrative tasks, allowing you to focus on providing high-quality care to your patients.

With TherapyPM, you can:

• Manage patient records and treatment plans efficiently.
• Submit electronic claims to Medicare and other payers with ease.
• Track claim statuses and payments in real-time.
• Generate customized reports for better practice insights

Don’t let billing complexities hinder your practice’s growth. Embrace TherapyPM and experience the convenience of a seamless, integrated solution tailored specifically for mental health professionals like MFTs.

Staying Informed and Up-to-Date

As with any new policy or regulation, Marriage and family therapists need to stay informed and up-to-date on the latest developments and guidelines related to Medicare enrollment and billing.

CMS and professional organizations offer resources, such as MLN Matters articles, guidance documents, webinars, and educational materials, to ensure a smooth transition and compliance with Medicare requirements. MFTs should regularly check for updates and attend relevant training sessions to maintain their knowledge and expertise.

To conclude, the ability of Marriage and family therapists to bill Medicare independently for mental health services represents a significant milestone in recognizing the crucial role they play in addressing the mental health needs of our communities.

By meeting the necessary enrollment criteria, following the appropriate billing procedures, and leveraging practice management solutions like TherapyPM, MFTs can expand their reach and provide vital support to Medicare beneficiaries.

This change not only benefits MFTs but also promotes greater access to mental health care for those who need it most.