The short answer
Since January 1, 2024, licensed mental health counselors and marriage and family therapists can enroll in Medicare and bill it directly. Enrolling makes sense if you see adults 65 and older, including many older Veterans and CHAMPVA beneficiaries, because Medicare usually pays first for them.
Can LPCs and LMFTs bill Medicare now?
Yes. Starting January 1, 2024, Medicare pays marriage and family therapists (MFTs) and mental health counselors (MHCs) directly for diagnosing and treating mental illness. See CMS's page for MFTs and MHCs.
CMS uses "mental health counselor" to cover state titles like LPC, LPCC, LMHC, and LCPC. Addiction counselors who meet all the MHC requirements can enroll as MHCs too.
Who qualifies?
Per CMS, you need:
- A master's or doctoral degree that qualifies you for licensure in your field.
- At least 2 years or 3,000 hours of supervised clinical experience after your master's degree.
- A license or certification as an MFT or MHC in the state where you provide services.
Medicare pays MFTs and MHCs at 75% of what it pays a clinical psychologist for the same service.
How do you enroll?
- Get an NPI through NPPES, if you don't already have one.
- Register in CMS's Identity & Access system.
- Enroll through PECOS, or with a paper CMS-855 application.
- Work with your Medicare Administrative Contractor (MAC) through approval.
Why does this matter for therapists who serve Veterans?
Because many older Veterans and family members have Medicare:
- CHAMPVA clients 65 and older generally must have Medicare Parts A and B to keep CHAMPVA. Medicare pays first, and CHAMPVA may pay what's left. See CHAMPVA at Age 65 and Medicare Coordination.
- Older Veterans often have Medicare alongside VA care. Medicare and VA don't coordinate benefits the way private insurance does; a Veteran chooses which to use for a given service.
If you aren't enrolled in Medicare, billing a Medicare-primary client gets complicated. Ask the program how it handles care from a provider Medicare can't pay before you start.
How ValorWell handles this
ValorWell handles billing for its pathways, including coordinating other coverage such as Medicare for CHAMPVA clients. ValorWell also handles credentialing administration; you supply your professional information and documents.
Important limits
- Medicare enrollment is your decision in your own practice. It brings Medicare's documentation and billing rules with it.
- Opting out has consequences. Rules on opting out of Medicare are specific; read CMS guidance before choosing that route.
- Rates and rules change yearly with the Physician Fee Schedule.
- This page isn't billing advice for a specific client's coverage.