Medicare Enrollment for Counselors and Marriage and Family Therapists
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
- Flat PricesNo percentage of collections
- Half Now, Half at SubmissionFor every enrollment application
- Closed Network?Your choice of a refund or a credit
- Live Status TrackingCheck any application by reference number
Since January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs) can enroll in Medicare and bill it directly. That includes licensed professional counselors, licensed mental health counselors and clinical professional counselors who meet the federal requirements, and addiction or alcohol and drug counselors who meet every MHC requirement. Enrollment is on CMS-855I through PECOS, the same application psychologists and clinical social workers use. This guide covers who qualifies, how to file, what Medicare pays for, and the mistakes that slow approval.
Who Is Eligible
A counselor or MFT is eligible for Medicare when three requirements are met, according to CMS:
- Degree: a master's or doctoral degree that qualifies for licensure or certification as an MFT, or as a mental health, clinical professional or professional counselor, under state law.
- License: licensed or certified in that profession by the state where you furnish services. CMS accepts a different state title when you meet every federal qualification.
- Supervised experience: at least 2 years or 3,000 hours of post-master's clinical supervised experience in a setting such as a hospital, skilled nursing facility, private practice or clinic. If supervision was not part of your state licensure, submit documentation of it with the application.
Associate and provisional licensees who have not finished their supervised hours do not meet the requirement.
How to Enroll: CMS-855I Through PECOS
Enrollment takes four steps that CMS lists in order. Register in the CMS Identity and Access Management System, get or confirm your NPI in NPPES, file the CMS-855I in PECOS (or on paper), and work with the Medicare Administrative Contractor for your state, which processes the application. The MFT and MHC specialties are available to select in PECOS. If you are joining a group, the same 855I reassigns your benefits to it; the group must already be enrolled or enrolling at the same time, and its PTAN does not change.
NPI Taxonomy
Your NPI record should carry the taxonomy for your profession. CMS lists 106H00000X for marriage and family therapists and 101YM0800X for mental health counselors. Check your record in NPPES before you file and update it if it shows a different code, so the NPI, PECOS and your commercial applications all describe you the same way.
Effective Dates
No MFT or MHC can have a Medicare effective date earlier than January 1, 2024, and claims for earlier dates of service are not payable. After that, Medicare's retrospective billing rule allows billing for up to 30 days before the effective date, and only when you met every requirement, including licensure, during that time. In practice, the date the contractor receives a complete application sets how early you can be paid, so file before you start seeing Medicare patients.
What Medicare Covers and Pays
Medicare Part B covers MFT and MHC services for the diagnosis and treatment of mental illness that state law authorizes you to furnish, and pays them at 75 percent of the physician fee schedule amount for a clinical psychologist. You must accept assignment. CMS's Medicare and Mental Health Coverage booklet lists the commonly used codes, including the psychiatric diagnostic evaluation (90791), psychotherapy (90832, 90834, 90837), crisis psychotherapy (90839, 90840) and family psychotherapy (90846, 90847). MFTs and MHCs were also added to the list of practitioners who can furnish Medicare telehealth. To see what your commercial contracts pay for the same codes, use our therapist insurance rates research or check your rates.
Enroll or Opt Out
Enrolling lets you bill Medicare and is required for most Medicare Advantage panels, which expect a Medicare enrollment before they contract. Opting out means you see Medicare patients only under a private contract, and neither you nor the patient can bill Medicare for your services. CMS says the opt-out period lasts 2 years and renews automatically unless you give written notice at least 30 days before it ends. For most counselors in private practice who want Medicare patients, enrolling is the better fit.
Common Mistakes
- Applying before the license is independent or before the supervised hours are complete
- Leaving out supervision documentation when the state license did not require it
- An NPI taxonomy that does not match the specialty selected in PECOS
- A surrogate who prepared the application but was never approved in CMS I&A, so it was never signed
- Seeing Medicare patients for months before filing, when only 30 days can be billed back
- Forgetting the reassignment when you work for a group, so claims under the group's Tax ID deny
PECS files Medicare enrollment for counselors and MFTs at the flat price on our pricing page. For commercial panels and the carve-out companies that credential most therapists, see behavioral health carve-outs and insurance credentialing for therapists.
Frequently Asked Questions
Can licensed professional counselors and MFTs bill Medicare?
Yes. Since January 1, 2024, marriage and family therapists and mental health counselors can enroll in Medicare and bill it independently. Licensed professional counselors, licensed mental health counselors and clinical professional counselors qualify as mental health counselors when they meet the federal degree, license and supervised experience requirements, whatever their state calls the license.
What are the Medicare requirements for a counselor or MFT?
CMS requires a master’s or doctoral degree that qualifies for licensure in the profession, a state license or certification as an MFT or as a mental health, clinical professional or professional counselor in the state where services are furnished, and at least 2 years or 3,000 hours of post-master’s supervised clinical experience. If supervision was not part of licensure, documentation goes in with the application.
What does Medicare pay counselors and MFTs?
Medicare pays MFTs and mental health counselors 75 percent of the physician fee schedule amount paid to a clinical psychologist for the same service, and they must accept assignment. Covered services are those for the diagnosis and treatment of mental illness that state law authorizes, and MFTs and MHCs can furnish Medicare telehealth.
Which NPI taxonomy should a counselor or MFT use for Medicare?
CMS lists 106H00000X for marriage and family therapists and 101YM0800X for mental health counselors. Check that the taxonomy on your NPI record in NPPES matches the specialty you select in PECOS before you apply, because payers cross-check the two and a mismatch is an avoidable delay.
Should a counselor opt out of Medicare instead of enrolling?
Only if you want to see Medicare patients strictly as private pay. Opting out means you and the patient sign a private contract and neither of you can bill Medicare for your services. CMS says the opt-out period lasts 2 years and renews automatically unless you give written notice at least 30 days before it ends.
Can my Medicare effective date go back before I applied?
Only a little. Medicare allows billing for services up to 30 days before the effective date when circumstances prevented enrolling sooner and you met every requirement, including licensure, during that time. No MFT or MHC can have an effective date earlier than January 1, 2024.
Sources: CMS: marriage and family therapists and mental health counselors · CMS MFT and MHC FAQ · CMS MLN: Medicare and mental health coverage · Noridian: MFT and MHC · 42 CFR 424.521 (retrospective billing).
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By the PECS credentialing team. Updated October 2026.