Traditional MedicareCoverageHigh impact
Medicare Coverage of Mental Health Counselor and Marriage and Family Therapist Services
Maryland Medicaid·MD · Psychiatry, Family Medicine, General Practice +1 more·Provider Transmittal
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Beginning January 1, 2024, Medicare now covers Mental Health Counselor (MHC) and Marriage and Family Therapist (MFT) services. Maryland providers must enroll with Medicare to bill these services to Medicare beneficiaries. Medicaid will recoup any claims submitted during the transition period (through June 30, 2024) once providers become Medicare-enrolled. Starting July 1, 2024, providers not enrolled with Medicare must transfer dually eligible patients to Medicare-enrolled providers.
Action Required
By June 30, 2024: Providers must complete Medicare enrollment application to bill MHC and MFT services. Billing team should: (1) Identify all dually eligible patients receiving mental health counseling or marriage and family therapy services; (2) Update billing software to route these claims to Medicare (not Medicaid) once enrollment is approved; (3) Establish tracking system for dates of service to ensure CMS's 30-day retroactive billing window is captured. By July 1, 2024: Any provider NOT enrolling with Medicare must transfer dually eligible patients to a Medicare-enrolled provider and provide clinical transition support. Billing team must coordinate patient transfers and ensure no service gaps occur. Failure to enroll by July 1, 2024 will result in inability to bill for these services and obligation to transfer patients. Note: Claims submitted to Medicaid during transition will be recouped once Medicare enrollment becomes effective.