CMS establishes new specialty codes, payment instructions for MFTs and MHCs

CMS recently established specialty codes and payment instructions for two new Medicare provider types: marriage and family therapists (MFT) and mental health counselors (MHC).

When enrolling in Medicare, MFTs are to use specialty code E1 and MHCs are to use E2. Providers can enroll in Medicare by completing a paper CMS-855 application or through the Internet-based Provider Enrollment, Chain, and Ownership System.

As of January 1, 2024, MFTs and MHCs can bill Medicare independently for services furnished for the diagnosis and treatment of mental illnesses. These providers will be paid at 75% of the Medicare Physician Fee Schedule (MPFS) fee rate.

MFT and MHC services are excluded from consolidated billing requirements under the skilled nursing facility prospective payment system, according to CMS. In addition, Medicare covers MFT and MHC services that are furnished in rural health clinics and Federally Qualified Health Centers.

Revenue integrity professionals can visit this CMS web page and read the 2024 MPFS final rule to learn more about the enrollment process and billing requirements for MFTs and MHCs.