Update: Licensed Addiction Counselors (LACs) have been removed from this requirement, which was originally posted on January 25, 2024.
Medicare will begin covering and making payments for the services of marriage and family therapists (MFT), mental health counselors on January 1, 2024.
For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who receive Medicaid coverage of services furnished by MFTs or MHCs services furnished by hospital outpatient departments, community mental health centers (CMHC), rural health clinics (RHC), federally qualified health centers (FQHC), or opioid treatment programs (OTP), beginning on January 1, 2024, Medicare will become the primary payer for these services provided by Medicare-enrolled practitioners or providers.
What does this mean for Medicaid-enrolled licensed marriage and family therapists (LMFT), licensed addiction counselors (all levels), licensed professional counselors (LPC), or licensed professional clinical counselors (LPCC) providers? If you are currently enrolled in Medicaid as an LMFT, LPC, or LPCC, you will need to submit your enrollment information to Medicare by January 31, 2024, to prevent any disruption in treatment and payment for dually eligible beneficiaries and payment of claims.
MFTs and MHCs could begin submitting their Medicare enrollment applications after the CY 2024 PFS final rule was issued on November 2, 2023. The effective date of enrollment may be up to 30 days before the submission of the enrollment application to Medicare, but no earlier than January 1, 2024, which is the date the new benefits authorized by the CAA, 2023 take effect. Newly Medicare-enrolled LMFTs, LPCs, and LPCCs will not be granted an effective date earlier than January 1, 2024, and claims with dates of service before January 1, 2024, will not be payable by Medicare.
Claims submission instructions:
If you are not yet enrolled with Medicare: submit your Medicare enrollment by Jan. 31, 2024, per the instructions linked below. Continue to submit claims to ND Medicaid while you are waiting for Medicare enrollment to be approved. Once ND Medicaid has confirmed your enrollment with Medicare, we will recoup claims paid to you as primary and you will need to bill Medicare for those claims. Medicaid will become the secondary payer. ND Medicaid will begin recouping claims in May 2024, to give Medicare ample time to approve provider applications.
If you are enrolled with Medicare: submit claims to Medicare for dates of service of Jan. 1, 2024, and after. Medicaid is now the secondary payer.
Medicaid-enrolled should follow the enrollment instructions found here
Thank you for your prompt attention to this matter. If you have questions, please reach out to Alyssa Neis.
Medicare will begin covering and making payments for the services of marriage and family therapists (MFT), mental health counselors on January 1, 2024.
For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who receive Medicaid coverage of services furnished by MFTs or MHCs services furnished by hospital outpatient departments, community mental health centers (CMHC), rural health clinics (RHC), federally qualified health centers (FQHC), or opioid treatment programs (OTP), beginning on January 1, 2024, Medicare will become the primary payer for these services provided by Medicare-enrolled practitioners or providers.
What does this mean for Medicaid-enrolled licensed marriage and family therapists (LMFT), licensed addiction counselors (all levels), licensed professional counselors (LPC), or licensed professional clinical counselors (LPCC) providers? If you are currently enrolled in Medicaid as an LMFT, LPC, or LPCC, you will need to submit your enrollment information to Medicare by January 31, 2024, to prevent any disruption in treatment and payment for dually eligible beneficiaries and payment of claims.
MFTs and MHCs could begin submitting their Medicare enrollment applications after the CY 2024 PFS final rule was issued on November 2, 2023. The effective date of enrollment may be up to 30 days before the submission of the enrollment application to Medicare, but no earlier than January 1, 2024, which is the date the new benefits authorized by the CAA, 2023 take effect. Newly Medicare-enrolled LMFTs, LPCs, and LPCCs will not be granted an effective date earlier than January 1, 2024, and claims with dates of service before January 1, 2024, will not be payable by Medicare.
Claims submission instructions:
If you are not yet enrolled with Medicare: submit your Medicare enrollment by Jan. 31, 2024, per the instructions linked below. Continue to submit claims to ND Medicaid while you are waiting for Medicare enrollment to be approved. Once ND Medicaid has confirmed your enrollment with Medicare, we will recoup claims paid to you as primary and you will need to bill Medicare for those claims. Medicaid will become the secondary payer. ND Medicaid will begin recouping claims in May 2024, to give Medicare ample time to approve provider applications.
If you are enrolled with Medicare: submit claims to Medicare for dates of service of Jan. 1, 2024, and after. Medicaid is now the secondary payer.
Medicaid-enrolled should follow the enrollment instructions found here
Thank you for your prompt attention to this matter. If you have questions, please reach out to Alyssa Neis.
Date of Update
Update Category
Provider Type
Provider Year
2024