CMS Releases Final Medicare Physician Fee Schedule Rule

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) issued the 2024 Medicare Physician Fee Schedule (MPFS) final rule that describes the processes and procedures for the implementation of Medicare Part B coverage for mental health counselors (MHCs) and marriage and family therapists (MFTs). NBCC is elated that counselors have now been officially added to federal law and regulations as a Medicare-eligible profession, effective Jan. 1, 2024, and can enroll immediately as Medicare providers.

A Watershed Moment for the Counseling Profession

The release of the final rule, which codifies mental health counselors as Medicare providers, is the culmination of a long and tireless effort to achieve Medicare recognition of the profession. The passage of the Mental Health Access Improvement Act in 2022 and the issuance of the 2024 Medicare Physician Fee Schedule final rule represent a major milestone for MFTs, counselors, and the Medicare Mental Health Workforce Coalition. Moreover, older Americans with mental health conditions will now have greatly improved access to needed services due to the availability of MFT and MHC services in their communities. Nearly 50% of Medicare beneficiaries go untreated for their behavioral health disorders. MFTs and counselors will be able to address a major unmet mental health need and play a critically important role in the entire mental health delivery and financing system.

Enrollment Process for Counselors

The MPFS final rule allows mental health counselors to enroll in Medicare right away and to bill for their services starting Jan. 1, 2024. Additionally, CMS is finalizing procedures to allow addiction counselors or drug and alcohol counselors who meet the applicable requirements to enroll in Medicare as MHCs.

Enrollment is now open for counselors and MFTs. Learn more or begin the enrollment process on the CMS website. Both online and paper applications are available.

Although enrollment is open now, the new benefit categories do not take effect until Jan. 1, 2024. Claims for services furnished to Medicare beneficiaries with dates of service prior to Jan. 1, 2024, will not be payable. 

Background on the Physician Fee Schedule

Since 1992, Medicare payment has been made under the MPFS for the services of physicians and other billing professionals—which will begin for counselors in 2024.

For most services furnished in an office setting, Medicare makes payment to practitioners at a rate based on the full range of resources involved in furnishing the service.

Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are applied to each service for work, practice expense, and liability insurance expense. These RVUs become payment rates through the application of a conversion factor. Geographic adjusters (geographic practice cost indexes) are also applied to the total RVUs to account for variation in costs by geographic area. Payment rates are calculated to include an overall payment update specified by statute.

NBCC’s Comments on Fee Schedule Result in Additional Recognition for Counselors

NBCC’s comments on the proposed rule for the MPFS, issued in July, proved incredibly fruitful on many key provisions.

CMS has specified that MHCs are included as distance site practitioners for purposes of furnishing telehealth services to Medicare recipients.

CMS will allow the health behavior assessment and intervention (HBAI) services described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168, and any successor codes, to be billed by MHCs in addition to clinical psychologists. HBAI codes are used to identify the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems.

CMS is finalizing an increase in the valuation for timed behavioral health services under the final MPFS rule. This proposal would apply an adjustment to the work RVUs for psychotherapy codes payable under the MPFS over a 4-year transition. In response to comments from NBCC and other stakeholders, CMS is also finalizing the application of this adjustment to psychotherapy codes that are billed with an evaluation and management (E/M) visit and to the HBAI codes.

CMS is also finalizing its proposal to modify the requirements for the hospice conditions of participation to allow MHCs to serve as members of the hospice interdisciplinary group.

The final rule allows MHCs to furnish services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). CMS is finalizing the requirements for the RHC and FQHC conditions for certification and conditions for coverage to allow MHCs to provide additional behavioral health services in these facilities.

For additional information on the implementation of Medicare Part B coverage for counselors, please visit our Medicare resource page to review materials and recently recorded webinars.