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CMS Releases the PROPOSED 2024 MEDICARE PHYSICIAN FEE SCHEDULE
July 21, 2023 by NBCC Government Affairs

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the proposed 2024 Medicare Physician Fee Schedule (MPFS), a rule that announces and solicits public comments on proposed policy changes for Medicare payments and other Medicare Part B issues effective on or after Jan. 1, 2024. The calendar year (CY) 2024 MPFS proposed rule aims to improve the behavioral health care system. 

The MPFS outlines payment for the services of physicians and other billing professionals such as mental health counselors (MHCs). Through the MPFS, CMS will be implementing sections of the Consolidated Appropriations Act (CAA), 2023, which provides coverage and payment for the services of counselors and marriage and family therapists (MFTs). This proposed rule finally activates what we have been collectively working toward for decades: the addition of counselors and MFTs as covered providers. This will significantly increase access to quality behavioral health care and provide additional opportunities for clinicians to care for clients across the life span. 

The key provisions in the proposed 2024 Medicare Physician Fee Schedule pertaining to counselors and MFTs include:

Eligibility Requirements to Participate in the Medicare Program

  • Counselors and MFTs must possess at a minimum a master's degree that qualifies for licensure or certification as a counselor or MFT pursuant to state law.
  • Counselors and MFTs must have performed at least 2 years or 3,000 hours of post–master’s degree clinical supervised experience in marriage and family therapy or mental health counseling in an appropriate setting.
  • The practitioner must be licensed as a counselor or MFT by the state in which they perform services.
  • Addictions counselors who meet these requirements are eligible to enroll in the Medicare program.

 

Enrollment in the Medicare Program 

  • Counselors and MFTs are allowed to enroll in Medicare after the CY 2024 Physician Fee Schedule Final Rule is published (likely to occur in early November 2023).  They would be able to bill Medicare for services starting Jan. 1, 2024, consistent with the CAA statute.
  • A provider or supplier must complete, sign, and submit to their assigned Medicare Administrative Contractor (MAC) the appropriate Form CMS–855 (OMB Control No. 0938–0685) application to enroll in the Medicare program and obtain Medicare billing privileges.

 

Payment Formula for Covered Services and Coding Issues

  • The payment amount for counselor and MFT services is 80% of the lesser of the actual charge for the services or 75% of the amount determined for clinical psychologist services under the Medicare Physician Fee Schedule.
  • To determine the payment amounts for services for 2024, CMS will update the Medicare Physician Fee Schedule Look-up Tool at the end of 2023. The 2024 MPFS does not provide details on codes for which Medicare will reimburse counselors and MFTs, which you may find on other public and private sector lists. However, CMS provides a list of the most common CPT codes for mental health services. Please see the Medicare Mental Health Booklet (pp. 22–25) for complete details.
  • CMS is making changes to Behavioral Health Integration codes to allow counselors and MFTs to provide integrated behavioral health care as part of primary care settings.
  • Additionally, CMS is proposing to 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 counselors and MFTs. HBAI codes are used to identify the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems.

 

Payment Under Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

  • CMS is proposing to codify payment provisions for counselors and MFTs in RHCs and FQHCs beginning Jan. 1, 2024. RHC and FQHCs would be paid under the RHC all-inclusive rate (AIR) and FQHC prospective payment system (PPS), respectively, when counselors and MFTs furnished RHC and FQHC services.

 

Participating on Hospice Teams

  • CMS is proposing to modify the requirements for the hospice Conditions of Participation (CoPs) to allow counselors and MFTs to serve as members of hospice interdisciplinary groups.

 

Payment for Telehealth Services

  • CMS will also recognize counselors and MFTs as telehealth practitioners, effective Jan. 1, 2024.
  • In accordance with amendments of the CAA, 2023, CMS is proposing to specify that counselors and MFTs are included as distant site practitioners for purposes of furnishing telehealth services.

 

This Fact Sheet provides additional information about the rule. 

NBCC will develop specific comments for submission to CMS on portions of the MPFS highlighted in this report pertaining to counselors. Interested parties can submit comments on the proposed rule by Sept. 11, 2023.

Comments can be submitted following the instructions in the unpublished proposed rule PDF document

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