Medicare Opened to Counselors in 2024. Enrollment Is the Part Most Practices Have Not Finished.
Since January 1, 2024 mental health counselors can enroll in Medicare and bill it directly. That is a new payer, a new enrollment, new documentation expectations and a rule about incident-to billing that catches group practices. CareVixis handles the enrollment and the billing so the new revenue actually arrives.
A New Payer Is Only Revenue Once You Are Enrolled and Billing It Correctly
The statute opened the door. It did not fill in the enrollment application, and it did not change the fact that a counselor’s claim follows different rules than a physician’s.
You have been able to bill Medicare directly since January 1, 2024
CMS implemented section 4121 of the Consolidated Appropriations Act, 2023: since January 1, 2024, mental health counselors may enroll in Medicare and bill it independently for the diagnosis and treatment of mental illness.1 Practices that put the enrollment off are turning away a payer their patients already carry.
The rate is fixed, and you must accept assignment
Medicare Part B pays mental health counselors at 75% of what a clinical psychologist is paid under the Physician Fee Schedule, and you must accept assignment.1 Knowing the rate before you build the schedule is the difference between a payer that works for your practice and one that quietly does not.
The incident-to rule runs one way only
Medicare may cover counseling services you provide as auxiliary personnel incident to the personal professional services of a physician, clinical psychologist, clinical nurse specialist, nurse practitioner, physician assistant or nurse midwife. It does not cover services provided incident to your personal professional services.2 A group practice that supervises associates has to route those claims accordingly.
More licences qualify than most counselors realize
Medicare’s mental health counselor category covers clinicians licensed or certified by the state as a mental health counselor, a clinical professional counselor, a professional counselor, or an addiction, alcohol or drug counselor.2 Addiction counselors who meet the requirements can enroll as MHCs.1 If you run substance use treatment alongside counseling, that is one enrollment, not two businesses.
Enrollment, Then Billing, Then Follow-Up. By One US-Based Team.
Getting on the panel and getting paid by it are two different jobs, and most practices lose money in the gap between them. We do both.
Claims, start to finish
Submission, clearinghouse, rejections, denials, appeals and accounts receivable follow-up. Not a portal you log into. Work that gets done.
Credentialing and enrollment
Medicare, Medicaid by state, the commercial payers and the behavioral health carve-outs. Plus CAQH upkeep and expiration tracking, which is where panels quietly lapse.
VixisIQ™ revenue intelligence
What was billed, what was paid, what is outstanding and what is stuck, without assembling it yourself from three systems.
VixisTrace™ root cause analysis
Not just which claims were denied. Why, and what has to change upstream so the same denial stops recurring.
Keep your EHR, or move
If your current system works, keep it and we manage the billing around it. Keeping the EHR you already have carries no monthly software fee from CareVixis.
A US-based team you can reach
100% US-based, zero outsourcing. You talk to the people who work your claims, not a queue in front of them.
Frequently Asked Questions
Yes. Since January 1, 2024, mental health counselors may enroll in Medicare and bill it independently for services furnished to diagnose and treat mental illness, under section 4121 of the Consolidated Appropriations Act, 2023.1
Medicare Part B pays mental health counselors at 75% of what a clinical psychologist is paid under the Medicare Physician Fee Schedule, and you must accept assignment.1 Commercial payers set their own rates independently.
Clinicians licensed or certified by their state as a mental health counselor, a clinical professional counselor, a professional counselor, or an addiction, alcohol or drug counselor, who also hold a qualifying master’s or doctoral degree and have at least two years or 3,000 hours of post-master’s supervised clinical experience in mental health counseling.2
No. Medicare may cover counseling services furnished as auxiliary personnel incident to the personal professional services of a physician, clinical psychologist, clinical nurse specialist, nurse practitioner, physician assistant or nurse midwife, but it does not cover services provided incident to a counselor’s own personal professional services.2
Yes, since CY 2024. CMS finalized allowing mental health counselors, marriage and family therapists and clinical social workers to bill CPT 96156, 96158, 96159, 96164, 96165, 96167 and 96168.3
Core revenue cycle management is 6% of insurance collections. Nothing on patient payments. VixisConnect™ communications and VixisGrowth™ growth services are +1% each, so all-in is 8%. Keeping the EHR you already have carries no monthly software fee from CareVixis. Month to month, no long-term agreement and no minimum.
How CareVixis Supports LMHC, LPC and Clinical Professional Counselors
Medicare enrollment, finished
The application, the revalidations and the commercial panels alongside it. See credentialing and payer enrollment.
Billing that respects the incident-to rule
Supervision structures decide where the claim goes. See billing and revenue cycle management.
Substance use work under the same roof
Addiction counseling enrolls through the same category. See substance use disorder billing.
Related provider types
Also see LCSW billing, LMFT billing and the overview for licensed therapists.
Let’s Talk About Your Counseling Practice
Tell us your license type, your payer mix and what you are running into right now. No sales pressure. No obligation. A straight conversation about whether CareVixis is the right fit, and an honest answer either way.
No credit card. No obligation. Just clarity about what is possible for your practice.
Sources
- CMS, Marriage and Family Therapists & Mental Health Counselors, Medicare Physician Fee Schedule. CMS
- CMS Medicare Learning Network, Medicare & Mental Health Coverage, MLN1986542, March 2026. CMS
- CMS, Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule, fact sheet. CMS
These are Medicare rules. Commercial payers set their own policies, rates and documentation requirements, and are not bound by the Medicare fee schedule or the Medicare benefit categories described above. Nothing here is legal, billing or compliance advice for a specific practice.
Mental Health Workflows, Connected
VixisMH™ is the mental-health specialty experience within the CareVixis ecosystem. It supports the clinical workflow while CareVixis connects revenue cycle, credentialing, communications, operations and growth around the practice. Keeping an existing EHR is fully supported.