(Medicare Benefit Policy Manual)

330  Marriage and Family Therapist (MFT)  Services  (Rev.  12448; Issued:01- 11-24, Effective: 01- 01-24; Implementation: 02- 12-24)   See the Medicare Claims  Processing  Manual  Chapter  12, Physician/Nonphysician Practitioners,  240, Marriage and Family Therapist  Services,  for payment  requirements.   A. Marriage and Family Therapist Defined    410.53 defines a  marriage and family therapist  as an individual  who:    Possesses a master's or doctor's degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law of the State in which such individual furnishes the services defined as marriage and family therapist services;    After obtaining such degree, has performed at least 2 years or 3,000 hours of post masters degree clinical supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice, or clinic; and   Is licensed or certified as a marriage and family therapist by the State in which the services are performed.   B. Marriage and Family Therapist Services  Defined   Section  1861(lll)(1)  of the Act defines  marriage and family therapist services as services furnished by an MFT for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the MFT is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are furnished, as would otherwise be covered if furnished by a physician or as an incident to a physicians professional service.   C. Covered  Services   Coverage is limited  to the services  a MFT is  legally  authorized to perform in accordance with State law (or State regulatory mechanism established by State law).  The services  of a MFT may be covered under Part B if they are:    The type of services for the diagnosis and treatment of mental illnesses that are otherwise covered if furnished by a physician, or as incident to a physicians service. (See 30 for a description of physicians services and 70 of Pub 100-1, the Medicare General  Information, Eligibility,  and Entitlement Manual, Chapter 5, for the definition of a physician.);   Performed  by a person who meets  the definition  of a MFT  (See subsection A.); and   Not otherwise excluded  from coverage.   A/B MACs  (B) should become familiar  with the State law or regulatory mechanism governing a MFTs scope of practice in their service area.  D. Noncovered  Services   Services of a MFT are not covered when furnished to inpatients of a hospital. In addition, MFT services are not covered if they are otherwise excluded from Medicare coverage even though a MFT is authorized by State law to perform them. For example, the Medicare law excludes from coverage services  that are not reasonable  and necessary for  the diagnosis or  treatment  of an illness or injury or to improve the functioning of a malformed body member.   E. Assignment Requirement   Assignment  is required.    340 - Mental Health Counselor (MHC) Services  (Rev. 12448; Issued:01- 11-24, Effective: 01- 01-24; Implementation: 02- 12-24)   See the Medicare Claims  Processing  Manual  Chapter  12, Physician/Nonphysician Practitioners,  250, Mental Health Counselor  Services,  for payment  requirements.   A. Mental Health Counselor  Defined    410.54 defines a mental health counselor  as an individual  who:    Possesses a master's or doctor's degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, professional counselor under the State law of the State in which such individual furnishes the services defined as mental health counselor services;    After obtaining such a degree, has performed at least 2 years or 3,000 hours of post masters degree clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic; and    Is licensed or certified as a mental health counselor, clinical professional counselor, professional counselor by the State in which the services are performed.   B. Mental Health Counselor  Services  Defined   Section  1861(lll)(3)  of the Act defines  mental health counselor services as services furnished by a mental health counselor (MHC) for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the MHC is legally authorized to perform u nder State law (or the State regulatory mechanism provided by the State law) of the State in which such services are furnished, as would otherwise be covered if furnished by a physician or as incident to a physicians professional service.   Additionally, to the extent that addiction counselors and alcohol and drug counselors who furnish services for the diagnosis and treatment of mental illnesses, including substance use disorders,  meet all of the statutory and regulatory requirements regarding education, clinical supervised experience, and State licensure for MHCs, such counselors can enroll in Medicare as MHCs.   C. Covered  Services   Coverage  is limited  to the services  a MHC is  legally  authorized to perform in accordance with State  law (or State  regulatory  mechanism  established  by State  law).  The services  of a MHC may be covered under Part B if they are:  a. The type of services for the diagnosis and treatment of mental illnesses that are otherwise covered if furnished by a physician, or as incident to a physicians service. (See 30 for a description of physicians services and 70 of Pub 100-1, the Medicare General  Information, Eligibility,  and Entitlement Manual, Chapter 5, for the definition of a physician.);  b. Performed  by a person who meets  the definition  of a MHC  (See subsection A.); and   c. Not otherwise excluded  from coverage.   A/B MACs  (B) should become familiar  with the State law or regulatory mechanism governing a MHCs scope of practice in their service area.  D. Noncovered  Services   Services of a MHC are not covered when furnished to inpatients of a hospital. In addition, MHC services are not covered if they are otherwise excluded from Medicare coverage even though a MHC is authorized by State law to perform them. For example, the Medicare law excludes from coverage services  that are not reasonable and necessary for the diagnosis or treatment  of an illness or injury or to improve the functioning of a malformed body member.  E. Assignment Requirement   Assignment is  required.      Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12448BP  01/11/2024 Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs)  02/12/2024 13469  R12425BP  12/21/2023 Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92 - Additional Publication Update  01/02/2024 13496 R12352BP  11/08/2023 Manual Updates for Coverage of Intravenous Immune Globulin (IVIG) For Treatment of Primary Immune Deficiency Diseases in the Home  01/02/2024 13414 R12299BP  10/12/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening - Full Agile Pilot CR   11/13/2023 13017 R12171BP  08/03/2023 Update to Pub. 100 -02 Medicare Benefit Policy, Chapter 15, Section 110.8 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Benefit Category Determinations   09/04/2023 13228 R11901BP  03/16/2023 Update to the Manual to Clarify Supervision Requirements for Diagnostic Tests  05/17/2023 13094 R11995BP   04/21/2023 Medicare Policy Updates for Dental Services as Finalized in the Calendar Year (CY) 2023 Physician Fee Schedule (MPFS) Final Rule 05/12/2023 13181 Rev #  Issue Date  Subject  Impl Date  CR#   R11905BP  03/16/2023 Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Policy Manual Chapter 15, Section 50.4.4.2  04/17/2023 13118 R11865BP  02/16/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening - Full Agile Pilot CR  - Rescinded and Replaced by Transmittal 1 2299   02/27/2023 13017 R11824BP  01/27/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening - Full Agile Pilot CR - Rescinded and Replaced by Transmittal 11865  02/27/2023 13017 R11769BP  12/30/2022 Manual Update Pub. 100 -02 Medicare Benefit Policy, Chapter 15, Section 110.8 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Benefit Category Determinations  01/31/2023 13029 R11771BP  12/30/2022 Internet-Only Manual (IOM) Updates for Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs)  01/31/2023 13029 R11764BP  12/22/2022 New Medicare Part B 01/03/2023 12804 Rev #  Issue Date  Subject  Impl Date  CR#  Immunosuppressant Drug Benefit (PBID)  Implementation  R11646BP   10/19/2022 New Medicare Part B Immunosuppressant Drug Benefit (PBID)  Implementation - Rescinded and Replaced by Transmittal 11764 01/03/2023 12804  07/28/2022 New Medicare Part B Immunosuppressant Drug Benefit (PBID)  Implementation  SENSITIVE/CONTROVERSIAL  DO NOT POST   Rescinded and Replaced by Transmittal 11646 01/03/2023 12804 R11426BP 05/20/2022 An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilit ation (ICR) Conditions of Coverage 07/05/2022 12613 R11399BP 05/04/2022 Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2  06/06/2022 12723 R11355BP  04/14/2022  Update to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID -19) and its Administration to Current Claims Processing Requirements and Other General Updates  05/06/2022 12634 Rev #  Issue Date  Subject  Impl Date  CR#  R11288BP  03/04/2022 Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants  02/15/2022 12543 R11272BP  02/18/2022 An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilit ation (ICR) Conditions of Coverage- Rescinded and replaced by transmittal 11426