Attention Licensed Marriage and Family Therapists (LMFTs) and Mental Health Counselors (MHCs)

Mar 20, 2024

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) announced finalization of the physician payment rule to include coverage for LMFTs and MHCs for behavioral health treatment.

This change is effective January 1, 2024. Until such a time as the MaineCare Benefits Manual (MBM) Section 1.07-3(C) is updated, LMFTs and MHCs must appeal Medicare denials related to medical necessity prior to billing MaineCare for services provided to eligible members. If the appeal results are unfavorable, the provider must submit the original denial, the appeal results, and a completed claim form to MaineCare for evaluation.

All providers delivering services reimbursable by Medicare must participate in Medicare to receive MaineCare reimbursement. MaineCare is the payor of last resort.

Medicare guidelines on qualified providers may be found at CMS.gov.

For questions, please contact you Provider Relations Specialist.