MFT And MHC Uptake In Medicare

As of January 1, 2024, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) became eligible to bill Medicare independently for their services to diagnose and treat mental illnesses. Expansion to new mental health clinicians in Medicare – with reimbursement at 75% of the physician fee schedule – was thought to be a cost-effective way to increase the number of clinicians available for beneficiaries.

Some data are now available* to take an early look at enrollment among MFTs and MHCs, as well as those opting out, and in relation to other mental health specialties in Medicare.

4,752 MFTs have enrolled in Medicare, 4,508 have opted out. Just over 25,000 MHCs have enrolled, and 3,768 have opted out.

Combined, MFTs and MHCs account for more than 1/3 of the behavioral health specialties that have opted out. Clinical psychologists remain the largest single group among the behavioral health specialists to have opted out.

Behavioral health specialties are five of the top six specialties that have opted out, comprising 57% of all opt-outs.

In terms of the number of MFTs and MHCs relative to other specialties in Medicare, with 25,000 newly enrolled, MHCs rank 19th among the 25 most numerous practitioners. Clinical Social Work, Clinical Psychologists, and Psychiatry rank 6th, 14th, and 15th among practitioners.

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All behavioral health practitioners combined (Clinical Social Work + Clinical Psychologists + Psychiatry + MFTs + MHCs) represent the second most prevalent specialty group type among practitioners enrolled in Medicare, at 10.5% of entire enrollment (194,073 of 1.8 million practitioners enrolled).


Data are not yet available regarding the number and types of services MFTs and MHCs have been providing in addition and in contrast to other behavioral health specialists during early uptake, and will not be for some time. Relevant publicly available data tend to lag about two years behind service provision. The number of behavioral health clinicians in Medicare has expanded by almost 30,000 so far, but productivity among the new clinicians, changes in access to care, and costs to Medicare remain unknown.

*Sources:  Opt Out Affidavits, May 2024 Update; Medicare Fee-For-Service Public Provider Enrollment, Q1 2024.

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