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Payment for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) in a Method II Critical Access Hospital (CAH)

The purpose of this Change Request (CR) is to establish payment instructions for Marriage and Family Therapists and Mental Health Counselors, as authorized by Section 4121 of the Consolidated Appropriations Act, 2023.

Physicians and non-physician practitioners billing on Type of Bill (TOB) 85X for professional services rendered in a Method II CAH have the option of reassigning their billing rights to the CAH. When the billing rights are reassigned to the Method II CAH, payment is made to the CAH for professional services (Revenue Codes (RC) 96X, 97X or 98X). Medicare makes payment for MFTs and MHCs to a Method II CAH is 80 percent of the lesser of the actual charge for the services or 75 percent of the Medicare Physician Fee Schedule (MPFS).

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 25, 2024

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.