Mental Health Counselors (MHCs)

10.2.3.18 – Mental Health Counselors (MHCs) (Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25) A. Definitions and Requirements Effective January 1, 2024, Medicare covers services furnished by MHCs. An MHC is defined in 42 CFR § 410.54(a) as an individual who: (1) Possesses a master's or doctor's degree which qualifies for licensure or certification as an MHC, clinical professional counselor, or professional counselor under the state law of the state in which such individual furnishes the services defined as mental health counselor services; (2) After obtaining such a degree, has performed at least 2 years or 3,000 hours of post-master’s degree clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic; and (3) Is licensed or certified as an MHC, clinical professional counselor, professional counselor, addiction counselor, or alcohol and drug counselor (ADC) by the state in which the services are performed. Under 42 CFR § 410.54(b)(1), MHC services means services furnished by an MHC (as defined in § 410.54(a)) 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 under state law (or the state regulatory 1417 mechanism provided by state law) of the state in which such services are furnished. The services must be of a type that would be covered if they were furnished by a physician or as incident to a physician's professional service and must meet the requirements of § 410.54. Per 42 CFR § 410.54(c)(2), MHC services furnished by an MHC to an inpatient of a Medicare- participating hospital are not MHC services for purposes of billing Medicare Part B: B. Verification As it does with Medicare supplier types, the contractor shall familiarize itself with the state licensure and associated education requirements for MHCs. This will assist the contractor in ascertaining whether the MHC meets all state requirements. In verifying the supplier’s compliance with: 1. § 410.54(a)(1) – Except as stated in the discussion of § 410.54(a)(3) below, the contractor shall require the supplier to submit a copy of the individual’s master’s or doctor’s degree. Whether a master’s or, instead, a doctor’s degree is required will depend on the applicable state’s requirements. 2. § 410.54(a)(2) – Except as stated in the discussion of § 410.54(a)(3) below, the contractor shall require the supplier to submit documentation verifying that they have performed, at a minimum, either 2 years or 3,000 hours of post-master’s clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic. (The supplier need only meet the 2-year or the 3,000-hour standard, not both.) Such documentation shall be one of the following: (i) A statement from the provider/supplier at which the MHC performed the services in question (e.g., hospital, clinic) verifying that the MHC performed services at that setting for the required number of years or hours. The statement shall: (a) Be on the provider’s/supplier’s letterhead (e-mail is not acceptable); and (b) Be signed by: (1) the supervisor under whom the MHC performed the services; (2) an applicable department head (e.g., chief of psychology) of the provider/supplier; or (3) a current authorized or delegated official of the provider/supplier (i.e., the AO/DO has already been approved as such in the provider/supplier’s enrollment record) if the provider/supplier is Medicare-enrolled. The statement need not contain standard, boilerplate language. It need only confirm to the contractor’s satisfaction that the year or hour requirement was met. Also, the contractor may accept statements from multiple providers/suppliers if the year or hour requirement was met by performing services at more than one setting. For instance, suppose Dr. Smith earned MHC experience by performing 1,000 hours at Hospital X and 2,000 hours at Hospital Y. The contractor can accept one statement from Hospital X concerning the 1,000 hours and another from Hospital Y regarding the remaining 2,000 hours so long as each statement meets the requirements of subsections (B)(2)(i)(a) and (B)(2)(i)(b) above. Put otherwise, the MHC can combine years and hours from multiple providers/suppliers to meet the requirements in § 410.54(a)(2). In addition: • A statement from the MHC’s current employer that the MHC met the year or time requirement at other settings besides the employer is not acceptable. All statements must be from the provider/supplier in which setting(s) the MHC performed the services. Using our example above, suppose Dr. Smith’s supervisor at Hospital X was Dr. Jones. Dr. Jones is no longer with Hospital X, however. Dr. Smith submits a statement from Dr. Jones stating that Dr. Smith performed 1,000 hours of MHC service at Hospital X. This statement cannot be accepted because it is not from Hospital X. • The setting can be any provider/supplier at which MHC services are furnished. It need not be one of the four provider/supplier types listed in § 410.54(a)(2). Moreover, the provider/supplier need not have been (or currently be) enrolled in Medicare at the time the MHC performed the services there; or (ii) A statement verifying that the MHC meets the year or hour requirements from a: (1) licensing or credentialing body for the state in which the MHC is enrolling; or (2) national MHC credentialing organization. The statement can be signed by any official of the state licensing/credentialing or national credentialing body. It must, however, be on the body’s letterhead. If the MHC fails to furnish the above documentation, the contractor shall develop for it consistent with the instructions in this chapter. 3. § 410.54(a)(3) – The contractor shall verify state licensure or certification consistent with existing policies for doing so in this chapter. If the contractor confirms to its satisfaction that the state already requires, as a condition of licensure or credentialing, the MHC to have: • Performed, at a minimum, either 2 years or 3,000 hours of clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic, the contractor can forgo verifying separate compliance with the § 410.54(a)(2) requirement described above; the MHC need not submit the documentation specified in subsection (B)(2). (This is because the licensure/credentialing already includes the year/hour requirement.) • A master’s or doctor’s degree (as applicable), the MHC need not submit a copy of the individual’s degree nor need the contractor verify that the MHC received said degree. C. Further Information 1. Other Titles - Individuals who meet all applicable statutory and regulatory qualifications to be an MHC --- even though they may be licensed or certified by their state under a different title to furnish mental health counseling --- may enroll as an MHC. This includes mental health professionals who otherwise meet the requirements of § 410.54(a). (While a clinical psychologist, for instance, must possess a doctoral degree in psychology to enroll as such in Medicare, only a master's degree is required for MHC enrollment.) In short, the individual's specific title under state law for purposes of mental health counseling is less important than whether the requirements of § 410.54(a) are met. As an example, addiction counselors, ADCs, and licensed professional counselors (LPCs) may enroll as MHCs if they meet the MHC requirements. They cannot, however, enroll as addiction counselors, ADCs, or LPCs, for Medicare does not recognize such supplier types. 2. Pre/Post Degree – As indicated above, all 2 years/3,000 hours of clinical supervised experience must have been performed post-degree. Pre-degree experience does not count towards the required time total under § 410.53(a)(2), even if the state permits pre-degree experience to be counted towards meeting state requirements. For example, suppose State X requires 1,000 hours of supervised experience for licensure. The hours can be performed pre-degree or post-degree. Jones, who is licensed by X, performed 1,000 hours before receiving the degree. Jones cannot apply these hours towards the § 410.53(a)(2) time requirement – even though Jones is licensed – and must furnish evidence of 2 years/3,000 hours post-degree experience. If, however, Jones had performed 500 hours pre-degree and 500 hours post-degree, the latter (but not the former) could be applied to the § 410.53(a)(2) time requirement. 3. Additional Policies - Like certain other individual practitioners, MHCs may opt-out of Medicare, form groups, reassign their benefits under § 424.80, receive reassigned benefits, and order/certify services to the extent otherwise permitted by law. They will complete the Form CMS-855I to bill for services and be subject to limited-risk screening (except as described in § 424.518(c)(3)). Until the Form CMS-855I is revised to include MHCs, the MHC shall check the “Undefined Non-Physician Practitioner Specialty” box and state “mental health counselor” in the line next thereto.