CMS Pub. 100-04, ch. 4, § 250.14

Marriage and Family Therapists (MFTs) and Mental Health Counselors

(MHCs) in a Method II CAH

(Rev. 12477; Issued:01-25-24; Effective: 01-01-24; Implementation:02-26-24)

The services of a LCSW, MFT or MHC that has reassigned their billing rights to a

Method II CAH are payable by Medicare when the procedure is billed on type of bill 85X

with revenue code (RC) 96X, 97X, and/or 98X. In addition, the LCSW services requires

an AJ modifier and the MFT or MHC must be enrolled as a MFT or MHC specialty.

Under Section 1834(g)(2)(B) of the Act, outpatient professional services performed in a

Method II CAH are paid 115 percent of such amounts as would otherwise be paid under

the Act if the services were not included in the outpatient CAH services.

The Medicare payment for services performed by a LCSW, MFT or MHC shall be 80

percent of the lesser of the actual charges for the services or 75 percent of the amount

determined for the payment of a psychologist.

Payment is calculated as follows:

((Facility specific MPFS amount times the LCSW, MFT or MHC reduction (75%))

minus (deductible and coinsurance)) times 115%.