Medicare Proposed Changes in Physician Fee Schedule to Improve Access to Behavioral Health Services


A collection of policies to expand the types of providers eligible to bill for behavioral health services through Medicare have been added to the proposed 2024 Medicare Physician Fee Schedule, the annual regulation that determines payment and coverage policies for clinician services. 

The Centers for Medicare & Medicaid Services (CMS), recognizing the need for more and varied behavioral health providers to fully meet the requirements of patients, has proposed adding marriage and family therapists and mental health counselors to the list of eligible providers under Medicare Part B coverage and payment. This includes an update to corresponding behavioral health integration codes to further facilitate integrated behavioral healthcare. Additionally, counselors that meet all applicable requirements would be permitted to enroll in Medicare as Mental Health Counselors. The proposal also seeks to increase the payment rate for office-based opioid use disorder treatment to two individual psychotherapy sessions per month and extend flexibilities for opioid treatment programs to bill Medicare for periodic assessments conducted through audio-only telecommunications. 

Along with the proposed changes to the physician fee schedule, CMS has requested feedback on ways to further expand access to behavioral health services, including through integration, interprofessional consultation, and intensive outpatient services, as well as methods for increasing psychiatrist participation in Medicare. Also requested is information on the use of digital therapies, including digital cognitive behavioral therapy.

For updated guidance on how to integrate behavioral health care into your primary care practice, visit the Integration Academy’s 2023 Lexicon, which defines behavioral health integration and details what to implement and expect during the integration process.