Q: Does Medicare cover a marriage and family therapist?
A: Yes, since 1 January 2024. Section 4121 of the Consolidated Appropriations Act, 2023 created a new Medicare benefit category for marriage and family therapist (MFT) and mental health counselor (MHC) services, furnished by and directly billed by those clinicians.¹
This matters more in California than anywhere else. LMFT is the state's largest clinical licence category. For decades the answer to "does Medicare cover my therapist" was no for most California therapists, and a great deal of published material still says so.
Which California licences these are
CMS defines the categories by what the state licence is, not by a list of state titles.
A California LMFT is the federal MFT. The test: a master's or doctoral degree qualifying the person for licensure as an MFT under the law of the state where services are furnished; at least 2 years or 3,000 hours of post-master's supervised clinical experience; and licensure by that state.²
A California LPCC is the federal MHC. CMS anticipated the naming problem: individuals who meet the qualifications "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."³ The federal category expressly covers a "mental health counselor, clinical professional counselor, or professional counselor."²
Be precise about the limit: CMS does not publish a state-by-state crosswalk naming "LMFT" or "LPCC." The mapping follows from the regulation's own definitional test, which is keyed to state licensure. It is not a CMS list you can point at.
Clinical psychologists and clinical social workers were already covered and remain so.⁴
They are paid less than a psychologist — and so is your share
This is the part almost nobody explains, and it is good news for the patient.
Medicare pays MFT and MHC services at "80 percent of the lesser of the actual charge… or 75 percent of the amount determined for payment of a psychologist."⁵ Clinical social workers are on the identical formula.⁶ Clinical psychologists are paid at 100% of the physician fee schedule amount.⁷
Read where the 80/20 split sits: the statute applies it to the 75% figure. So your 20% coinsurance is 20% of the reduced approved amount, not of the psychologist rate. In round numbers for a 45-minute session in 2026, that is roughly $18–20 with an LMFT, LPCC or LCSW against roughly $24–27 with a clinical psychologist, depending on where in California you are.⁸
They must accept assignment. MFTs and MHCs are mandatory-assignment providers, so they cannot bill you above the Medicare-approved amount.⁹
What you pay in 2026
- Part B deductible: $283 for the year.¹⁰
- Standard Part B premium: $202.90 a month.¹⁰
- Then 20% coinsurance on the Medicare-approved amount.¹¹
And put to bed a claim that is still everywhere: the old outpatient mental health treatment limitation — the one that made you pay 50% for therapy while other care was 20% — is fully phased out. The regulation's own schedule steps it up to "For expenses incurred in CY 2014 and subsequent years, 100 percent."¹² Mental health is on the same 20% as anything else, and has been for over a decade.
Annual depression screening is $0 if the provider accepts assignment.¹¹
Two limits worth knowing
No "incident to" billing of their own work. MFT and MHC services can be covered as auxiliary personnel incident to a physician or other qualifying practitioner, but CMS does not cover services provided incident to the MFT's or MHC's own professional services.¹³
Not in partial hospitalisation or intensive outpatient. Medicare does not pay under the MFT or MHC benefit category for services a hospital outpatient department or community mental health centre provides to patients in a PHP or IOP.¹³
Do this: if your therapist is a California LMFT or LPCC and told you years ago that they could not take Medicare, ask again — the answer changed in 2024 and enrolment has no application fee. If you are the one looking, ask a prospective therapist plainly: "Are you enrolled with Medicare, and do you accept assignment?" Enrolment is per-clinician, not automatic, so a licensed LMFT may still not be enrolled. Original Medicare vs Advantage for therapy → · The full Medicare route →
Sources
- CMS, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) Provider Enrollment FAQs, Q1 — cms.gov.
- Same FAQ, Q2 (MFT) and Q3 (MHC); 42 CFR §410.54 — ecfr.gov. Restated in CMS, Medicare & Mental Health Coverage, MLN1986542, March 2026, pp. 23–24 — cms.gov.
- Same FAQ, Q13.
- MLN1986542 (March 2026), pp. 12, 14, 15.
- 42 U.S.C. §1395l(a)(1)(FF) — ssa.gov.
- 42 U.S.C. §1395l(a)(1)(F).
- 42 CFR §414.62 — "The fee schedule for clinical psychologist services is set at 100 percent of the amount determined for corresponding services under the physician fee schedule" — ecfr.gov.
- Our computation from the CMS CY2026 Physician Fee Schedule Relative Value Files (RVU26C) and the CY2026 GPCI file, non-facility, applied to CPT 90834 in California localities, then reduced to 75% and multiplied by the 20% coinsurance — cms.gov. Labelled as our computation, not a CMS-published rate; CMS applies rounding conventions at intermediate steps. For a definitive figure use the CMS Physician Fee Schedule Look-Up Tool. Note also that CY2026 has two conversion factors — $33.57 for qualifying APM participants and $33.40 for others — cms.gov.
- MLN1986542 (March 2026), pp. 23–24.
- CMS, 2026 Medicare Parts A & B Premiums and Deductibles, 14 November 2025 — cms.gov.
- Medicare.gov, Mental health care (outpatient) — medicare.gov.
- 42 CFR §410.155(a) — ecfr.gov.
- MLN1986542 (March 2026), pp. 23–24.
All figures read on 18 August 2026 and carry the year they apply to. This page is not legal or financial advice. Free one-to-one Medicare counselling is available in California from HICAP at 1-800-434-0222.