2024 Physician Fee Schedule Final Rule Delivers Behavioral Health Wins

The Centers for Medicare & Medicaid Services (CMS) recently issued the 2024 Medicare Physician Fee Schedule (PFS) final rule, and it includes significant developments that will benefit individuals with mental illness and the behavioral health industry as a whole. 

Starting in 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs) can bill Medicare for their services. Addiction counselors or drug and alcohol counselors who meet the applicable requirements also can enroll in Medicare as mental health counselors.  

To account for these new rules, CMS announced it was revising behavioral health integration (BHI) codes so MFTs and MHCs can bill for these services as of Jan. 1, 2024. 

CMS also announced it was revising the requirements for federally qualified health centers (FQHCs) and rural health clinics (RHCs) to allow marriage and family therapists and mental health counselors to provide additional behavioral health services in these facilities. 

These rule changes should have a wide-reaching and positive impact on behavioral health services. 

• At a time when we are experiencing a substantial behavioral health workforce shortage, CMS is expanding the pool of available providers who can deliver services to Medicare beneficiaries. 
• Medicare beneficiaries increasingly require behavioral health services. "Serious mental illness, substance use disorders, and anxiety and depressive disorders are at crisis level in older adults," writes Dr. Tara Cortes, who also notes that approximately 75% of long-term care residents have one or more mental health diagnoses.  
• By 2040, 80 million Americans are projected to be over 65, which will further expand the number of Medicare beneficiaries seeking mental health support. 
• FQHCs and RHCs provide services to populations often struggling with social determinants of health (SDOH) barriers, which are "known to influence mental health outcomes." The ability for marriage and family therapists and mental health counselors to provide covered behavioral health services in FQHCs and RCHs will help these populations receive the services they need and continue to move healthcare toward achieving behavioral health equity. 

Use of the Proem evidence-based clinical workflow support engine will further magnify the benefits associated with these rules' changes. Proem can help therapists and counselors determine a correct diagnosis for Medicare beneficiaries more efficiently, including for those individuals with more complex and co-occurring conditions. This will help Medicare beneficiaries receive timelier and more accurate treatment and support while enabling therapists and counselors to provide services to more beneficiaries, thus helping keep the costs of care down. 

"We are encouraged by the steps CMS has taken to ensure that more people have access to mental healthcare providers through expanded Medicare coverage,” said Proem CEO John Letter. “At Proem, we help healthcare providers ease the pain caused by mental illness by enabling them to make accurate diagnoses more quickly and efficiently so their patients can get the help they need. With the new Medicare physician fee schedule, more seniors will be able to start their mental healthcare journey to wellness.”