CMS Finalizes Expanded Behavioral Health Medicare Policies, Including Payment Bumps for Crisis Care and SUD Treatment

The Centers for Medicare & Medicaid Services (CMS) is prioritizing whole-person health and behavioral health care in its finalized physician payment rule for 2024.

Specifically, the new rule – released Wednesday – allows marriage and family therapists (MFTs) and mental health counselors (MHCs), including substance use disorder (SUD) counselors, to enroll in Medicare for the first time.

Additionally, the finalized rule increases payment for crisis care, SUD treatment and psychotherapy. Psychotherapy performed jointly with an office visit and for behavioral health assessment and intervention services will also receive increased compensation.


“The impact of these changes means that people with Medicare will be able to access Marriage and Family Therapists and Mental Health Counselors for behavioral health treatment, access culturally-sensitive care from community health workers, care navigators, and peer support workers, access primary care where the provider is invested in a long-term, trusting relationship, and that caregivers for persons with Medicare will have access to appropriate training,” Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said in a statement. “Taken holistically, these are some of the largest changes ever towards a Medicare that recognizes people with Medicare as whole persons, with their own families and unique life stories. After all, people are more than the sum of their ailments and diagnoses.”

The rules also include a set of “Principal Illness Navigation” codes that apply to the services of non-clinical behavioral health staff members such as peer support specialists. The Principal Illness Navigation services also apply to the services used to help people diagnosed with high-risk conditions, like cancer, get linked up to the right support and resources.

CMS noted that it received feedback to expand access to behavioral health services through more digital options such as digital therapeutics and digital cognitive behavioral therapy.


But for now, these therapies didn’t make it into the final rule.

“The policies announced today aim to strengthen Medicare and advance health equity by expanding access to care and services for people who are part of underserved communities,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “In addition, we are bolstering our commitment to Biden-Harris Administration priorities including behavioral health care, supporting family caregivers, promoting value-based care, and advancing the President’s Cancer Moonshot.”

A fact sheet on the final rule is available here.

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