Medicare Billing for Therapists: Part B, Enrollment, and Fee Schedule

Medicare Part B covers outpatient psychotherapy for eligible beneficiaries, but billing Medicare as a therapist involves choosing an enrollment status, understanding fee schedule rates, and knowing where Medicare Advantage plans fit in — and where they don't.

Medicare Part B Psychotherapy Coverage

Medicare Part B covers individual and group psychotherapy, psychiatric diagnostic evaluations, and certain other mental health services when provided by a qualified mental health professional. Coverage requires a medically necessary diagnosis and appropriate documentation.

Eligible provider types for Medicare billing include: licensed clinical social workers (LCSWs), clinical psychologists, psychiatrists, and nurse practitioners with mental health training. LPCs, LMFTs, and marriage and family therapists were added to Medicare's recognized provider list effective January 1, 2024, after the Consolidated Appropriations Act of 2023 expanded access.

Your Three Enrollment Options

Every therapist must choose one of three statuses with Medicare:

• Participating (PAR)— You enroll as an in-network provider. You must accept Medicare's fee schedule as payment in full, cannot balance-bill Medicare patients, and must submit claims on the patient's behalf. Medicare pays 80% of the allowed amount; the patient (or their Medigap plan) pays the remaining 20% after their deductible.
• Non-Participating (non-PAR) — You enroll but are not contracted. You may see Medicare patients but can only charge up to 115% of the Medicare fee schedule. Medicare pays 80% of 95% of the fee schedule; you must submit claims if the patient requests it; balance billing up to the limiting charge is permitted.
• Opt-Out — You formally opt out of Medicare entirely. You can see Medicare patients under private contracts that you both sign, at any fee you choose. You cannot submit claims to Medicare for any services, and patients cannot seek Medicare reimbursement. This is the only path where a Medicare-eligible patient could use a superbill-style document — but only through the private contract arrangement, not standard Medicare. Opt-out requires filing an opt-out affidavit with your Medicare Administrative Contractor (MAC) and renews every 2 years.

2026 Medicare Physician Fee Schedule — Psychotherapy Codes

The following are the 2026 Medicare non-facility (office) rates under the Physician Fee Schedule. Facility rates (hospital outpatient, CMHC) are lower.

• 90837 (Individual psychotherapy, 60 min) — $83.73 non-facility
• 90834 (Individual psychotherapy, 45 min) — $65.29 non-facility
• 90832 (Individual psychotherapy, 30 min) — $44.84 non-facility
• 90791 (Psychiatric diagnostic evaluation) — $120.43 non-facility
• 90847 (Family therapy with patient present) — $78.30 non-facility
• 90853 (Group therapy) — $23.15 non-facility (per participant)

These rates represent Medicare's allowed amount. PAR providers receive 80% of these rates from Medicare; the remaining 20% is patient responsibility. Non-PAR providers can bill up to the limiting charge (115% of 95% of the fee schedule).

Medicare Administrative Contractors (MACs)

Medicare is administered regionally by MACs — private companies contracted by CMS to process claims. Your MAC depends on your geographic location. Common MACs for mental health providers include Noridian, Palmetto GBA, CGS, and Novitas. Enroll with your regional MAC via the PECOS enrollment system at pecos.cms.hhs.gov.

Medicare Advantage vs Traditional Medicare

Medicare Advantage (Part C) plans are run by private insurers approved by Medicare. Each plan sets its own network, cost-sharing, and prior authorization requirements — separate from traditional Medicare rules. A therapist who is in the traditional Medicare program is not automatically in any Medicare Advantage network; those are separate credentialing relationships.

Importantly: you cannot use a traditional Medicare superbill for a client with traditional Medicare unless you have opted out. Traditional Medicare requires claims to be submitted directly. Only in the opt-out model can a patient receive a document resembling a superbill and pay privately.

Telehealth Under Medicare in 2026

Medicare telehealth flexibilities for behavioral health have been extended through several legislative actions. As of 2026, Medicare continues to cover audio-video telehealth for mental health services when the provider is enrolled. Patients must have had an in-person visit with the provider within the prior 12 months (or have one within 12 months of the telehealth visit). Use Place of Service 10 and, where required, modifier GT.