What changed on January 1, 2024?

For the first time, Medicare began paying Licensed Marriage and Family Therapists (LMFTs) and Licensed Mental Health Counselors (LMHCs, including California's LPCCs) directly under Part B. Before 2024, these provider types could not bill Medicare regardless of training or licensure. The Consolidated Appropriations Act of 2023 created the new benefit category, and CMS implemented it on January 1, 2024.

Why does this matter for California specifically?

California has the largest mental health provider shortage in the country. Before the 2024 expansion, Medicare-accepting psychologists and LCSWs had wait times of three to six months in most metros. LMFTs and LPCCs make up the largest share of California's licensed mental health workforce (the California Board of Behavioral Sciences licenses tens of thousands), but they were locked out of Medicare. Opening Medicare to LMFTs and LPCCs effectively doubled the eligible provider pool overnight, though it takes time for individual providers to complete Medicare enrollment.

How does an LMFT or LMHC bill Medicare?

The provider must first enroll in Medicare through the PECOS system. Once enrolled, they bill Part B at 80 percent of the Medicare-approved amount for each session. The standard outpatient psychotherapy CPT codes apply: 90832 (30 minutes), 90834 (45 minutes), 90837 (60 minutes), 90847 (family therapy with patient present). The patient pays the 20 percent coinsurance after the Part B deductible, or a Medigap or Medi-Cal covers it.

Are LMFTs and LMHCs paid the same as psychologists?

Under the 2024 rule, LMFTs and LMHCs are paid 75 percent of the psychologist rate for the same CPT code. The patient experience is identical, the clinical service is identical, but Medicare pays the LMFT or LMHC about three-quarters of what it pays a psychologist. The differential matters to providers deciding whether to enroll, less so to families.

Does Medicare cover telehealth for LMFT and LMHC visits?

Yes. Telehealth coverage for mental health is permanent under Medicare, including for the new LMFT and LMHC provider types. Real-time video from the patient's home is covered. Audio-only mental health visits are also permanently covered, which matters for older California patients without strong broadband or video comfort.

How do I find a Medicare-enrolled LMFT or LMHC in California?

Use the Medicare.gov 'Care Compare' tool (medicare.gov/care-compare) and filter by specialty and ZIP code. Confirm enrollment directly with any provider before scheduling; the 2024 expansion is still rolling out and not every California LMFT or LPCC has completed Medicare enrollment yet. The Inclusive Therapists, Psychology Today, and Therapy for Older Adults directories also let you filter by 'accepts Medicare' though those lists are self-reported.

Does this affect Medicare Advantage plans the same way?

Yes. Medicare Advantage plans are required to cover at least the same services as Original Medicare, so LMFT and LMHC visits are now in-network for Advantage plan members whose plans contract with these providers. Some Advantage plans have been faster than others at building out their LMFT and LPCC networks in California; check the plan's provider directory before assuming access.

Medicare mental health: the 2024 LMFT/LMHC expansion

What changed in January 2024

For roughly 30 years, Medicare paid for outpatient psychotherapy only when it was delivered by a psychiatrist, a clinical psychologist, a Licensed Clinical Social Worker, a clinical nurse specialist, a nurse practitioner, or a physician assistant. Two of the largest mental health professions in the country, Licensed Marriage and Family Therapists and Licensed Mental Health Counselors, were excluded. California seniors needing therapy ran into this wall constantly.

The Consolidated Appropriations Act of 2023 changed the law. Effective January 1, 2024, LMFTs and LMHCs (including California’s LPCCs, Licensed Professional Clinical Counselors) became eligible to enroll in Medicare and bill Part B directly for covered outpatient mental health services. The change is the single largest expansion of Medicare mental health coverage in three decades.

What the new benefit covers

Medicare Part B now pays LMFTs and LMHCs for individual psychotherapy (CPT 90832, 90834, 90837), family therapy with patient present (90847), family therapy without patient present (90846), group psychotherapy (90853), and psychiatric diagnostic evaluation (90791). It pays at 80 percent of the Medicare fee schedule amount; the patient (or a Medigap, Medicare Advantage plan, or Medi-Cal) pays the 20 percent coinsurance after the Part B deductible.

Telehealth is permanent for these services, including from the patient’s home. Audio-only sessions are also permanently covered for mental health, which is meaningful for older California patients whose broadband is unreliable or whose comfort with video is limited.

Why this matters for California

California has the largest mental health provider workforce in the country and the largest provider shortage. The math is straightforward: the LMFT and LPCC license categories make up the largest share of the state’s licensed mental health professionals. The California Board of Behavioral Sciences licenses tens of thousands of LMFTs and LPCCs. Before 2024, almost none of them could see Medicare patients.

For a senior in a smaller California city, or in any rural county, the old rule often meant a three to six month wait for a Medicare-accepting psychologist or LCSW, if one existed at all. The new rule opens the door to a much larger provider pool. The change is not instant; each individual LMFT or LPCC has to complete Medicare enrollment through the PECOS system, which takes weeks to months. But the trajectory is clear, and the number of Medicare-enrolled LMFTs and LPCCs in California is rising every quarter.

What an LMFT or LMHC does, and why it matters for older adults

LMFTs are trained in systems-based therapy, including family therapy, couples therapy, and individual therapy with attention to relational context. For California seniors, this matters in two ways. First, much of the distress older adults bring to therapy is relational: grief, adult-child conflict, caregiving strain, marital change after retirement. Second, family therapy itself is sometimes the right modality, and before 2024 Medicare-accepting family therapists were nearly impossible to find.

LMHCs (and California LPCCs) are trained as generalist clinical counselors, with similar scope of practice to LCSWs for outpatient mental health. They handle depression, anxiety, grief, adjustment disorders, PTSD, and substance use disorders. For California seniors, they are now a fully covered Medicare option alongside LCSWs.

How to find a Medicare-enrolled LMFT or LMHC

Use the Medicare.gov “Care Compare” tool and filter by specialty (Marriage and Family Therapist or Mental Health Counselor) and ZIP code.
Call the provider directly to confirm Medicare enrollment. The 2024 expansion is still rolling out and online directories may lag.
Ask whether the provider bills Medicare directly (most enrolled providers do) or whether the patient pays up front and submits the claim.
For dual-eligible patients, confirm that the provider accepts Medi-Cal as the secondary payer so the patient is not responsible for the 20 percent coinsurance.
If looking for a specific population focus (older adults, dementia caregivers, grief, late-life depression), ask the provider about their experience. Some California LMFTs and LPCCs have specifically built older-adult practices in response to the 2024 expansion.
For Medicare Advantage members, check the plan’s provider directory; Advantage networks may include LMFTs and LPCCs the patient did not previously have access to.

Telehealth and audio-only sessions

Telehealth coverage for mental health is permanent under Medicare. Real-time video visits from the patient’s home are covered at the same rates as in-person visits. Audio-only mental health visits are also permanently covered, which is a meaningful access expansion for older California adults.

Audio-only matters for two populations specifically. Rural seniors with unreliable broadband can keep a stable therapy relationship by phone when video would drop. Older adults with mild cognitive impairment or hearing or visual impairment often function better in an audio-only session than in a video session that requires them to manage a screen.

How LMFT and LMHC coverage fits with the rest of Medicare mental health

The 2024 expansion does not replace anything that already existed. It adds two new provider categories alongside the existing list. The covered mental health professional pool for a Medicare beneficiary now looks like this:

Psychiatrists (medical doctors specializing in mental health, can prescribe medication)
Clinical psychologists (doctoral-level non-prescribers in most states; California is moving toward limited prescribing for medical psychologists)
Licensed Clinical Social Workers (master’s level, broad scope)
Clinical nurse specialists, nurse practitioners, physician assistants (can prescribe within scope)
Licensed Marriage and Family Therapists (new in 2024)
Licensed Mental Health Counselors, including California LPCCs (new in 2024)

The patient experience for the new categories is identical to the existing ones: 80 percent Medicare coverage after the deductible, 20 percent patient coinsurance, no session limit, permanent telehealth coverage.

How to think about the choice of provider type

For most California seniors seeking outpatient therapy, the most important factors are availability, fit, and language match, not license type. An LMFT and an LCSW and an LPCC providing weekly therapy for late-life depression are doing similar work; the patient should choose based on personal fit and access, not on the credential.

Medication management is the exception. Only psychiatrists, certain psychologists with prescribing authority, and the prescribing nursing and physician categories can prescribe psychiatric medications. A common California arrangement is a primary care physician or a psychiatric nurse practitioner handling medication, with weekly therapy provided by an LMFT, LCSW, or LPCC. The collaboration is straightforward and well supported under the new rules.

Common misconceptions to clear up

“Medicare still doesn’t cover LMFTs.” It does, since January 1, 2024.

“An LMFT is less qualified than a psychologist.” Different training, similar scope for outpatient psychotherapy. California LMFTs and LPCCs complete a master’s degree, 3,000 supervised hours, and a state licensing exam.

“The new rule is temporary.” It is permanent, written into Medicare statute by the Consolidated Appropriations Act of 2023.

“Audio-only therapy isn’t real therapy.” It is, and Medicare permanently covers it for mental health. For many older California adults, audio-only access is the difference between getting care and not getting care.

Related services and next steps

This guide explains coverage and eligibility, not medical advice. Talk to a licensed clinician about care decisions. California Care Compass does not place referrals on Services & Treatments pages.

Medicare mental health counseling: the 2024 expansion to LMFTs and LMHCs.