Massachusetts Medicare Part B for Therapists and Psychiatrists
Massachusetts Medicare Part B pays for outpatient mental health care, and it pays psychiatrists, psychologists and other licensed clinicians who enroll. This guide explains who processes your claims, who can bill, how enrollment works and how long telehealth flexibilities last. Status is current as of October 15, 2026. Confirm each CMS page before you act. This is operational guidance, not legal advice.
Billing on your own? See our guide to solo therapist billing in Massachusetts.
Who processes Massachusetts Medicare Part B claims
Massachusetts Medicare Part B claims go to one Medicare Administrative Contractor (MAC). National Government Services (NGS) holds the Jurisdiction K contract, which covers Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont. See the CMS Jurisdiction K page, last modified July 8, 2026.
NGS began operating as Wellpoint Federal on April 1, 2026, and its portal now sits at provider.wellpointfederal.com. Phone lines changed on some pages, so use the contact details printed on your current MAC portal. Our Massachusetts insurance companies contact guide lists the contractor and the private insurer numbers.
Who can bill Massachusetts Medicare Part B for mental health
The CMS booklet Medicare and Mental Health Coverage, dated March 2026, lists who can bill:
- Physicians, especially psychiatrists, are paid at 100 percent of the Physician Fee Schedule.
- Clinical psychologists, with a doctoral degree and an independent-level license, are paid at 100 percent if they accept assignment.
- Clinical social workers need a master’s or doctoral degree, two years of supervised clinical social work and state licensure, and must accept assignment.
- Marriage and family therapists and mental health counselors have been able to enroll and bill Medicare independently since January 1, 2024, if they meet state licensure and supervised experience rules.
How to enroll for Massachusetts Medicare Part B
CMS lists four steps on its provider enrollment page, last modified June 2, 2026:
- Get an NPI (National Provider Identifier) through NPPES.
- Complete the application in PECOS, or use a paper form if you cannot apply online. The CMS-855I is the form for individual practitioners.
- Pay the application fee if one applies.
- Work with your MAC.
The MAC’s Part B guide says an NPI is required before it processes an application and that you should respond to MAC requests within 30 days. Medicaid enrollment does not carry over, so see our MassHealth provider enrollment guide for that separate process.
Telehealth under Massachusetts Medicare Part B
CMS says that through December 31, 2027, telehealth is available anywhere in the U.S., including the home, and audio-only in the home is allowed. See the CMS Telehealth FAQ. Geographic and place-of-service limits for behavioral health have been permanently removed.
For mental health telehealth at home, an in-person visit requirement applies after December 31, 2027: one visit within 6 months before the first telehealth service and at least one every 12 months after. From January 1, 2028, audio-only for home behavioral health is allowed only if the clinician can use video and the patient cannot or does not consent. Use place of service 10 for the patient’s home.
Filing limits for Massachusetts Medicare Part B
CMS says to file Medicare claims with your MAC no later than one calendar year after the date of service, per MLN006976. A late claim is denied, and that denial cannot be appealed as a determination. Exceptions exist in the Claims Processing Manual. Medicare Advantage plans are private plans, so follow the member’s card and the plan contract. For the 45-day private insurer rule, see our Massachusetts prompt pay law guide.
Where MCM South helps
MCM South Medical Billing Service bills for psychotherapists and psychiatrists. We currently serve practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If Massachusetts Medicare Part B billing is slowing your practice, get a free quote or schedule a consultation.
Keep learning: the insurance companies contact by state directory, the CPT and E/M code guide, the billing terms glossary, insurance credentialing, credentialing and network status and the mental health billing FAQ.
FAQs
Who processes Massachusetts Medicare Part B claims?
National Government Services, which began operating as Wellpoint Federal on April 1, 2026, holds the Jurisdiction K contract that covers Massachusetts.
Can a licensed mental health counselor bill Massachusetts Medicare Part B?
Yes. Mental health counselors and marriage and family therapists have been able to bill Medicare independently since January 1, 2024 if they meet the requirements.
How long do I have to file a Massachusetts Medicare Part B claim?
Claims must reach the MAC no later than one calendar year after the date of service.
Does Massachusetts Medicare Part B still cover telehealth?
CMS says telehealth flexibilities run through December 31, 2027, with an in-person visit rule for mental health telehealth after that date.
