Connecticut Medicare Part B: 6 Easy Steps for Therapists
Connecticut Medicare Part B pays for outpatient mental health care, but only when the practitioner is enrolled and the claim goes to the right contractor. Status is current as of October 17, 2026. This post is operational guidance, not legal advice. For the wider picture, see our state billing guides and the Resources hub.
Billing on your own? See our guide to solo therapist billing in Connecticut.
Who processes Connecticut Medicare Part B claims
Every connecticut medicare part b claim goes to one Medicare Administrative Contractor (MAC), the company CMS hires to process and pay claims in a region. Knowing which one saves you from misdirected claims.
CMS (the Centers for Medicare & Medicaid Services) assigns Part B claims in Connecticut to National Government Services (NGS), as part of Jurisdiction K, per a CMS award fact sheet. NGS began operating as Wellpoint Federal on April 1, 2026. The announcement says providers do not need to re-enroll because of the name change.
Who can bill Medicare for mental health
The CMS MLN mental health booklet (March 2026) lists physicians, especially psychiatrists, clinical psychologists, clinical social workers, nurse practitioners, and physician assistants. Since January 1, 2024, marriage and family therapists and mental health counselors can enroll and bill Medicare independently too. Medicare pays for these services under Part B, the medical insurance part of Medicare that covers outpatient care. Prescribers bill evaluation and management (E/M) codes plus add-on psychotherapy codes. Psychotherapists bill psychotherapy codes.
Enrollment, assignment, and opt-out
CMS runs enrollment through PECOS, its online enrollment system. Social workers, counselors, and marriage and family therapists must accept assignment, which means taking the Medicare-allowed amount as payment in full. A practitioner who sees Medicare patients but does not enroll must opt out. CMS says you cannot both enroll and opt out. Opt-out requires an affidavit filed with the contractor and a private contract with each patient, and it renews every two years. Pick one path for each practitioner and document the decision. Billing staff should know it too.
Telehealth and incident-to rules
Under the CMS telehealth FAQ (updated October 8, 2026), Medicare telehealth flexibilities run through December 31, 2027. Behavioral health stays eligible from the home after that. An in-person visit requirement for mental health telehealth applies after December 31, 2027. Incident-to means billing a helper’s service under the supervising practitioner. Per the MLN booklet, behavioral health incident-to services need only general supervision. Social work, marriage and family therapy, and counseling services generally cannot be billed incident-to.
Timely filing for Medicare claims
Fee-for-service Medicare claims must reach the contractor within one calendar year of the date of service, per CMS guidance. Miss it and the claim is denied. Track every claim from the day you submit it. Private plans use their own limits, so keep them separate in your workflow. Our in-network vs out-of-network guide explains the difference.
Practical tips for connecticut medicare part b
Start your connecticut medicare part b enrollment early, before you schedule Medicare patients. Confirm the enrollment record matches your license, group, and address. Decide early whether you will enroll or opt out, because you cannot do both. Check each claim for assignment and the right place of service, and set a calendar alert well before the one-year deadline. Good connecticut medicare part b habits protect your cash flow. Keep a short checklist for connecticut medicare part b claims and review it monthly. Review the insurance companies contact directory and our credentialing service for private-payer steps.
Where MCM South helps
MCM South Medical Billing Service, LLC bills for psychotherapists and psychiatrists in Georgia (GA), Massachusetts (MA), Connecticut (CT), Texas (TX), Florida (FL), New York (NY), Colorado (CO), Tennessee (TN), North Carolina (NC), and Illinois (IL). We handle claims, follow-up, and denials so you can focus on patients. Get a Free Quote or Schedule a Consultation.
Keep learning: browse the Billing Terms Glossary, the CPT and E/M code guide, the insurer contacts by state, and private practice management tips.
More from MCM South: Connecticut insurance companies contact guide; Medicare Part B glossary entry; MAC jurisdictions glossary entry.
FAQs
Who is the connecticut medicare part b contractor?
CMS lists National Government Services in Jurisdiction K. It began operating as Wellpoint Federal on April 1, 2026, with no re-enrollment needed.
Can a licensed professional counselor bill Medicare in Connecticut?
Mental health counselors and marriage and family therapists can enroll and bill Medicare independently since January 1, 2024. They must meet Medicare’s requirements and accept assignment.
How long do I have to file a Medicare claim?
One calendar year from the date of service. Claims received later are denied.
Is connecticut medicare part b telehealth still allowed for therapy?
Yes. CMS says flexibilities run through December 31, 2027, and behavioral health from the home continues after that, with an in-person visit requirement for mental health telehealth.
