Medicare Timely Filing for Therapists: What the 12-Month Rule Means
Medicare timely filing for therapists means your claim must reach your Medicare Administrative Contractor (MAC) within one year of the date of service. Miss that window and Medicare denies the claim. On Monday morning, check your oldest unbilled Medicare sessions first.
What the Medicare timely filing rule is
Timely filing is the deadline for getting a claim to the payer. For Original Medicare, Noridian Medicare explains that under 42 CFR 424.44, claims for services on or after January 1, 2010 must reach the MAC within one calendar year (12 months) of the date of service, or Medicare denies them. The federal rule sets the same one-year general limit. A service dated February 29 must be filed by February 28 of the next year.
This rule covers Medicare Part B, which is where psychotherapists and psychiatrists bill. Prescribers follow the same 12-month rule for their visits.
How the 12 months are counted
For Part B, timeliness is measured from the claim’s starting service date, called the “from” date. First Coast Service Options, a MAC, adds that electronic claims received after 6 p.m. Eastern time, or on a weekend or holiday, count as received the next business day. Do not send a claim on the last day and expect the clock to stop that evening. See the First Coast timely filing FAQ for its examples.
Rejected claims do not count as filed
A claim that is returned or rejected as unprocessable does not count as filed. First Coast says that happens when information is missing, invalid, or incomplete, and you must correct it and resubmit. That is why a clean claim matters. Fix the rejection fast, because the original date of service keeps the clock running.
Exceptions are narrow
For Medicare timely filing for therapists, the exceptions are narrow. Noridian says delays caused by a Medicare program error can extend the deadline through the last day of the sixth calendar month after the error is corrected. The federal rule also allows extensions for some retroactive Medicare entitlement cases, and for error requests it does not allow extensions beyond four years from the service date. Noridian points to CMS Publication 100-04, Chapter 1, Section 70 for details. Treat extensions as rare. If you think one applies, ask your MAC before you assume.
Medicare regions: which MAC gets your claim
Medicare splits the country into regions called jurisdictions, and one MAC jurisdiction handles Part B claims for each. Your claim must reach the MAC for the state where you bill, so for Medicare timely filing for therapists the clock runs at your own region’s contractor. The table below follows CMS’s MAC provider portal list, which is an older version, plus the contractor pages I could open. CMS lists the current jurisdictions. Confirm your state on your MAC’s site before you rely on it.
| Region | Medicare Administrative Contractor | States and territories | Provider site |
|---|---|---|---|
| JE | Noridian Healthcare Solutions | California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands | Noridian Medicare Portal, JE Part B |
| JF | Noridian Healthcare Solutions | Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming | Noridian Medicare Portal, JF Part B |
| J5 | WPS Government Health Administrators | Iowa, Kansas, Missouri, Nebraska | WPS Government Health Administrators |
| J8 | WPS Government Health Administrators | Indiana, Michigan | WPS Government Health Administrators |
| J6 | National Government Services (NGS) | Illinois, Minnesota, Wisconsin | NGS Medicare site (forwards to Wellpoint Federal; see our Wellpoint Federal guide) |
| JK | National Government Services (NGS) | Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont | NGS Medicare site (forwards to Wellpoint Federal) |
| JH | Novitas Solutions | Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas | Novitas Solutions |
| JL | Novitas Solutions | Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania | Novitas Solutions |
| JJ | Palmetto GBA | Alabama, Georgia, Tennessee | Palmetto GBA |
| JM | Palmetto GBA | North Carolina, South Carolina, Virginia, West Virginia | Palmetto GBA |
| JN | First Coast Service Options | Florida, Puerto Rico, U.S. Virgin Islands | First Coast Medicare |
| J15 | CGS Administrators | Kentucky, Ohio | CGS Medicare and the myCGS portal |
In our ten currently served states, Georgia and Tennessee are in JJ, North Carolina is in JM, Florida is in JN, Connecticut, Massachusetts and New York are in JK, Colorado and Texas are in JH, and Illinois is in J6. CMS announced on June 24, 2026 that Novitas won the Jurisdiction H contract, with the new contract expected to begin July 1, 2026. In Virginia, the CMS list shows Part B for Arlington County, Fairfax County and the city of Alexandria handled by Novitas JL rather than JM.
Medicare Advantage and Medicaid are separate
The 12-month rule above is for Original Medicare. A Medicare Advantage plan, a commercial plan and each state Medicaid program set their own limits, so read each payer’s manual. Our guides to timely filing for therapists and state billing guides cover the other payers. Never carry Medicare’s limit over to another plan.
What to do Monday morning
- Run a report of Medicare sessions with no paid or denied claim.
- Sort by date of service and start with the oldest.
- Fix any rejected claim and resubmit it right away.
- Keep your clearinghouse acceptance reports as proof of when you sent each claim. See our guide to proof of timely filing.
- Read your MAC’s website for any notice that affects your claims.
How MCM South helps with Medicare timely filing for therapists
MCM South works with psychotherapists and psychiatrists. We help with Medicare timely filing for therapists on the billing side, such as tracking claims so they go out on time and working rejections. See our behavioral health billing services or ask for a free quote below.
Where MCM South works
MCM South works with psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. See insurance company contacts by state, who we serve and the state billing guides. This post is operational guidance for billing, not legal advice.
The short version: Medicare timely filing for therapists
For Medicare timely filing for therapists, get each claim to your MAC within 12 months of the date of service, fix rejected claims right away, and keep proof of when you sent them. Other payers have different limits. More guides are in Resources. Keep Medicare timely filing for therapists on your weekly claims checklist.
Sources checked (November 3, 2026)
- Noridian Medicare: Timely filing
- CMS: MAC provider portals by state (older version)
- CMS: Who are the MACs
- CMS: Jurisdiction H award fact sheet (June 2026)
- First Coast Service Options: Timely filing FAQ
- First Coast: Returned or rejected claims and timely filing
- eCFR: 42 CFR 424.44
Keep going
Related reading
Frequently asked questions
What is the Medicare timely filing limit for therapists?
Original Medicare generally requires the claim to reach your MAC within one calendar year (12 months) of the date of service, under 42 CFR 424.44. Claims filed after that are denied unless an exception applies.
When does the Medicare timely filing clock start?
For Part B, it starts with the claim’s “from” date, the first date of service on the claim. Electronic claims received after 6 p.m. Eastern or on a weekend or holiday count as received the next business day, according to First Coast.
Does a rejected claim count as filed?
No. A claim returned or rejected as unprocessable does not count as filed. Correct it and resubmit it, and the original date of service keeps the clock running.
Do Medicare Advantage plans use the same filing limit?
Not necessarily. The 12-month rule is for Original Medicare, so read each Medicare Advantage plan’s provider manual for its own deadline.
