New York Medicare Part B: 6 Easy Steps for Therapists
New York Medicare Part B pays for outpatient mental health care, and the rules are different from commercial plans and from Medicaid. This guide is for solo and group practices with psychotherapists and psychiatrists. Status is current as of October 17, 2026. It is operational guidance, not legal advice.
Billing on your own? See our guide to solo therapist billing in New York.
Who processes New York Medicare Part B claims
Medicare Part B is the part of Medicare that covers outpatient care. For fee-for-service claims, a Medicare Administrative Contractor (MAC) processes them. CMS lists National Government Services (NGS) as the Part A and Part B MAC for Jurisdiction K, which includes New York, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. So your enrollment and claims questions go to NGS, not to a New York state agency.
This is Medicare, which is federal. It is separate from state billing rules and from New York Medicaid.
Who can bill Medicare Part B for mental health
CMS lists several practitioner types in its Medicare and Mental Health Coverage booklet. Here is the short version:
- Psychiatrists and other physicians.
- Clinical psychologists, who need a doctoral degree and an independent license.
- Clinical social workers (CSWs).
- Marriage and family therapists (MFTs) and mental health counselors (MHCs). Since January 1, 2024, they can enroll and bill Medicare independently.
CSWs, MFTs and MHCs must accept assignment. Clinical psychologists are paid at the full fee schedule rate only if they accept assignment. Assignment means you accept the Medicare-approved amount as payment in full.
How to enroll for New York Medicare Part B
For New York Medicare Part B, start with your National Provider Identifier (NPI) in NPPES. Update NPPES first, because changes there do not carry over to PECOS. Then enroll in the Provider Enrollment, Chain and Ownership System (PECOS). The Noridian enrollment guide explains the systems. Individuals use the CMS-855I form. Group practices that bill under their own enrollment use the CMS-855B form.
Enrollment is not the same as being in network with a commercial payer. For that, see in-network vs out-of-network.
Telehealth, incident-to and supervision
CMS says Medicare covers telehealth for behavioral and mental health on a permanent basis, using two-way real-time audio and video. Audio-only is allowed based on the patient’s limitations, abilities or preferences. The patient must be at home. This comes from the March 2026 CMS booklet, so recheck it before you change your workflow.
Incident-to billing lets a physician or certain practitioners bill for services by auxiliary staff. CMS says behavioral health incident-to services can be furnished under general supervision. CSWs, MFTs and MHCs do not bill incident to their own services.
Timely filing and opting out
New York Medicare Part B claims must be filed within 12 months of the date of service under 42 CFR 424.44. Noridian, another MAC, says a claim denied for timely filing has no appeal rights. Track this deadline by date of service, not by the date you noticed the denial.
Some practitioners opt out of Medicare. Under CMS program integrity instructions, opt-out lasts two years, requires a signed affidavit filed with the MAC, and requires private contracts with Medicare patients. Ask a lawyer before you opt out.
Practical tips for new york medicare part b
Check each clinician’s license type before you bill new york medicare part b, because the rules differ for psychiatrists, psychologists and counselors. Keep your NPI, PECOS and billing records matched. Set a calendar alert for the 12-month limit on every open claim. When a new york medicare part b claim is denied, fix it and resubmit within the window. Read our private practice management guides for cash flow habits.
Where MCM South helps
MCM South Medical Billing Service, LLC does mental and behavioral health billing only. We serve psychotherapists and psychiatrists in GA, MA, CT, TX, FL, NY, CO, TN, NC and IL. Ready to hand off your billing? Get a Free Quote or Schedule a Consultation.
Keep learning: Browse all MCM South resources, look up terms in the Billing Terms Glossary, and compare other states in the State and Regional Billing Guides.
More from MCM South: New York insurance companies contact guide; Medicare Part B glossary entry; MAC jurisdictions glossary entry; timely filing glossary entry; Medicare behavioral health billing guide; Texas Medicare Part B guide; Georgia Medicare Part B guide.
FAQs
Who is the Medicare Part B contractor for New York?
For New York Medicare Part B, CMS lists National Government Services as the Part A and Part B MAC for Jurisdiction K, which includes New York.
Can an LMFT or mental health counselor bill Medicare in New York?
Yes, if they enroll for New York Medicare Part B. CMS says MFTs and MHCs can enroll in Medicare and bill independently since January 1, 2024, and they must accept assignment.
How long do I have to file a Medicare claim?
Twelve months from the date of service under 42 CFR 424.44. Claims filed late are denied, and Noridian says there are no appeal rights for that denial.
Does Medicare cover telehealth therapy?
CMS says it covers telehealth for behavioral and mental health on a permanent basis, with audio and video, and audio-only in some cases. Confirm current details before billing.
