North Carolina Medicare Part B: 4 Easy Steps
North Carolina Medicare Part B pays for outpatient mental health care when the provider is licensed, enrolled and billing correctly. Status is current as of October 17, 2026. This is operational guidance, not legal advice. Here is how psychotherapists and psychiatrists in North Carolina get set up and paid, in plain steps you can start on Monday.
Who can bill North Carolina Medicare Part B for mental health
Medicare Part B is the outpatient medical side of Medicare. The Centers for Medicare & Medicaid Services (CMS) mental health booklet lists who may bill: psychiatrists (MDs and DOs), clinical psychologists, clinical social workers, nurse practitioners, physician assistants, clinical nurse specialists, and, since January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs).
Medicare pays MFTs and MHCs 75% of what a clinical psychologist gets under the Physician Fee Schedule. Your North Carolina license has to meet the CMS definition for your discipline, including supervised clinical experience.
Who processes North Carolina Medicare Part B claims
Palmetto GBA is the Medicare Administrative Contractor (MAC) for A/B Jurisdiction M. That covers North Carolina, South Carolina, Virginia and West Virginia. Your enrollment, claims and appeals go to Palmetto GBA, not to a state office.
North Carolina Medicare Part B enrollment steps
Enrollment is a federal process, not a state one. The four steps below follow CMS guidance. Do them in order, and keep copies of everything you submit.
- Get your National Provider Identifier (NPI). CMS asks for an NPI through the National Plan and Provider Enumeration System (NPPES).
- Register in the CMS Identity & Access (I&A) system.
- Apply in PECOS. The Provider Enrollment, Chain and Ownership System (PECOS) takes the online application. Individuals use form CMS-855I. Groups use CMS-855B. CMS says online applications tend to process faster than paper.
- Choose how you will be paid. Clinical social workers, MFTs and MHCs must accept assignment, which means taking the Medicare-approved amount as payment in full.
Telehealth, filing deadlines and opt-out
Medicare telehealth
CMS says behavioral health telehealth is not subject to the home-location limits, so patients can be seen at home. Audio-only is allowed for behavioral health. An in-person visit requirement is scheduled to begin after December 31, 2027. Read the current CMS telehealth FAQ before you schedule.
Timely filing
Medicare Part B claims must reach the MAC within 12 months, one calendar year, from the date of service. Late claims are denied unless an exception applies, such as administrative error. Under North Carolina Medicare Part B, the clock starts at the service date, not the date you enrolled or the date a patient told you about coverage. See the timely filing glossary entry.
Incident-to and opt-out
Clinical social workers, MFTs and MHCs cannot bill incident-to. Nurse practitioners and physician assistants can. A provider who opts out signs a private contract with each patient and gets no Medicare payment for two years. The opt-out renews automatically every two years. Opt-out also means no payment from Medicare Advantage plans, so decide with care and talk to your attorney.
North Carolina Medicare Part B vs private payers and Medicaid
Private payers
Private insurers set their own contracts. Being in-network or out-of-network with a private plan does not make you a Medicare provider. See our credentialing page and the North Carolina insurance companies contact guide.
North Carolina Medicaid
Medicaid is a different program with its own enrollment. Start with our State and Regional Billing Guides and the Medicaid managed care guide.
Practical tips for north carolina medicare part b
Enroll before you see Medicare patients, because your effective date drives what you can bill. Match your CPT codes to the individual psychotherapy codes and document the visit. Set a calendar alert at 10 months for any unpaid claim, so a lost claim never turns into a timely filing denial. When you review north carolina medicare part b rules each quarter, check the telehealth FAQ and the Palmetto GBA site first.
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). If North Carolina Medicare Part B claims are piling up, Get a Free Quote or Schedule a Consultation.
Keep learning: browse the Resources hub, the State and Regional Billing Guides, and the Billing Terms Glossary.
More from MCM South: MAC jurisdictions glossary entry; Medicare behavioral health billing guide; Texas Medicare Part B guide; Georgia Medicare Part B guide.
FAQs
Who is the Medicare contractor for North Carolina?
Palmetto GBA, for A/B MAC Jurisdiction M, which also covers South Carolina, Virginia and West Virginia.
Can an LPC or MFT bill Medicare in North Carolina?
Yes, if your license meets the CMS definition. MFTs and MHCs have been able to enroll since January 1, 2024.
How long do I have to file a Medicare claim?
12 months from the date of service.
Does North Carolina Medicare Part B cover telehealth therapy?
Yes. For North Carolina Medicare Part B patients, CMS allows behavioral health telehealth at home, including audio-only. An in-person visit requirement is scheduled to start after December 31, 2027.
