Credentialing for LCSWs, LPCs and LMFTs
Insurance Credentialing for LCSWs, LPCs and LMFTs
Medtransic handles insurance credentialing for licensed clinical social workers (LCSWs), professional counselors (LPCs) and marriage and family therapists (LMFTs), solo or in a group. We match your NPI record to your license, keep your CAQH profile attested, enroll you in Medicare and file every commercial application. It costs $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer. You can follow every application and its stage in your client portal.
Who can bill which payer
Illustrative| Enrolls in Medicare | Commercial | Medicare pays | |
|---|---|---|---|
| LCSW | 75% rate | ||
| LPC | 75% rate | ||
| LMFT | 75% rate | ||
| Associate | Via supervisor |
YesVariesNo
- Credentialing
- $150
- per application, per provider
- Typical time
- 60-90 days
- with each payer, in our experience
- Tracking
- Live
- every application and its stage in your portal
- Contract
- None
- no long-term contract
Where counselor applications get stuck
Several of these rules are new since 2024, and some run opposite to what owners expect.
- A profession that reads differently on each record
- Since January 1, 2024, Medicare has its own specialty types for MFTs and mental health counselors. Your NPI taxonomy, Medicare enrollment and commercial applications must name the same profession.
- Supervisee sessions billed under the licensed clinician
- Medicare does not cover services billed incident to an LCSW, MFT or mental health counselor. They can only work incident to a physician, clinical psychologist, nurse practitioner or certain others.
- A compact privilege a payer may not accept
- A Counseling Compact privilege equals a license in the other state, but payer acceptance is a separate question. The compact tells counselors to check with their insurer before applying.
- A privilege that runs out at license renewal
- A compact privilege expires with the home-state license it was issued under. It has to be renewed on its own in CompactConnect.
- Hiring around the Social Work Compact too early
- More than 30 states have enacted it, but no multistate licenses are issued yet, and the compact says that will take 12 to 24 months. Until then, LCSWs cannot use it.
Who handles what on a counselor's file
Medtransic runs
- Matching your NPI taxonomy, CAQH profile and applications to one license
- Building your CAQH profile and keeping it attested
- Medicare enrollment in PECOS for each clinician who sees Medicare patients
- Commercial and behavioral health applications, followed up to a decision
- Payer enrollment in a new state once your license or privilege is issued
- Each application, its stage and the documents we need, in your client portal
Your practice keeps
- Your license, supervised hours and renewals
- Your Counseling Compact application, which only you may submit
- Your malpractice policy
- Signing the applications and choosing which payers to join
Can LCSWs, LPCs and LMFTs Bill Medicare?
Yes. Medicare now enrolls all three license types, under these CMS rules as of October 2026.
LPCs and LMFTs, since January 1, 2024
MFTs and mental health counselors, including professional counselors, can bill Medicare on their own. Addiction counselors who meet the same requirements can enroll as mental health counselors.
What Medicare requires
LMFTs and counselors need a qualifying master's or doctorate, at least 2 years or 3,000 hours of supervised experience after the master's, and a state license or certification. LCSWs need a social work master's or doctorate, at least 2 years of supervised clinical social work, and a state license or certification.
What Medicare pays
All three are paid 75% of the fee schedule amount Medicare pays a clinical psychologist for the same service. All three must accept assignment.
Where the work can happen
LMFTs and counselors can treat Medicare patients by telehealth and bill Part B directly for skilled nursing facility residents. Psychologists, LCSWs, LMFTs and counselors can all bill the monthly behavioral health integration service when they do the work personally.
What the LCSW benefit leaves out
Medicare does not pay LCSWs under their own benefit for hospital inpatient services, or for partial hospitalization or intensive outpatient work at a hospital outpatient department or community mental health center. Some skilled nursing and dialysis facility work is excluded too.
How we credential a counselor, start to finish
We run these steps for each clinician, so every payer sees the same license and profession.
NPI record checked first
We check your NPI taxonomy matches your license: clinical social worker, professional or mental health counselor, or marriage and family therapist.
CAQH profile built and attested
We load your license, malpractice cover and work history, then keep the attestation current for whenever a payer reads it.
Medicare, once you qualify
We file Medicare's enrollment application in PECOS as soon as you are licensed and have finished your supervised hours.
Commercial and behavioral health networks
We file with each payer you choose and follow up until there is a decision.
Tracked in your client portal
Each application shows its stage in your client portal, with any document we still need from you.
Only you may submit your Counseling Compact application; employers and credentialing companies may not legally do it for you. Once your privilege is issued, we handle payer enrollment for that state.
Before you add a state or an associate
Check these rules before you add a state or put an associate on the schedule.
| Program or payer | What it allows | Who qualifies, and limits |
|---|---|---|
| Counseling Compact | Privileges in Arizona, Arkansas, Georgia, Indiana, Louisiana, Minnesota, Ohio, Oklahoma, Tennessee and Wyoming as of October 1, 2026. Another 29 states and DC are completing the steps. | Counselors licensed in and living in a live state. Recent graduates still completing supervised hours are not eligible. Fees vary by state. |
| Medicare, for associates | Work billed incident to a physician, psychologist or nurse practitioner under general supervision, with the supervisor reachable by phone. | No enrollment until licensed with supervised hours done. Other incident-to rules apply, and it is not allowed in hospitals or skilled nursing facilities. |
| Optum commercial plans | Supervised services by pre-licensed clinicians under its commercial behavioral health plans, effective October 1, 2024. | Not Medicare, Medicaid or ABA. In most states, only network groups with a participation agreement signed by September 30, 2024. |
| Other commercial payers | Each payer sets its own rules for associates. | We check each one before an associate goes on the schedule. |
Your client portal, included
Your EHR shows what you billed. Your portal shows what we are doing about it.
Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.
- Did that claim get paid?
- Every claim with its stage and amount, the denials we're working, and your receivables by age.
- Where is my application with Aetna?
- Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.
- What do you still need from me?
- One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.
When credentialing can wait
- If you are still an associate, Medicare will not enroll you until you are licensed and your supervised hours are done. Come back when the license is issued.
- If every client pays you directly and you plan to join no panels, you do not need credentialing. For billing later, we bill inside SimplePractice, TherapyNotes and other systems, at 4-8% of what we collect for you.
Questions counselors and therapists ask about credentialing
Can LPCs and LMFTs bill Medicare?
Yes. Since January 1, 2024, licensed marriage and family therapists and mental health counselors, including professional counselors, can enroll and bill Medicare directly. Medicare pays them 75% of what it pays a clinical psychologist, and they must accept assignment.
How much does Medicare pay an LCSW?
The same share: 75% of the fee schedule amount for clinical psychologists. LCSWs must accept assignment too.
Can I bill my associate's sessions under my license?
Not in Medicare, which does not cover services billed incident to an LCSW, MFT or mental health counselor. Commercial payers set their own rules; Optum, for example, publishes a supervision policy for its commercial plans. We check each payer before you schedule an associate.
Can Medtransic apply for my Counseling Compact privilege?
No. The compact requires the counselor to complete and submit the application personally. Once you hold the privilege, we file your payer enrollment for that state.
Can LCSWs use the Social Work Licensure Compact yet?
Not yet. More than 30 states have enacted it, but multistate licenses are not being issued. Clinical social workers will need an accredited MSW or higher, the qualifying national exam, and 3,000 hours or 2 years of supervised clinical practice.
How long does counselor credentialing take, and what does it cost?
In our experience it usually takes 60 to 90 days with each payer. Medtransic charges $150 per application, per provider, and there is no long-term contract.
Keep reading
- Credentialing for therapists and behavioral health →
- Mental and behavioral health billing services →
- CAQH provider profile guide →
- Payer enrollment →
- Telehealth billing →
- Psychologist credentialing →
- PMHNP credentialing →
- BCBA credentialing →
- Leaving Headway, Alma or Grow →
- Child and adolescent mental health billing →
- The client portal →
+ − Sources: 9 checked 2026-10-04
- CMS, Marriage and family therapists and mental health counselors (Physician Fee Schedule), checked 2026-10-04
- CMS, Medicare & Mental Health Coverage (MLN1986542, March 2026), checked 2026-10-04
- CMS, New Medicare provider specialty codes and payment for MFTs and MHCs (transmittal), checked 2026-10-04
- HHS guidance portal, New Medicare provider specialty codes for MFTs and MHCs, checked 2026-10-04
- HL7 Terminology, Behavioral health and social service provider taxonomy (NUCC code set), checked 2026-10-04
- Counseling Compact, home page (live states, privileges, applications), checked 2026-10-04
- Social Work Licensure Compact, home page, checked 2026-10-04
- Social Work Licensure Compact, compact map (updated July 8, 2026), checked 2026-10-04
- Optum, Supervisory services reimbursement policy (commercial behavioral health), checked 2026-10-04
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